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https://www.iampsychiatry.uk/adult-adhd-medication/

ADHD Medication During Pregnancy and Breastfeeding The decision to stop or keep ADHD medication during breastfeeding and pregnancy is a challenge for women suffering from the condition There is a lack of information about how longterm exposure to these medications may affect the foetus A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication during the uterus dont develop neurological developmental disorders such as hearing or vision impairment febrile seizures or IQ impairment medication for adhd in adults acknowledge the need for higherquality research RiskBenefit Analysis Women who are expecting and taking ADHD medication should weigh the benefits of taking it versus the risks to the fetus Physicians dont have the necessary data to make unequivocal recommendations but they can provide information about benefits and risks that can aid pregnant women in making informed decisions A study published in Molecular Psychiatry found that women who took ADHD medications during early pregnancy did not face an increased risk of fetal heart malformations or major structural birth defects The researchers used a large populationbased casecontrol study to determine the prevalence of major structural birth defects in infants born to mothers who had taken stimulants during early pregnancy as well as those who had not Pediatric cardiologists clinical geneticists and other experts looked over the cases to ensure that the classification was correct and to eliminate any bias The study of the researchers had some limitations Most important they were not able to differentiate the effects of the medication from the effects of the disorder that is underlying This makes it difficult to know whether the small associations observed in the exposed groups are due to the use of medication or the confounding effect of comorbidities The researchers also did not study longterm outcomes for offspring The study found that infants whose mothers had taken ADHD medication during pregnancy had a slightly greater risk of being admitted to the neonatal care unit NICU compared to mothers who did not use any medication during pregnancy or had discontinued taking their medication prior to or during pregnancy This was due to central nervous system disorders The higher risk of admission was not influenced by the stimulant medication used during pregnancy Women who were taking stimulant ADHD medication during pregnancy were also at an elevated risk of having a caesarean delivery or having a baby born with a low Apgar score less than 7 These increases didnt appear to be influenced by the type of medication that was used during pregnancy Researchers suggest that the minor risks associated with the use ADHD medications during early pregnancies could be offset by the greater benefits to both mother and baby of continuing treatment for the womans condition Physicians should discuss the issue with their patients and where possible help them develop strategies to improve coping skills that can lessen the negative impact of her condition on her daily functioning and relationships Interactions with Medication Doctors are increasingly faced with the decision of whether to maintain treatment or stop it during pregnancy as more women are diagnosed with ADHD Most of the time these decisions are taken in the absence of clear and authoritative evidence either way so physicians have to weigh their experience from their own experiences those of other doctors and what the research suggests on the subject along with their best judgment for each patient In particular the issue of possible risks to the baby can be a challenge Many of the studies on this issue are based on observational data rather than controlled research and their conclusions are often contradictory Most studies focus on livebirths which could underestimate the severity of teratogenic effects which can cause terminations or abortions of pregnancy The study that is discussed in the journal club addresses these issues by analyzing both the data from deceased and live births The conclusion The conclusion While certain studies have demonstrated an association between ADHD medications and the possibility of certain birth defects other studies have found no connection and the majority of studies have a neutral or slight negative effect In each case it is imperative to conduct a thorough study of the risks and benefits should be conducted It can be challenging if not impossible for women suffering from ADHD to stop taking their medication In a recent article in Archives of Womens Mental Health by psychologist Jennifer Russell she notes that stopping ADHD medications during pregnancy can cause depression and feelings of loneliness A loss of medication may affect the ability to safely drive and to perform workrelated tasks which are crucial aspects of normal life for people with ADHD She suggests that women who arent sure whether to take the medication or discontinue it due to pregnancy educate their family members coworkers and acquaintances about the condition the impact on daily functioning and the advantages of staying on the current treatment regimen It can also make the woman feel more comfortable when she is struggling with her decision It is important to remember that some medications are able to pass through the placenta so if a woman decides to discontinue her ADHD medication during pregnancy and breastfeeding she must be aware that the effects of the medication could be transferred to the infant Birth Defects and Risk of As the use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder ADHD grows as do concerns over the impact that these medications could have on the fetuses A recent study published in the journal Molecular Psychiatry adds to the body of information on this topic Researchers used two massive data sets to examine over 43 million pregnancy and determine if stimulant medication use increased birth defects Researchers discovered that although the overall risk is low firsttrimester ADHD medication exposure was associated with slightly higher rates of specific heart defects like ventriculoseptal defects The researchers of the study could not discover any link between the use of early medications and congenital anomalies such as facial deformities or club feet The results are in line with previous studies which showed an insignificant but small increase in cardiac malformations for women who began taking ADHD medication prior to the time of the time of pregnancy The risk was higher in the latter half of pregnancy as many women begin to discontinue their ADHD medications Women who used ADHD medications during the first trimester of their pregnancies were also more likely to have caesarean section low Apgar score following delivery and a baby that required breathing assistance at birth However the authors of the study were unable to eliminate selection bias by limiting the study to women who didnt have any other medical conditions that could have contributed to the findings The researchers hope their research will serve to inform the clinical decisions of physicians who encounter pregnant women The researchers recommend that while discussing risks and benefits are important the decision on whether to continue or stop medication should be in light of the severity of each womans ADHD symptoms and her requirements The authors also warn that while discontinuing the medications is an option it isnt a recommended practice because of the high rate of depression and other mental health issues in women who are pregnant or postpartum Additionally the research suggests that women who choose to stop taking their medication are more likely to have difficulties getting used to life without them following the babys arrival Nursing It can be overwhelming to become a mom Women who suffer from ADHD who have to deal with their symptoms while attending physician appointments and preparing for the arrival of their child and adapting to new routines in the home may face a lot of challenges Many women decide to continue taking their ADHD medication during pregnancy The majority of stimulant medicines pass through breast milk in small amounts therefore the risk for infant who is breastfeeding is low The rate of exposure to medication will differ based on dosage and frequency of administration as well as the time of day Additionally different medications enter the babys system via the gastrointestinal tract or through breast milk The effect on a newborns health is not fully comprehended Some doctors may decide to stop stimulant medication during a womans pregnancy due to the lack of research This is a difficult decision for the woman who must weigh the advantages of continuing her medication against the potential risks to the fetus In the meantime until more information is available doctors should inquire with all pregnant patients about their history of ADHD and if they are taking or planning to take medication during the perinatal period A increasing number of studies have revealed that the majority of women are able to safely continue to take their ADHD medication during pregnancy and breastfeeding In response a rising number of patients are choosing to continue their medication They have discovered in consultation with their doctor that the benefits of continuing their current medication outweigh risk It is crucial for women suffering from ADHD who are considering breastfeeding to seek out a specialist psychiatrists advice prior becoming pregnant They should discuss their medication with their prescriber and the pros and cons for continuing treatment This includes nonpharmacological strategies Psychoeducation is also necessary to help pregnant women with ADHD be aware of the symptoms and underlying disorder They should also learn about treatment options and reinforce strategies for coping This should be a multidisciplinary approach together with obstetricians GPs and psychiatry Pregnancy counseling should include a discussion of a treatment plan for the mother and the child as well as monitoring for indicators of deterioration and if needed adjustments to the medication regime