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

ADHD Medication During Pregnancy and Breastfeeding Women with ADHD have to make a difficult choice about whether to continue or stop taking ADHD medication during pregnancy and breastfeeding There are few data on how exposure to ADHD for a long time could affect the fetus A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication during the uterus do not develop neurological developmental conditions like impaired vision or hearing febrile seizures or IQ impairment The authors acknowledge the need for higherquality studies RiskBenefit Analysis Women who are pregnant and taking ADHD medications need to balance the advantages of using them against the risks to the fetus Physicians dont have the necessary data to provide clear recommendations but they can provide information regarding risks and benefits that assist pregnant women in making informed choices A study published in Molecular Psychiatry concluded that women who were taking ADHD medication during their early pregnancy did not have a greater risk of fetal malformations or structural birth defects The researchers used a large populationbased casecontrol study to determine the prevalence of major structural birth defects in babies born to mothers who took stimulants during early pregnancy and those who did not Clinical geneticists and pediatric cardiologists reviewed the cases to ensure correct case classification and to limit the chance of bias However the researchers study had its limitations The most important issue was that they were unable to distinguish the effects of the medication from the effects of the disorder that is underlying This limitation makes it difficult to determine whether the small differences observed in the exposed groups are due to the use of medication or the confounding effect of comorbidities The researchers also did not study the longterm effects for the offspring The study revealed that infants whose mother took ADHD medication during pregnancy had a higher risk of admission to the neonatal care unit NICU as compared to those whose mothers didnt take any medication during pregnancy or had quit taking the medication prior to or during pregnancy This increase was due to central nervous systemrelated disorders and the higher risk of admission was not found to be influenced by which stimulant medications were used during pregnancy Women who were taking stimulant ADHD medications during pregnancy also had a higher likelihood of having an emergency caesarean section or having one whose baby scored low on the Apgar scale less than 7 These increases didnt seem to be influenced by the kind of medication used during pregnancy The researchers suggest that the risk of a small amount with the use of ADHD medications during the early stages of pregnancy may be offset by the greater benefit to both the mother and child from continued treatment for the womans disorder Physicians should talk to their patients about this and as much as possible assist them develop coping strategies that may reduce the effects of her disorder on her daily life and relationships Interactions with Medication As more women than ever are diagnosed with ADHD and being treated with medication the dilemma of whether or not to end treatment during pregnancy is one that doctors are having to confront These decisions are usually made without clear and reliable evidence Instead doctors must consider their own expertise the experience of other physicians and the research on the topic Particularly the subject of potential risks to the baby can be tricky The research on this issue is based on observation rather than controlled studies and a lot of the results are conflicting In addition most studies limit their analysis to live births which can undervalue the serious teratogenic effects that can cause abortion or termination of the pregnancy The study presented in this journal club addresses these limitations by analyzing data on live and deceased births Conclusion Some studies have revealed a positive correlation between ADHD medications and certain birth defects other studies have not found a correlation Most studies show that there is a neutral or slight negative impact In every case an indepth evaluation of the risks and benefits is required For women suffering from ADHD and ADD the decision to stop medication is difficult if not impossible In fact in a recent article in Archives of Womens Mental Health psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can lead to increased depression feelings of isolation and family conflict for these patients The loss of medication can also affect the ability to drive safely and complete workrelated tasks which are essential aspects of normal life for those suffering from ADHD She suggests that women who arent sure whether to take the medication or discontinue it due to pregnancy educate their family members colleagues and friends about the condition the impact on daily functioning and the benefits of continuing the current treatment regimen It will also help a woman feel confident about her decision It is important to remember that certain medications are able to be absorbed through the placenta therefore if a patient decides to stop her ADHD medication during pregnancy and breastfeeding she must be aware that the effects of the drug could be transferred to the infant Birth Defects and Risk of As the use of ADHD medications to treat symptoms of attention deficit hyperactivity disorder ADHD grows as do concerns about what impact the medications could have on the fetuses Recent research published in the journal Molecular Psychiatry has added to the body knowledge on this subject Researchers utilized two massive data sets to study over 43 million pregnancies and determine if the use of stimulant medications caused birth defects Researchers discovered that while the risk overall is low firsttrimester ADHD exposure to medication was associated with slightly higher risk of certain heart defects like ventriculoseptal defects The researchers of the study did not discover any connection between the use of early medications and congenital anomalies like facial deformities or club feet The results are in line with previous studies that showed the existence of a slight but significant increase in the number of cardiac malformations among women who began taking ADHD medication prior to the time of the birth of their child The risk grew during the latter part of pregnancy when a lot of women are forced to stop taking their ADHD medication Women who used ADHD medication in the first trimester of their pregnancy were also more likely to have caesarean section low Apgar score after delivery and a baby that required breathing assistance during birth The authors of the study could not eliminate bias due to selection because they limited their study to women who did not have any other medical conditions that might have contributed to the findings Researchers hope that their study will provide doctors with information when they encounter pregnant women They recommend that while a discussion of risks and benefits is important however the decision to stop or continue medication should be based on each womans needs and the severity of her ADHD symptoms The authors caution that even though stopping the medication is an option to consider it is not recommended because of the high incidence of depression and mental health issues for women who are pregnant or who have recently given birth Additionally the research suggests that women who decide to stop taking their medications are more likely to experience a difficult time adjusting to life without them following the birth of their baby Nursing The responsibilities that come with being a new mother can be overwhelming Women suffering from ADHD can face severe challenges when they must manage their symptoms go to doctor appointments prepare for the birth of a child and adjust to a new routine This is why many women decide to continue taking their ADHD medication throughout the pregnancy The risk for breastfeeding infant is minimal because the majority of stimulant medications passes through breast milk at low levels However the amount of exposure to medications by the infant can differ based on dosage frequency it is taken and at what time it is administered In addition different medications are introduced into the babys system via the gastrointestinal tract or through breast milk The impact of these medications on the health of a newborn is not fully comprehended Because of the lack of research some doctors may recommend stopping stimulant medication during the pregnancy of a woman This is a difficult decision for the mother who must weigh the advantages of her medication against the risk to the foetus As long as more information is available GPs can inquire about pregnant patients if they have a history of ADHD or if they are planning to take medication in the perinatal stage A growing number of studies have shown that the majority of women are able to safely continue their ADHD medication while they are pregnant and nursing As a result more and more patients opt to do this and in consultation with their doctor they have discovered that the benefits of continuing their current medication far exceed any risk adult adhd treatments I Am Psychiatry is crucial for women suffering from ADHD who are thinking of breastfeeding to seek out a specialist psychiatrists advice prior becoming pregnant They should discuss their medication with their prescriber and discuss the pros and cons of continued treatment including nonpharmacological management strategies Psychoeducation should also be provided to help women with ADHD be aware of their symptoms and the root cause Learn about the available treatments and to reinforce existing coping strategies This should be an approach that is multidisciplinary including the GP obstetricians and psychiatry The pregnancy counselling should consist of discussion of a management plan for both mother and child and monitoring for signs of deterioration and when necessary making adjustments to the medication regimen