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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 isnt much information on how longterm exposure to these medications can affect the fetus A recent study published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological issues like hearing loss or vision febrile seizures or IQ impairment The authors acknowledge that further highquality research is needed RiskBenefit Analysis Pregnant women who take ADHD medications must weigh the benefits of taking them against potential risks to the foetus The doctors dont have the information to give clear advice but can provide information on risks and benefits to aid pregnant women in making informed decisions A study published in Molecular Psychiatry concluded that women who were taking ADHD medication in early pregnancy were not at a higher risk of fetal malformations or structural birth defects Researchers used a vast populationbased study of casecontrol to assess the risk of major structural birth defects in babies born to mothers who took stimulants during early pregnancy as well as those who had not Clinical geneticists and pediatric cardiologists examined the cases to ensure correct classification of the cases and to reduce the chance of bias However the study had its limitations Researchers were unable to in the first place to separate the effects caused by the medication from the disorder This makes it difficult for researchers to determine whether the few associations observed between the exposed groups were due to the use of medication or if they were caused by comorbidities The researchers did not examine longterm outcomes for the offspring The study revealed that babies whose mothers had taken ADHD medication during pregnancy had a higher chance of being admitted to the neonatal care unit NICU in comparison to mothers who didnt take any medication during pregnancy or discontinued taking their medication prior to or during pregnancy This increase was due to central nervous systemrelated disorders and the increased risk for admission did not appear to be influenced by which stimulant medications were used during pregnancy Women who were taking stimulant ADHD medication during pregnancy were also at an increased risk of having a caesarean delivery or having a baby with an low Apgar score less than 7 These increases appear to be independent of the type of medication taken during pregnancy The research suggests that the low risk associated with the use of ADHD medications during early pregnancy could be offset by the higher benefit for both mother and child from continued treatment for the womans condition Physicians should discuss this with their patients and where they are able assist them in developing strategies for improving their coping skills that can lessen the negative impact of her condition on her daily functioning and relationships Medication Interactions Many doctors are faced with the decision of whether to continue treatment or stop during pregnancy as more women are diagnosed with ADHD These decisions are usually made without clear and authoritative evidence Instead medication for adults with add must take into account their own experience in conjunction with the experiences of other doctors and the research that has been conducted on the subject Particularly the subject of potential risks for the baby can be a challenge The research that has been conducted on this topic is based on observations instead of controlled studies and many of the findings are contradictory Additionally the majority of studies limit their analysis to live births which can underestimate the severity of teratogenic effects that could result in abortion or termination of the pregnancy The study that is discussed in the journal club addresses these limitations by analyzing data on live and deceased births The conclusion is that while certain studies have demonstrated a positive association between ADHD medications and the possibility of certain birth defects others have found no connection and most studies show a neutral or even slightly negative effect In the end a careful riskbenefit assessment must be done in each case For women suffering from ADHD and ADD the decision to discontinue medication can be difficult if not impossible In fact in an article published in Archives of Womens Mental Health psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can lead to increased depression feelings of loneliness and family conflict for those suffering from the disorder Furthermore a loss of medication can affect the ability to do jobrelated tasks and drive safely that are crucial aspects of a normal life for many people suffering from ADHD She suggests that women who arent sure whether to continue taking the medication or stop it due to their pregnancy educate family members colleagues and friends about the condition the effects on daily functioning and the advantages of staying on the current treatment plan Educating them can also make the woman feel more comfortable when she is struggling with her decision Certain medications can pass through the placenta If the patient decides not to take her ADHD medication while breastfeeding its important to be aware that the medication could be passed on to her baby Risk of Birth Defects As the use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder ADHD grows as do concerns about the effects that the drugs might have on the fetuses A study that was published in the journal Molecular Psychiatry adds to the body of information on this topic Researchers used two massive data sets to examine more than 43 million pregnant women and determine whether stimulant medications increased the risk of birth defects While the overall risk remains low the researchers discovered that the firsttrimester exposure to ADHD medications was linked to an increase in the risk of specific heart defects such as ventriculoseptal defect VSD The authors of the study could not discover any link between early use of medication and congenital anomalies such as facial deformities or club feet The findings are in line with previous studies that have shown the presence of a small but significant increase in the risk of developing cardiac malformations in women who started taking ADHD medications prior to the time of pregnancy This risk increased during the latter half of pregnancy when a large number of women stopped taking their medication Women who used ADHD medication in the first trimester of pregnancy were also more likely to experience caesarean sections a low Apgar score after delivery and a baby who needed breathing assistance at birth The authors of the study could not remove bias in selection since they limited the study to women without other medical conditions that could have contributed to the findings The researchers hope their study will serve to inform the clinical decisions of physicians who encounter pregnant women The researchers suggest that while discussing risks and benefits are important the decision about whether to continue or stop taking medication should be in light of the severity of each womans ADHD symptoms and the needs of the woman The authors also caution that even though stopping the medication is an alternative it is not a recommended practice because of the high incidence of depression and other mental health problems in women who are pregnant or postpartum Furthermore research suggests that women who decide to stop taking their medication are more likely to have a difficult time adjusting to life without them following the babys arrival Nursing The responsibilities that come with being a new mom can be overwhelming Women who suffer from ADHD who have to manage their symptoms while attending doctor appointments and making preparations for the arrival of a child and adjusting to new household routines are often faced with a number of difficulties Therefore many women decide to continue taking their ADHD medications throughout pregnancy The majority of stimulant drugs are absorbed by breast milk in very small quantities so the risk to infant who is breastfeeding is low The amount of exposure to medications will vary based on the dosage the medication is administered its frequency and time of day Additionally different medications enter the body of the baby differently through the gastrointestinal tract as well as breast milk The impact of this on a newborn infant is not well known Because of the lack of evidence some doctors may be inclined to discontinue stimulant medication during the pregnancy of a woman Its a difficult choice for the mother who must weigh the advantages of taking her medication as well as the potential risks to the embryo In the meantime until more information is available doctors may inquire about pregnant patients if they have any background of ADHD or if they intend to take medication in the perinatal stage A increasing number of studies have proven that women can continue to take their ADHD medication during pregnancy and breastfeeding In response an increasing number of patients are opting to continue their medication They have found through consultation with their doctor that the benefits of continuing their current medication outweigh any potential risks Women with ADHD who plan to breastfeed should seek advice from an expert psychiatrist prior to becoming pregnant They should discuss their medication with their physician and discuss the pros and cons of continued treatment including nonpharmacological strategies Psychoeducation should also be offered to help pregnant people with ADHD understand their symptoms and the underlying disorder Learn about the available treatments and to reinforce existing strategies for coping This should include a multidisciplinary approach with the GP as well as obstetricians psychiatry and obstetricians Pregnancy counselling should include the discussion of a treatment plan for both mother and child as well as monitoring for signs of deterioration and if necessary adjustments to the medication regimen