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add medication adult During Pregnancy and Breastfeeding The choice of whether to stop or continue ADHD medications during pregnancy and breastfeeding is challenging for women with the condition. There aren't enough data on how exposure to ADHD for a long time could affect the pregnant fetus. A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological disorders such as impaired hearing or vision, febrile seizures, or IQ impairment. The authors acknowledge the need for more high-quality research. Risk/Benefit Analysis Women who are pregnant and take ADHD medication need to evaluate the benefits of using it versus the dangers for the baby. Physicians do not have the necessary data to give clear guidelines, but they can provide information about risks and benefits that help pregnant women make informed choices. A study published in Molecular Psychiatry found that women who took ADHD medications in early pregnancy did not face an increased risk of fetal cardiac malformations or major structural birth defects. Researchers conducted a large population-based case control study to assess the frequency of major structural defects in infants born to mothers who used stimulants during pregnancy. Clinical geneticists and pediatric cardiologists reviewed the cases to ensure correct case classification and to limit the possibility of bias. The study of the researchers was not without limitations. The most important issue was that they were unable to distinguish the effects of the medication from the disorder at hand. This limitation makes it difficult to determine whether the small associations observed in the groups that were exposed are due to medication use or confounding by comorbidities. Additionally, the researchers did not look at long-term offspring outcomes. The study did reveal that infants whose mothers took ADHD medication during pregnancy were at a higher risk of being admitted to the neonatal intensive care unit (NICU) than infants who were born without any medication or taken off their medication prior to or during pregnancy. This increase was due to central nervous system-related disorders and the higher risk of admission did not appear to be affected by the type of stimulant medications were taken during pregnancy. Women who used stimulant ADHD medication during pregnancy also had an elevated chance of having a caesarean section or having a child with an low Apgar score (less than 7). These risks did not appear to be affected by the type of medication that was used during pregnancy. The research suggests that the risk of a small amount with the use of ADHD medications during early pregnancy could be offset by the greater benefits to both the mother and child of continuing treatment for the woman's disorder. Physicians should speak with their patients about this and, if possible, help 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 before are being diagnosed with ADHD and being treated with medication, the question of whether or not to discontinue treatment during pregnancy is a question that doctors are having to have to face. Most of the time, these decisions are made without clear and authoritative evidence in either case, which means that doctors must weigh what they know, the experiences of other doctors, and what research suggests about the subject, along with their own judgments for each individual patient. The issue of potential risks for infants can be difficult to determine. The research that has been conducted on this topic is based on observations instead of controlled studies and the results are in conflict. In addition, most studies limit their analysis to live births, which may 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 examining both data on live and deceased births. The conclusion: While some studies have shown a positive association between ADHD medications and the risk of certain birth defects, other studies have not found any evidence of a link and the majority of studies have a neutral or slightly negative effect. In the end, a careful risk/benefit analysis must be conducted in every case. For many women with ADHD and ADD, the decision to discontinue medication is difficult if not impossible. In a recent article in Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can increase depression and feelings of being isolated. In addition, a decrease in medication can interfere with the ability to do work-related tasks and safely drive which are essential aspects of daily life for many people suffering from ADHD. She suggests that women who are not sure whether to continue taking the medication or stop it due to their pregnancy educate family members, coworkers, and acquaintances about the condition, its impact on daily functioning and the advantages of staying on the current treatment. It can also help a woman feel confident about her decision. It is important to note that some medications are able to be absorbed through the placenta so if the patient decides to stop taking her ADHD medication during pregnancy and breastfeeding, she should be aware that the effects of the drug can be transferred to the child. Birth Defects Risk As the use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases, so do concerns about what impact the drugs could have on the fetuses. A study that was published in the journal Molecular Psychiatry adds to the existing information on this topic. Researchers utilized two massive datasets to analyze more than 4.3 million pregnant women and determine whether stimulant medications increased birth defects. Although the risk overall is low, the researchers found that exposure in the first trimester to ADHD medicines was associated with an increased risk of certain heart defects such as ventriculoseptal defect (VSD). The researchers behind the study found no association between the use of early medications and other congenital abnormalities, such as facial clefting or club foot. The results are consistent with previous studies that have shown the presence of a small, but significant increase in the risk of developing cardiac malformations among women who began taking ADHD medications prior to the birth of their child. The risk was higher in the later part of pregnancy, when many women begin to discontinue their medication. Women who took ADHD medication in the first trimester of pregnancy were also more likely to experience caesarean section, low Apgar score following delivery, and a baby who required breathing assistance during birth. However the researchers of the study were unable to eliminate selection bias by limiting the study to women who didn't have any other medical issues that could be a contributing factor to these findings. The researchers hope their study will aid in the clinical decisions of doctors who treat pregnant women. The researchers recommend that while discussing risks and benefits are crucial, the decision on whether to continue or stop medication should be made according to the severity of each woman's ADHD symptoms and her requirements. The authors warn 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 among women who are pregnant or recently gave birth. Additionally, research suggests that women who stop taking their medications will have a difficult transitioning to life without them after the baby is born. Nursing It can be overwhelming to become a mom. Women suffering from ADHD are often faced with a number of difficulties when they must manage their symptoms, attend doctor appointments and prepare for the birth of their child and adjust to new routines. Many women opt to continue taking their ADHD medication during pregnancy. The risk to nursing infant is low because the majority of stimulant medications is absorbed through breast milk in low amounts. However, the amount of medication exposure to the newborn can vary depending on dosage, how often it is administered and at what time the medication is administered. In addition, various medications are introduced into the baby's system through the gastrointestinal tract or through breast milk. The impact of these medications on a newborn's health is not completely known. Some physicians may discontinue stimulant medication during a woman's pregnancy due to the lack of research. It is a difficult decision for the woman who must weigh the benefits of taking her medication as well as the risks to the fetus. In the meantime, until more information is available, GPs may ask pregnant patients whether they have a history of ADHD or if they plan to take medication in the perinatal period. A growing number of studies have proven that the majority of women are able to safely continue taking their ADHD medication during pregnancy and while breastfeeding. In the end, an increasing number of patients choose to do so and in consultation with their physician, they have discovered that the benefits of continuing their current medication far 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 prescriber, and the pros and cons for continuing treatment. This includes non-pharmacological strategies. Psychoeducation is also necessary to help pregnant women suffering from ADHD recognize the signs and the underlying disorder. They should also be informed about treatment options and reinforce strategies for coping. This should be a multidisciplinary effort with the GPs, obstetricians and psychiatry. The pregnancy counselling should consist of discussion of a management plan for both the mother as well as the child, and monitoring for signs of deterioration, and the need for adjustments to the medication regimen.