20 TRAILBLAZERS LEAD THE WAY IN ADHD MEDICATION PREGNANCY

20 Trailblazers Lead The Way In ADHD Medication Pregnancy

20 Trailblazers Lead The Way In ADHD Medication Pregnancy

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ADHD Medication During Pregnancy and Breastfeeding

Women with ADHD must make a difficult decision on whether to keep or stop taking ADHD medication during pregnancy and breastfeeding. There is a lack of information about how long-term exposure to these drugs may affect the foetus.

A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological disorders like hearing loss or vision, febrile seizures or IQ impairment. The authors acknowledge the need for higher-quality research.

Risk/Benefit Analysis

Pregnant women who use ADHD medications need to balance the benefits of taking them against the potential risks to the foetus. Physicians don't have the data to make unambiguous recommendations but they can provide information on the risks and benefits to assist pregnant women to make informed choices.

A study published in Molecular Psychiatry found that women who took ADHD medications during their early pregnancy did not face an increased risk of fetal cardiac malformations or major birth defects that are structural. Researchers used a vast population-based case-control study to determine the prevalence of major structural birth defects in babies born to mothers who took stimulants during the early stages of pregnancy and those who had not. Pediatric cardiologists and clinical geneticists examined the cases to ensure accurate case classification and to minimize the chance of bias.

The research conducted by the researchers had some limitations. The researchers were not able in the beginning, to separate the effects triggered by the medication from the disorder. This limitation makes it difficult for researchers to establish whether the few associations observed between the groups that were exposed to medication use, or if they were confounded by comorbidities. In addition the study did not examine long-term offspring outcomes.

The study showed that babies whose mothers had taken ADHD medication during pregnancy were at a slightly greater risk of being admitted to the neonatal care unit (NICU) as compared to those whose mothers 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-related disorders, and the increased risk for admission did not appear to be influenced by which stimulant medications were taken during pregnancy.

Women who took stimulant ADHD medications during pregnancy also had a higher risk of having caesarean sections or one whose baby scored low on the Apgar scale (less than 7). These risks did not seem 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 can be offset by greater benefits to both baby and mother of continued treatment for the woman’s disorder. Physicians should discuss the issue with their patients and, when they are able, assist them in developing strategies to improve their coping abilities that may minimize the impact of her disorder on her daily life and relationships.

Medication Interactions

As more women than ever are being diagnosed with ADHD and being treated with medication, the question of whether to keep or end treatment during pregnancy is one that more and more doctors confront. Most of the time, these decisions are made in the absence of solid and reliable evidence regardless, so doctors have to weigh their experience, the experiences of other doctors, and what research suggests on the subject and their best judgment for each patient.

The issue of potential risks to infants is particularly tricky. The research that has been conducted on this topic is based on observation instead of controlled studies and the results are contradictory. Most studies restrict their analysis to live-births, which could underestimate the teratogenic impact leading to abortions or terminations of pregnancy. The study presented in the journal club addresses these limitations by analyzing the data from deceased and live births.

Conclusion Some studies have found a positive correlation between ADHD medications and certain birth defects however, other studies haven't established a link. The majority of studies show an unintended, or somewhat negative, impact. In the end, a careful risk/benefit analysis is required in every instance.

It can be difficult, if not impossible for women with ADHD to stop taking their medication. In a recent article in the Archives of Women's 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 perform work-related tasks, which are essential aspects of daily life for those with ADHD.

She suggests that women who are not sure whether to continue taking the medication or stop due to pregnancy should educate family members, coworkers and friends about the condition, its effects on daily functioning, and the benefits of continuing the current treatment plan. It can also help a woman feel supported in her decision. It is also worth noting that some medications are able to be absorbed through the placenta therefore, if a patient decides to discontinue her ADHD medication during pregnancy and breastfeeding, she should be aware that the effects of the medication could be passed on to the baby.

Birth Defects Risk

As the use and misuse of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases the concern over the possible effects of the drugs on foetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge on this issue. Researchers utilized two massive data sets to examine over 4.3 million pregnancy and determine if the use of stimulant medications caused birth defects. While the overall risk remains low, the scientists did find that first-trimester exposure to ADHD medications was associated with a slightly higher rate of specific heart defects, such as ventriculoseptal defect (VSD).

The researchers of the study found no link between early use of medication and other congenital anomalies, like facial clefting, or club foot. The findings are in line with previous studies revealing the presence of a small, but significant increase in the risk of cardiac malformations among women who began taking ADHD medications before the birth of their child. The risk increased in the latter half of pregnancy when many women stopped taking their medication.

Women who took ADHD medication in the first trimester of their pregnancy were also more likely to have a caesarean section, a low Apgar score after delivery and a baby who needed breathing assistance at birth. However, the authors of the study were not able to eliminate bias due to selection by limiting the study to women who did not have any other medical issues that could have contributed to the findings.

Researchers hope their research will inform physicians when they encounter pregnant women. They advise that while the discussion of the risks and benefits is crucial, the decision to stop or keep medication should be based on each woman's requirements and the severity of her ADHD symptoms.

The authors caution that, even though stopping the medication is a possibility to consider, it is not advised because of the high incidence of depression and mental health issues in women who are expecting or who have recently given birth. Research has also shown that women who stop taking their medication will have a difficult transitioning to life without them after the baby is born.

Nursing

It can be a challenge to become a mother. Women suffering from ADHD are often faced with a number of difficulties when they must deal with their symptoms, attend doctor appointments, prepare for the birth of a baby and adjust to new routines. This is why many women decide to continue taking their ADHD medication throughout the pregnancy.

The majority of stimulant medications are absorbed by breast milk in small amounts, so the risk for nursing infant is very low. The amount of exposure to medications will differ based on dosage, frequency of administration and time of day. Additionally, individual 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 fully known.

Because of the lack of research, some physicians may be inclined to discontinue stimulant medications during the course of pregnancy. This is a difficult decision for the woman who must weigh the benefits of continuing her medication against the risk to the fetus. Until more information is available, GPs should ask all pregnant patients about their experience with ADHD and whether they plan or are taking to take medication during the perinatal period.

Numerous studies have demonstrated that women can continue to take their ADHD medication in a safe manner during pregnancy and breast-feeding. In response, an increasing number of patients are opting to do so. They have found through consultation with their doctor, that the benefits of continuing their current medication far outweigh any potential risks.

Women with ADHD who are planning to nurse should seek advice from a specialist psychiatrist prior to becoming pregnant. They should discuss the medication they are taking with their physician and discuss the pros and cons for continuing treatment. This includes non-pharmacological strategies. Psychoeducation should also more info be provided to help pregnant women suffering from ADHD be aware of their symptoms and the underlying disorder Learn about the available treatment options and reinforce existing strategies for coping. This should include an approach that is multidisciplinary, including the GP as well as obstetricians, psychiatry and obstetricians. Pregnancy counseling should include discussion of a treatment plan for the mother and the child, as well as monitoring for indicators of deterioration, and, if necessary adjustments to the medication regimen.

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