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References

Prescribing in pregnancy and breastfeeding CHAPTER 7 ■ ■Hypnotic benzodiazepine receptor agonists (Z drugs) are probably not associated with an increased risk of congenital malformations,211,212 but an increased risk of premature birth, low birth weight and small for gestational age has been reported.211 ■ ■Zolpidem may be associated with an increased likelihood of caesarean section.213 ■ ■Available data do not appear to show an association between in utero benzodiazepine and/or Z drug exposure and neurodevelopmental disorders.214–216 Attention deficit hyperactivity disorder (ADHD) in pregnancy Methylphenidate and amfetamines are probably not major teratogens.217,218 A small increased risk of cardiac malformations has been reported with methylphenidate but is not seen with amfetamines.219 There may be a small increased risk of spontaneous abortion with methylphenidate and a small increased risk of premature birth and low birth weight with amfetamines.218 Modafinil may be associated with an increased risk of congenital malformations (including congenital heart defects, hypospadias and orofacial clefts).220,221 In the UK, the MHRA advises that modafinil should not be used during pregnancy.220 Women of child-­bearing age must understand the risk of taking modafinil in pregnancy and should be advised to use effective contraception during treatment with modafinil and for 2 months after discontinuing treatment.220 Available data do not show an increased risk of neurodevelopmental disorders in children exposed to ADHD medications in utero.222,223 References

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