ADHD Medication During Pregnancy and Breastfeeding
The choice of whether to stop or continue ADHD medication during pregnancy and nursing is challenging for women with the condition. Little data exists about how long-term exposure to these drugs could affect the foetus.
A recent study 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 studies.
Risk/Benefit Analysis
Women who are pregnant and taking ADHD medication should consider the benefits of taking it against the potential dangers for the foetus. Physicians don't have the data to make unambiguous recommendations, but can provide information about risks and benefits to aid pregnant women in making informed choices.
A study published in Molecular Psychiatry found that women who used ADHD medications in early pregnancy did not have a significantly increased risk of fetal cardiac malformations or major structural birth defects. Researchers used a large population-based study of case control to compare the incidence of major structural defects in infants who were born to mothers who used stimulants during pregnancy. Pediatric cardiologists and clinical geneticists looked over the cases to ensure correct case classification and to limit the possibility of bias.
However, the researchers' study was not without its flaws. Most important, they were unable to distinguish the effects of the medication from the underlying disorder. That limitation makes it difficult to determine whether the limited associations observed in the exposed groups are due to the use of medication or confounding by comorbidities. The researchers did not examine long-term outcomes for offspring.
The study did show that infants whose mothers had taken ADHD medications during pregnancy were at a greater risk of being admitted to the neonatal intensive care unit (NICU) than infants who whose mothers did not take any medication or had taken off their medication prior to or during pregnancy. The reason for this was central nervous system disorders. The increased risk of admission was not affected by the stimulant medication that was used during pregnancy.
Women who took stimulant ADHD medication during pregnancy also had an elevated risk of having a caesarean section or having a child with a low Apgar score (less than 7). These increases appear to be unrelated to the type of medication taken during pregnancy.
The researchers suggest 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 mother and child from continued treatment for the woman's condition. Doctors should discuss with their patients about this issue and try to help them develop coping skills that may reduce the effects of her disorder on her daily life and relationships.
Medication Interactions
As more women than ever are diagnosed with ADHD and being treated with medication, the question of whether to continue or end treatment during pregnancy is one that more and more physicians have to face. These decisions are usually made without clear and reliable evidence. Instead, doctors have to take into account their own experience and experience, as well as the experiences of other physicians and the research on the topic.
The issue of risk to the infant can be extremely difficult. The research on this issue is based on observations rather than controlled studies and a lot of the results are conflicting. Furthermore, most studies restrict their analysis to live births, which can underestimate the severity of teratogenic effects that could lead to abortion or termination of the pregnancy. The study that is discussed in this journal club addresses these issues by examining data on both live and deceased births.
The conclusion: While some studies have shown an association between ADHD medications and the risk of certain birth defects, others have found no connection and the majority of studies show a neutral or even slightly negative effect. Therefore an accurate risk-benefit analysis must be done in each instance.
It can be difficult, if not impossible for women suffering from ADHD to stop taking their medication. In a recent piece published in Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can lead to depression and feelings of isolation. The loss of medication can also impact the ability to drive safely and complete work-related tasks, which are vital aspects of normal life for people with ADHD.
She recommends that women who are unsure about whether to continue or stop medication in light of their pregnancy should consider educating family members, friends and colleagues about the condition, its impact on daily functioning, and on the advantages of staying on the current treatment plan. It can also help a woman feel more confident in her decision. Some medications can pass through the placenta. If a patient decides to stop taking her ADHD medication while breastfeeding, it is important to be aware that the medication may be transferred to her baby.
Birth Defects Risk
As the use and abuse of ADHD medication to treat symptoms of attention deficit disorder hyperactivity disorder (ADHD) is increasing, so does concern about the possible effects of the drugs on fetuses. A study that was published in the journal Molecular Psychiatry adds to the body of information on this topic. Utilizing two huge data sets, researchers were able to look at more than 4.3 million pregnancies to determine whether the use of stimulant medications increased the risk of birth defects. Although the risk overall remains low, the researchers found that exposure in the first trimester to ADHD medications was linked to an increase in the risk of specific heart defects, such as ventriculoseptal defect (VSD).
The researchers behind the study found no association between early medication use and other congenital abnormalities, such as 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 heart malformations in women who started taking ADHD medications before the birth of their child. The risk grew in the latter half of pregnancy, when a lot of women begin to discontinue their medication.
Women who used ADHD medication in the first trimester of their pregnancies were also more likely to experience caesarean sections, a low Apgar score following delivery, and a baby who required breathing assistance at birth. The authors of the study could not remove bias in selection since they restricted the study to women without other medical conditions that could have contributed to the findings.
Researchers hope that their study will help doctors when they meet pregnant women. The researchers recommend that while discussing risks and benefits are crucial, the decision regarding whether or not to stop taking medication should be based on the severity of each woman's ADHD symptoms and her requirements.
The authors also advise that while discontinuing the medications is an alternative, it is not an option that is recommended due to the high incidence of depression and other mental health problems in women who are pregnant or recently post-partum. Further, research shows that women who stop taking their medications will have a tough transitioning to life without them once the baby is born.
Nursing
It can be a stressful experience becoming a mother. Women with ADHD who must work through their symptoms while attending doctor appointments as well as getting ready for the arrival of their child and getting used to new routines at home may face a lot of challenges. Many women choose to continue taking their ADHD medication during pregnancy.
The majority of stimulant drugs are absorbed through breast milk in small amounts, so the risk for breastfeeding infant is minimal. However, the rate of exposure to medications by the newborn may differ based on dosage, how often it is administered and the time of day it is administered. Additionally, individual medications enter the baby's system differently through the gastrointestinal tract as well as breast milk, and the effect of this on a newborn is not fully known.
Some doctors may decide to stop stimulant medications during a woman's pregnancy due to the lack of research. This is a difficult decision for the patient, who must balance the benefits of keeping her medication against the potential risks to the embryo. As visit your url as more information is available, GPs may ask pregnant patients whether they have an history of ADHD or if they are planning to take medication during the perinatal phase.
A increasing number of studies have proven that women can continue their ADHD medication during pregnancy and breastfeeding. As a result, an increasing number of patients opt to do this and, after consulting with their doctor, they have discovered that the benefits of keeping their current medication outweigh any potential risks.
It is essential for women with ADHD who are contemplating breastfeeding to seek a specialist psychiatrist's advice prior 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 is also needed to help pregnant women suffering from ADHD understand the symptoms and underlying disorder. They should also be informed about treatment options and reinforce strategies for coping. This should be a multidisciplinary effort together with obstetricians, GPs and psychiatry. Pregnancy counseling should include discussion of a treatment plan for the mother as well as the child, and monitoring for signs of deterioration, and, if necessary modifications to the medication regimen.