ADHD Medication During Pregnancy and Breastfeeding
Women with ADHD face a difficult decision on whether to keep or stop taking ADHD medication during pregnancy and breast-feeding. Little data exists about how long-term exposure to these medications can affect the fetus.
A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication during utero do not develop neurological developmental conditions like hearing or vision impairment, febrile seizures, or IQ impairment. The authors acknowledge that more high-quality studies are needed.
Risk/Benefit Analysis
Women who are pregnant and taking ADHD medication need to consider the benefits of taking it against the possible risks for the baby. Doctors don't have the necessary data to give clear guidelines however they can provide information about the risks and benefits to aid pregnant women in making informed decisions.
A study published in Molecular Psychiatry found that women who used ADHD medications during their early pregnancy did not have a significantly increased risk of fetal heart malformations or major structural birth defects. Researchers used a large sample-based case control study to assess the frequency of structural defects that were major in infants born to mothers who were taking stimulants during pregnancy. Clinical geneticists, pediatric cardiologists and other experts examined the cases to confirm that the classification was correct and to reduce any bias.
The study of 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 to determine whether the limited associations observed in the exposed groups result from medication use or confounding by comorbidities. In addition the researchers did not study long-term offspring outcomes.
The study found that infants whose mother took ADHD medication during pregnancy had a higher risk of admission to the neonatal care unit (NICU) in comparison to mothers who 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 was not found to be influenced by which stimulant medication was used during pregnancy.
Women who were taking stimulant ADHD medications during pregnancy also had a higher risk of having an emergency caesarean section or having the baby was not scoring well on the Apgar scale (less than 7). These increases did not appear to be influenced by the type of medication that was used during pregnancy.
The researchers suggest that the low risk associated with the use of ADHD medications during the early stages of pregnancy could be offset by the greater benefits to both mother and child of continuing treatment for the woman's condition. Physicians should discuss the issue with their patients and, where they are able, assist them in developing strategies to improve coping skills which can reduce the effects of her disorder on her daily life and relationships.
Medication Interactions
Many doctors are confronted with the dilemma of whether to keep treatment or stop as more women are diagnosed with ADHD. These decisions are usually made without clear and reliable evidence. Instead, doctors have to consider their own expertise and experience, as well as the experiences of other doctors, and the research that has been conducted on the subject.
The issue of risk to the infant can be particularly tricky. A lot of studies on this topic are based on observational evidence rather than controlled research and their findings are often contradictory. Additionally, the majority of studies limit their analysis to live births, which may underestimate the severity of teratogenic effects that could lead to abortion or termination of the pregnancy. adhd medication online discussed in the journal club addresses these limitations by analyzing both data on live and deceased births.
The conclusion is that while some studies have found a positive association between ADHD medications and the possibility of certain birth defects, other studies have found no such relationship and the majority of studies have a neutral or slight negative effect. In the end an accurate risk-benefit analysis must be conducted in every instance.
It can be difficult, if not impossible, for women suffering from ADHD to stop taking their medication. In an article published in the Archives of Women's Mental Health psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can increase depression, feelings of loneliness and family conflict for these patients. A loss of medication may also affect the ability to safely drive and to perform work-related tasks which are crucial aspects of everyday life for those with ADHD.
She recommends women who are uncertain about whether to keep or stop medication in light of their pregnancy should consider the possibility of educating friends, family members and colleagues about the condition, its impact on daily life, and the advantages of continuing the current treatment plan. Educating them can also aid in ensuring that the woman feels supported as she struggles with her decision. It is important to remember that certain medications can be absorbed through the placenta so if a woman decides to discontinue her ADHD medication during pregnancy and breastfeeding, she must be aware of the possibility that traces of the drug could be passed on to the baby.
Birth Defects and Risk of
As the use and abuse of ADHD medications to treat the symptoms of attention deficit disorder hyperactivity disorder (ADHD) increases as does the concern about the possible effects of the drugs on foetuses. A recent study published in the journal Molecular Psychiatry adds to the existing knowledge on this subject. Utilizing two huge data sets, researchers were able to analyze more than 4.3 million pregnancies and determine whether stimulant medication use increased the risk of birth defects. While the overall risk remains low, the researchers discovered that the first-trimester exposure to ADHD medications was linked to an increase in the risk of specific heart defects, like ventriculo-septal defects (VSD).
The authors of the study found no connection between the use of early medications and congenital abnormalities like facial clefting, or club foot. The results are in the same vein as previous studies that showed the existence of a slight, but significant increase in the number of cardiac malformations among women who began taking ADHD medication before pregnancy. The risk was higher in the latter half of pregnancy, when a lot of women decide to stop taking their ADHD medication.
Women who took ADHD medication during the first trimester were more likely to require a caesarean delivery, have an insufficient Apgar after birth and had a baby that required help breathing when they were born. The authors of the study were not able to remove bias in selection since they limited the study to women who did not have any other medical conditions that might have contributed to the findings.
Researchers hope that their study will help doctors when they see pregnant women. They suggest that although discussing risks and benefits is important but the decision to stop or maintain medication must be based on each woman's requirements and the severity of her ADHD symptoms.
The authors also caution that while discontinuing the medications is an option, it isn't an option to consider due to the high prevalence of depression and other mental health issues among women who are pregnant or who are recently postpartum. Additionally, research suggests that women who stop taking their medication will have a harder time adjusting to a life without them once the baby is born.
Nursing
The responsibilities that come with being a new mom can be overwhelming. Women with ADHD who have to manage their symptoms while attending doctor appointments, preparing for the arrival of a baby and adjusting to new household routines are often faced with a number of difficulties. Many women decide to continue taking their ADHD medication during pregnancy.
The risk for breastfeeding infant is not too high since the majority of stimulant medication passes through breast milk at low levels. However, the rate of exposure to medication by the newborn can vary depending on the dosage, frequency it is taken and the time of day it is administered. In addition, various medications enter the baby’s system via the gastrointestinal tract, or through breast milk. The effect on a newborn's health is not completely known.
Some doctors may decide to stop stimulant medication during a woman's pregnancy due to the lack of research. It's a difficult choice for the woman, who must weigh the advantages of her medication against the risk to the fetus. As long as there is no more information, doctors should inquire with all pregnant patients about their experience with ADHD and whether they are planning or taking to take medication during the perinatal time.
Numerous studies have proven that women can continue taking their ADHD medication without risk during pregnancy and breast-feeding. In the end, an increasing number of patients choose to do so, and in consultation with their doctor they have found that the benefits of maintaining their current medication far outweigh any risks.
It is essential for women with ADHD who are contemplating breastfeeding to seek a specialist psychiatrist's guidance prior to becoming pregnant. They should discuss their medication with their doctor as well as the pros and cons for continuing treatment. This includes non-pharmacological strategies. Psychoeducation is also necessary to help pregnant women with ADHD understand the symptoms and underlying disorder. They should also learn about treatment options and strengthen coping mechanisms. This should be a multidisciplinary process with the GPs, obstetricians and psychiatry. Counselling for pregnancy should include discussion of a management plan for both the mother as well as the child, monitoring for signs of deterioration and the need for adjustments to the medication regimen.