ADHD Medication During Pregnancy and Breastfeeding
Women suffering from ADHD have to make a difficult choice on whether to keep or stop taking ADHD medication during pregnancy and breast-feeding. There are few data regarding how exposure over time may affect the foetus.
A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological issues such as impaired hearing 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 medications need to balance the advantages of using them against the risks to the foetus. Physicians do not have the necessary data to provide clear recommendations however they can provide information about benefits and risks that can help pregnant women make informed choices.
A study published in Molecular Psychiatry concluded that women who were taking ADHD medication during their early pregnancy were not at a greater risk of fetal malformations, or structural birth defects. Researchers conducted a large population-based case-control study to assess the risk of major structural birth defects in babies born to mothers who had taken stimulants in the early stages of pregnancy, as well as those who had not. Pediatric cardiologists, clinical geneticists and other experts reviewed the cases in order to confirm that the classification was accurate and to reduce any bias.
The study conducted by the researchers was not without limitations. In particular, they were unable to distinguish the effects of the medication from those of the disorder at hand. This limitation makes it difficult for researchers to determine if the small associations observed among the exposed groups were due to the use of medication, or if they were confounded by comorbidities. The researchers did not look at the long-term effects for the offspring.
The study did reveal that babies whose mothers had taken ADHD medications during pregnancy were at slightly greater risk of being admitted to the neonatal intensive care unit (NICU) than infants who were born without any medication or had stopped their medications before or during pregnancy. This was due to central nervous system-related disorders, and the increased risk of admission did not appear to be affected by the type of stimulant medication was used during pregnancy.
Women who were taking stimulant ADHD medications during pregnancy also had a higher chance of having to have caesarean sections or a baby that scored low on the Apgar scale (less than 7). These increases appear to be unrelated to the type of medication used during pregnancy.
Researchers suggest that the small risks posed by the use of ADHD medications in early pregnancies may be offset by the greater benefits to both mother and baby of continuing treatment for the woman's disorder. Physicians should discuss this with their patients and, if 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
More and more doctors are faced with the decision of whether to continue treatment or stop as more women are diagnosed with ADHD. Most of the time, these decisions are made without any evidence that is clear and definitive in either case, which means that doctors must weigh what they know, the experiences of other doctors, and what the research suggests on the subject as well as their own judgments for each individual patient.
Particularly, the issue of potential risks for the infant can be difficult. The research on this subject is based on observations rather than controlled studies and the results are in conflict. The majority of studies limit their analysis to live births, which can underestimate the teratogenic impact that can lead to abortions or terminations of pregnancy. The study that is discussed in the journal club addresses these limitations by analyzing both information on deceased and live births.
The conclusion: While certain studies have demonstrated that there is a positive correlation between ADHD medications and the possibility of certain birth defects, other studies have found no connection, and most studies show a neutral or even slight negative effect. As a result an accurate risk-benefit analysis must be done in each case.
For a lot of women with ADHD, the decision to discontinue medication is difficult if not impossible. In fact, in a recent article in 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 those suffering from the disorder. A loss of medication may also affect the ability to safely drive and complete work-related tasks, which are essential aspects of normal life for those suffering from ADHD.
She suggests that women who are not sure whether to continue taking medication or stop it due to their pregnancy, educate their family members, colleagues, and friends about the condition, its impact on daily functioning and the benefits of continuing the current treatment plan. Educating them can also aid in ensuring that the woman feels supported as she struggles with her decision. Certain medications can pass through the placenta. If the patient decides to not take her ADHD medication while breastfeeding, it is crucial to be aware that the drug may be transferred to her baby.
Birth Defects and Risk of
As the use and abuse of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases the concern over the potential adverse effects of the drugs on fetuses. A study that was published in the journal Molecular Psychiatry adds to the existing knowledge about this subject. Researchers used two huge datasets to analyze over 4.3 million pregnancy and determine if the use of stimulant medications increased birth defects. Researchers found that while the risk overall is low, first-trimester ADHD medication exposure was associated with slightly higher risk of specific heart defects like ventriculoseptal defects.
The authors of the study could not discover any connection between early medication usage and other congenital anomalies, like facial deformities, or club feet. The results are in line with previous studies revealing an increase, but not significant, in the risk of cardiac malformations among women who started taking ADHD medications prior to the birth of their child. website The risk was higher during the latter part of pregnancy, as many women are forced to stop taking their ADHD medications.
Women who took ADHD medication in the first trimester of their pregnancies were also more likely to undergo caesarean section, low Apgar score following delivery, and a baby who required breathing assistance at birth. However the authors of the study were not able to eliminate bias due to selection by restricting the study to women who did not have any other medical issues that could have contributed to the findings.
The researchers hope that their research will aid in the clinical decisions of physicians who treat pregnant women. The researchers suggest that while discussing the risks and benefits are crucial, the decision on whether to continue or stop medication should be made in light of the severity of each woman's ADHD symptoms and her requirements.
The authors also caution that even though stopping the medication is an alternative, it is not an option to consider due to the high incidence of depression and other mental health problems in women who are pregnant or who are recently postpartum. Research has also shown that women who stop taking their medication will have a tough adjustment to life without them after the baby is born.
Nursing
The responsibilities of being a new mom can be overwhelming. Women with ADHD may face a lot of challenges when they must manage their symptoms, go to doctor appointments and prepare for the birth of their child and adjust to a new routine. This is why many women decide to continue taking their ADHD medications throughout pregnancy.
The risk to a nursing infant is low because the majority of stimulant medication is absorbed through breast milk at low levels. The amount of exposure to medications will differ based on dosage the medication is administered, its frequency and the time of day. Additionally, individual medications enter the infant's system differently through the gastrointestinal tract and breast milk, and the effect of this on a newborn is not well known.
Some physicians may discontinue stimulant medications during a woman's pregnancy due to the lack of research. This is a complicated decision for the patient, who must weigh the benefits of keeping her medication against the possible risks to the embryo. As long as there is no more information, GPs should ask all pregnant patients about their history of ADHD and whether they plan or are taking to take medication during the perinatal period.
Numerous studies have proven that women can continue taking their ADHD medication safely during pregnancy and breast-feeding. In response, a growing number of patients are opting to do so. They have found after consulting with their doctors that the benefits of continuing their current medication outweigh any potential risks.
Women with ADHD who plan to breastfeed should seek advice from a specialist psychiatrist before becoming pregnant. They should discuss their medication with their physician and discuss the advantages and disadvantages of continued treatment, including non-pharmacological strategies. Psychoeducation is also necessary to help pregnant women with ADHD be aware of the symptoms and the underlying disorder. They should also learn about treatment options and reinforce the coping mechanisms. This should be a multidisciplinary process including obstetricians, GPs and psychiatrists. Pregnancy counseling should consist of a discussion of a treatment plan for the mother and child, as well as monitoring for signs of deterioration, and, if needed adjustments to the medication regime.