ADHD Medication During Pregnancy and Breastfeeding
Women with ADHD must make a difficult decision regarding whether or not to stop taking ADHD medication during pregnancy and breast-feeding. There are few data on how long-term exposure may affect a fetus.
A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication during the uterus do not develop neurological developmental disorders such as hearing or vision impairment seizures, febrile seizures, or IQ impairment. The authors acknowledge that further high-quality studies are needed.
Risk/Benefit Analysis
Women who are pregnant and taking ADHD medications must weigh the advantages of using them against the risks to the foetus. Doctors don't have enough data to make unambiguous recommendations, but can provide information on the risks and benefits to aid pregnant women in making an informed decision.
A study published in Molecular Psychiatry concluded that women who were taking ADHD medication during early pregnancy were not at a greater risk of fetal malformations or structural birth defects. Researchers used a large population-based case control study to examine the prevalence of major structural defects in infants who were born to mothers who took stimulants during pregnancy. Pediatric cardiologists and clinical geneticists examined the cases to ensure an accurate case classification and to limit the possibility of bias.
However, the study was not without its flaws. Most important, they were unable to distinguish the effects of the medication from the effects of the disorder at hand. That limitation makes it difficult to determine whether the limited associations observed in the groups that were exposed are due to medication use or comorbidities that cause confusion. In addition the researchers did not study the long-term effects of offspring on their parents.
The study did show that infants whose mothers took ADHD medication during pregnancy were at a greater risk of being admitted to the neonatal intensive care unit (NICU) than infants who were born without any medication or stopped their medications before 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 were taking stimulant ADHD medications during pregnancy also had a higher chance of having a caesarean section or the baby was not scoring well on the Apgar scale (less than 7). These increases did appear to be unrelated to the type of medication taken during pregnancy.
The research suggests that the small risk associated with the use of ADHD medications during early pregnancy may be offset by the greater benefits to both mother and child of continued treatment for the woman's disorder. Physicians should speak with their patients about this issue and, if possible, help them improve coping skills which may reduce the effects of her disorder on her daily functioning and her relationships.
Medication Interactions
Doctors are increasingly faced with the decision of whether to maintain treatment or stop it during pregnancy as more women are diagnosed with ADHD. The majority of these decisions are made without any evidence that is clear and definitive in either case, which means that doctors must weigh their knowledge about their experiences, the experiences of other doctors, and what the research says on the topic, along with their own best judgment for each patient.
The issue of risk to infants is particularly tricky. A lot of studies on this topic are based on observational evidence rather than controlled research and their conclusions are often contradictory. Additionally, the majority of studies limit their analysis to live births, which could undervalue the serious teratogenic effects that can cause abortion or termination of the pregnancy. The study presented in this journal club addresses these shortcomings by looking at data from both live and deceased births.
The conclusion: While certain studies have demonstrated a positive association between ADHD medications and the possibility of certain birth defects, other studies have found no such relationship, and most studies demonstrate a neutral or slight negative effect. In each case an in-depth study of the risks and benefits must be performed.
For a lot of women with ADHD, the decision to stop medication is difficult if not impossible. In an article recently published in Archives of Women's Mental Health, psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can lead to increased depression, feelings of loneliness and family conflict for those suffering from the disorder. In addition, a decrease in medication can interfere with the ability to perform job-related tasks and drive safely which are essential aspects of a normal life for many people with ADHD.
She recommends that women who are unsure about whether to continue or stop medication in light of their pregnancy consider informing family members, friends and colleagues on the condition, its impact on daily functioning, and on the benefits of keeping the current treatment plan. It can also help the woman feel supported in her struggle with her decision. Certain medications can pass through the placenta. If the patient decides to not take her ADHD medication while breastfeeding, it is important to be aware that the medication could be transferred to the baby.
Birth Defects Risk
As the use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) grows, so do concerns about the effects that the medications could have on foetuses. A recent study published in the journal Molecular Psychiatry adds to the existing knowledge on this subject. With two massive data sets researchers were able look at more than 4.3 million pregnancies to determine whether the use of stimulant medications 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 increased risk of specific heart defects, such as ventriculo-septal defect (VSD).
The researchers behind the study found no connection between early use of medication and congenital abnormalities such as facial clefting or club foot. The results are in line with 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 prior to the time of pregnancy. The risk grew in the later part of pregnancy, when many women are forced to stop taking their medication.
Women who took ADHD medication during the first trimester were more likely need a caesarean and also have a low Apgar after birth and had a baby that required help breathing after birth. The researchers of the study could not eliminate bias due to selection because they restricted the study to women with no other medical conditions that might have contributed to the findings.
The researchers hope that their research will aid in the clinical decisions of doctors who treat pregnant women. The researchers suggest that, while discussing the risks and benefits are important, the decision regarding whether or not to stop medication should be in light of the severity of each woman's ADHD symptoms and her needs.
The authors warn that, while stopping the medication is a possibility to look into, it is not advised due to the high prevalence of depression and other mental disorders in women who are expecting or have recently given birth. Furthermore, research suggests that women who decide to stop taking their medications are more likely to have difficulties adjusting to life without them following the baby's arrival.
Nursing
It can be overwhelming becoming a mother. Women with ADHD who must work through their symptoms while attending doctor appointments and making preparations click here for the arrival of their child and adapting to new routines in the home may face a lot of challenges. As such, many women decide to continue taking their ADHD medication throughout the pregnancy.
The majority of stimulant drugs are absorbed by breast milk in very small amounts, so the risk to the nursing infant is very low. However, the frequency of exposure to medication by the newborn may differ based on dosage, how often it is administered and the time of the day the medication is administered. In addition, different drugs enter the infant's system through the gastrointestinal tract, or through breast milk. The impact on a newborn's health is not completely known.
Some physicians may discontinue stimulant medications during a woman's pregnancy due to the lack of research. It's a difficult choice for the woman, who must weigh the benefits of continuing her medication against the risk to the fetus. As long as more information is available, doctors can ask pregnant patients if they have any background of ADHD or if they are planning to take medication during the perinatal period.
Numerous studies have demonstrated that women can continue taking their ADHD medication without risk during pregnancy and while breast-feeding. In response, an increasing number of patients are opting to continue their medication. They have concluded, in consultation with their doctor, that the benefits of continuing their current medication outweigh possible risks.
It is essential for women with ADHD who are thinking of breastfeeding to seek out a specialist psychiatrist's guidance prior to becoming pregnant. They should discuss their medication with their doctor and discuss the pros and cons for continuing treatment. This includes non-pharmacological strategies. Psychoeducation should also be provided to help pregnant women suffering from ADHD understand their symptoms and the underlying disorder Learn about the available treatments and to reinforce existing strategies for managing. This should include a multidisciplinary approach with the GP as well as obstetricians, psychiatry and obstetricians. The pregnancy counselling should consist of the discussion of a treatment plan for both mother and child, as well as monitoring for signs of deterioration and the need for adjustments to the medication regimen.