ADHD Medication During Pregnancy and Breastfeeding
Women suffering from ADHD face a difficult decision about whether to continue or stop taking ADHD medication during pregnancy and breastfeeding. There aren't many studies on how long-term exposure may affect a pregnant fetus.
A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus do not develop neurological developmental disorders such as hearing or vision impairment seizures, 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 need to weigh the benefits of taking it against the possible risks to the baby. Doctors don't have the necessary data to give clear guidelines, but they can provide information about risks and benefits that aid pregnant women in making informed choices.
A study published in Molecular Psychiatry found that women who used ADHD medications during their early pregnancy did not have an increased risk of fetal heart malformations or major structural birth defects. The researchers used a large, population-based case-control study to determine the prevalence of major structural birth defects in babies born to mothers who had taken stimulants during early pregnancy and those who had not. Pediatric cardiologists, clinical geneticists and other experts examined the cases to confirm that the classification was correct and to eliminate any bias.
The study conducted by the researchers had some limitations. The most important issue was that they were unable to separate the effects of the medication from the effects of the underlying disorder. That limitation makes it difficult to determine whether the limited associations observed in the groups that were exposed are due to medication use or confounding by comorbidities. Additionally the researchers did not study long-term offspring outcomes.
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 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 higher risk of admission was not influenced by the stimulant medications used during pregnancy.
Women who were taking stimulant ADHD medication during pregnancy were also at an increased risk of having a caesarean delivery or having a child with low Apgar score (less than 7). These increases didn't appear to be affected 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 higher benefit to both the mother and child of continuing treatment for the woman's disorder. Physicians should discuss the issue with their patients and, if possible, assist them in developing strategies to improve coping skills which can reduce the negative impact of her condition on her daily functioning and relationships.
Medication Interactions
As more women than ever are diagnosed with ADHD and being treated with medication, the issue of whether to continue or end treatment during pregnancy is a question that more and more doctors confront. These decisions are usually taken without clear and authoritative evidence. Instead, doctors must consider their own expertise in conjunction with the experiences of other doctors and the research on the topic.
The issue of potential risks for infants can be particularly tricky. The research on this subject is based on observations instead of controlled studies and many of the findings are contradictory. In addition, most studies limit their analysis to live births, which could underestimate the severity of teratogenic effects that could result in abortion or termination of the pregnancy. The study that is discussed in the journal club addresses these limitations by analyzing both data on live and deceased births.
The conclusion The conclusion: While some studies have shown an association between ADHD medications and the possibility of certain birth defects, other studies have found no connection, and most studies have a neutral or slightly negative impact. In the end an accurate risk-benefit analysis must be done in each case.
It can be difficult, if not impossible, for women suffering from ADHD to stop taking their medication. In fact, in a recent article in the 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 these patients. A loss of medication may also impact the ability to drive safely and to perform work-related tasks which are crucial aspects of daily life for those with ADHD.
She recommends women who are unsure about whether to keep or stop medication in light of their pregnancy, consider the possibility of educating friends, family members and colleagues about the condition, its impact on daily functioning, and on the benefits of keeping the current treatment plan. Educating them can also aid in ensuring that the woman feels supported in her struggle with her decision. Certain medications can be passed through the placenta. If a woman decides to stop taking her ADHD medication while pregnant and breastfeeding, it's important to be aware that the drug could be passed on to her infant.
Risk of Birth Defects
As the use of ADHD medication to treat the symptoms of attention deficit hyperactivity disorder (ADHD) grows there are concerns over the impact that these drugs might have on fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge on this subject. Using two massive data sets researchers were able to examine more than 4.3 million pregnancies and see whether stimulant medication use increased the risk of birth defects. Although the risk overall remains low, the scientists discovered that the first-trimester exposure to ADHD medicines was associated with a slightly higher rate of certain heart defects, such as ventriculo-septal defect (VSD).
adult attention deficit hyperactivity disorder medication I Am Psychiatry of the study found no link between early medication use and other congenital anomalies, like facial clefting, or club foot. The findings are in line with previous studies revealing a small but significant increase in the risk of developing cardiac malformations among women who started taking ADHD medications prior to pregnancy. The risk grew in the latter half of pregnancy, when many women are forced to stop taking their ADHD medication.
Women who took ADHD medications in the first trimester of their pregnancies were also more likely to undergo a caesarean section, a low Apgar score after delivery and a baby who needed breathing assistance during birth. However, the authors of the study were not able to eliminate bias due to selection by limiting the study to women who did not have any other medical conditions that could have contributed to these findings.
The researchers hope their research will help inform the clinical decisions of physicians who treat pregnant women. The researchers suggest that, while discussing the risks and benefits are important, the decision on whether to continue or stop taking medication should be based on the severity of each woman's ADHD symptoms and her needs.
The authors caution that, while stopping the medication is an option to look into, it is not advised because of the high incidence of depression and other mental problems in women who are expecting or who have recently given birth. Additionally, the research suggests that women who decide to stop taking their medications are more likely to experience difficulties getting used to life without them after the baby's arrival.
Nursing
The responsibilities that come with being a new mom can be overwhelming. Women with ADHD who must work through their symptoms while attending doctor appointments and preparing for the arrival of their child and getting used to new routines at home can experience severe challenges. As such, many women decide to continue taking their ADHD medication throughout the pregnancy.
The majority of stimulant drugs are absorbed through breast milk in very small quantities, so the risk for infant who is breastfeeding is low. The amount of exposure to medications can vary depending upon the dosage, frequency of administration and the time of day. In addition, various medications are introduced into the baby's system via the gastrointestinal tract or through breast milk. The impact of these medications on the health of a newborn is not completely comprehended.
Because of the lack of research, some doctors may be inclined to discontinue stimulant drugs during the pregnancy of a woman. It's a difficult choice for the woman who must weigh the benefits of taking her medication as well as the potential risks to the fetus. In the meantime, until more information is available, GPs may inquire about pregnant patients if they have any history of ADHD or if they plan to take medication during the perinatal period.
A increasing number of studies have revealed that women can continue their ADHD medication during pregnancy and breastfeeding. In the end, an increasing number of patients are choosing to do so and, after consulting with their doctor, they have found that the benefits of keeping their current medication far outweigh any potential risks.
It's important for women with ADHD who are thinking of breastfeeding to seek out a specialist psychiatrist's guidance prior to becoming pregnant. They should review their medications with their physician and discuss the pros and cons of continued treatment, including non-pharmacological strategies. Psychoeducation should also be provided to help pregnant people with ADHD understand their symptoms and underlying disorder Learn about the available treatments and to reinforce existing strategies for managing. This should be a multidisciplinary process with the GPs, obstetricians, and psychiatry. Pregnancy counselling should include discussion of a management plan for both mother and child, monitoring for signs of deterioration and the need for adjustments to the medication regimen.