ADHD Medication During Pregnancy and Breastfeeding
Women with ADHD have to make a difficult choice regarding whether or not to stop taking ADHD medication during pregnancy and breast-feeding. There aren't enough data on how long-term exposure may affect the pregnant fetus.
A recent study published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological disorders such as hearing loss or vision, febrile seizures, or IQ impairment. The authors acknowledge that further high-quality studies are required.
Risk/Benefit Analysis
Women who are expecting and taking ADHD medication should consider the benefits of taking it against the potential risks to the baby. The doctors don't have the information to give clear advice, but can provide information on the risks and benefits to assist pregnant women to make informed decisions.
A study published in Molecular Psychiatry found that women who took ADHD medications during their early pregnancy did not face an increased risk of fetal cardiac malformations or major birth defects that are structural. Researchers conducted a massive 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 reviewed the cases to ensure an accurate classification of the cases and to reduce the possibility of bias.
The study of the researchers had some limitations. The researchers were unable to, in the first place to distinguish the effects triggered by the medication from the disorder. That limitation makes it difficult to know whether the small associations observed in the groups that were exposed are due to medication use or confounding by comorbidities. Additionally the study did not examine the long-term outcomes of offspring.
The study revealed that babies whose mothers took ADHD medication during pregnancy had a greater risk of being admitted to the neonatal care unit (NICU), compared to those whose mothers didn't take any medication during pregnancy or had discontinued taking 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 medication that was used during pregnancy.
Women who took stimulant ADHD medications during pregnancy also had a higher risk of having to have a caesarean section or the baby was not scoring well on the Apgar scale (less than 7). These increases did not seem to be influenced by the kind of medication used during pregnancy.
The research suggests that the low 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 discuss the issue with their patients and, when possible, help them develop strategies to improve their coping abilities which can 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 dilemma of whether or not to stop treatment during pregnancy is a question that doctors are having to confront. These decisions are frequently made without clear and reliable evidence. Instead, physicians must consider their own expertise and experience, as well as the experiences of other physicians and the research on the subject.
In particular, the issue of possible risks to the infant can be difficult. Many studies on this issue 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 can undervalue the serious teratogenic effects that can lead to abortion or termination of the pregnancy. The study presented in this journal club addresses these issues by looking at data from both live and deceased births.
Conclusion A few studies have revealed an association between ADHD medications and certain birth defects, other studies have not found a correlation. Most studies have shown that there is a neutral, or slightly negative, impact. In all cases, a careful analysis of the risks and benefits must be performed.
It isn't easy, but not impossible for women with ADHD to stop taking their medication. In a recent article in the Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can increase depression and feelings of being isolated. Additionally, the loss of medication can interfere with the get more info ability to do job-related tasks and drive safely, which are important aspects of daily life for many people with ADHD.
She suggests women who are unsure about whether to keep or stop taking medication because of their pregnancy consider the possibility of educating friends, family members and colleagues on the condition, its impact on daily functioning, and on the advantages of staying on the current treatment regimen. It can also help women feel supported in her decision. Certain medications can pass through the placenta. If a woman decides to stop taking her ADHD medication while pregnant and breastfeeding, it is important to be aware that the drug could be transferred to the baby.
Risk of Birth Defects
As the use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases as do concerns about what impact the medications could have on fetuses. Recent research published in the journal Molecular Psychiatry has added to the body knowledge on this issue. Researchers utilized two massive datasets to analyze over 4.3 million pregnant women and determine if stimulant medication use caused birth defects. Although the risk overall remains low, the researchers discovered that the first-trimester exposure to ADHD medications was linked to an increased risk of certain heart defects, such as ventriculoseptal defect (VSD).
The authors of the study found no association between early use of medication and congenital abnormalities such as facial clefting or club foot. The findings are in line with previous studies that have shown the presence of a small, but significant increase in the risk of developing cardiac malformations in women who started taking ADHD medications prior to the time of the time of pregnancy. The risk grew in the later part of pregnancy, as many women begin to discontinue their ADHD medications.
Women who were taking ADHD medication in the first trimester were more likely to require a caesarean delivery and also have a low Apgar after delivery and have a baby who needed breathing assistance at birth. The researchers of the study were unable to remove bias in selection since they limited the study to women who did not have any other medical conditions that could have contributed to the findings.
Researchers hope that their research will provide doctors with information when they encounter pregnant women. The researchers recommend that while discussing the risks and benefits are important, the choice about whether to continue or stop medication should be in light of the severity of each woman's ADHD symptoms and her requirements.
The authors caution that, even though stopping the medication is a possibility to consider, it is not recommended because of the high incidence of depression and mental health issues for women who are pregnant or recently gave birth. Additionally, the research suggests that women who decide to stop taking their medications are more likely to have difficulties adapting to life without them following the baby's arrival.
Nursing
The responsibilities of a new mom can be overwhelming. Women who suffer from ADHD who have to deal with their symptoms while attending physician appointments as well as preparing for the arrival of their child and adapting to new routines in the home can experience severe challenges. Many women decide to continue taking their ADHD medication during pregnancy.
The majority of stimulant medicines are absorbed through breast milk in very small amounts, so the risk to nursing infant is very low. However, the frequency of exposure to medication by the newborn may differ based on dosage, frequency it is administered and at what time the medication is administered. In addition, different medications enter the baby’s system through the gastrointestinal tract, or through breast milk. The impact of these medications on the health of a newborn is not fully understood.
Because of the lack of research, some physicians may recommend stopping stimulant medication during the pregnancy of a woman. It is a difficult decision for the woman who must weigh the benefits of her medication against the risk to the fetus. Until more information is available, GPs should ask all pregnant patients about their experience with ADHD and whether they plan or are taking to take medication during the perinatal period.
Numerous studies have demonstrated that women can continue to take their ADHD medication without risk while breastfeeding and during pregnancy. In response, an increasing number of patients are choosing to do so. They have found after consulting with their doctors, that the benefits of continuing their current medication outweigh any possible risks.
Women who suffer from ADHD who are planning to breastfeed should seek advice from a specialist psychiatrist before becoming pregnant. They should discuss their medication with their prescriber and discuss the advantages and disadvantages of continued treatment, including non-pharmacological management strategies. Psychoeducation is also needed to help pregnant women suffering from ADHD recognize the signs and the underlying disorder. They should also be informed about treatment options and reinforce coping mechanisms. This should involve a multidisciplinary approach with the GP as well as obstetricians, psychiatry and obstetricians. Pregnancy counseling should include a discussion of a treatment plan for the mother and the child, and monitoring for signs of deterioration, and, if needed modifications to the medication regimen.