ADHD Medication During Pregnancy and Breastfeeding
The decision to stop or keep ADHD medication during pregnancy and nursing is a challenge for women suffering from the condition. Little data exists about how long-term exposure to these drugs could affect the foetus.
A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological issues like hearing loss or vision, febrile seizures or IQ impairment. The authors acknowledge the need for higher-quality research.
Risk/Benefit Analysis
Women who are expecting and taking ADHD medication should consider the benefits of taking it against the possible risks for the foetus. The doctors don't have the information to make unambiguous recommendations, but can provide information about risks and benefits to aid pregnant women in making informed choices.
A study published in Molecular Psychiatry found that women who were taking ADHD medications in early pregnancy did not face a significantly increased risk of fetal cardiac malformations or major birth defects that are structural. Researchers conducted a large, population-based case-control study to determine the prevalence of major structural birth defects in infants born to mothers who had taken stimulants in the early stages of pregnancy, and those who did not. Pediatric cardiologists, clinical geneticists and other experts looked over the cases to make sure that the classification was accurate and to eliminate any bias.
The research conducted by the researchers was not without its limitations. Most important, they were not able to differentiate the effects of the medication from the effects of the disorder that is underlying. This limitation makes it difficult to know whether the limited associations observed in the exposed groups are due to the use of medication or confounding by comorbidities. Additionally the study did not examine the long-term effects of offspring on their parents.
The study did reveal that babies whose mothers had taken ADHD medication during pregnancy were at a slightly higher risk of being admitted to the neonatal intensive care unit (NICU) than infants who were born without any medication or cut back on their medications prior to or during pregnancy. The reason for this was central nervous system-related disorders and the higher risk of admission was not found to be affected by the type of stimulant medications were taken during pregnancy.
Women who were taking stimulant ADHD medications during pregnancy also had a higher risk of having caesarean sections or a baby that scored low on the Apgar scale (less than 7). These increases did appear to be independent of the type of medication taken during pregnancy.
Researchers suggest that the minor risk of using ADHD medications during early pregnancies may be offset by the more beneficial outcomes for both baby and mother of continued treatment for the woman's disorder. Physicians should discuss this with their patients and, where possible, help them develop strategies to improve their coping abilities which can reduce the effects of her disorder on her daily functioning and relationships.
add adhd medication are confronted with the dilemma of whether to maintain treatment or stop as more women are diagnosed with ADHD. Often, these decisions are taken in the absence of solid and reliable evidence regardless, so doctors have to weigh their experience from their own experiences, those of other doctors, and what research suggests on the subject and their best judgment for each patient.
Particularly, the subject of potential risks for the baby can be a challenge. The research on this issue is based on observations rather than controlled studies and a lot of the results are in conflict. In addition, most studies limit their analysis to live births, which could underestimate severe teratogenic effects that cause abortion or termination of the pregnancy. The study that is discussed in this journal club addresses these issues by examining data on both live and deceased births.
Conclusion Some studies have shown a positive correlation between ADHD medications and certain birth defects, other studies have not established a link. Most studies show an unintended, or slightly negative, effect. In the end, a careful risk/benefit analysis is required in every instance.
It can be challenging, if not impossible for women suffering from ADHD to stop taking their medication. In fact, in an article recently published in Archives of Women's Mental Health psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can increase depression, feelings of isolation and family conflict for these patients. In addition, a decrease in medication can affect the ability to do work-related tasks and safely drive that are crucial aspects of daily life for many people suffering from ADHD.
She suggests that women who aren't sure whether to take the medication or discontinue it due to pregnancy, educate their family members, coworkers and acquaintances about the condition, the effects on daily functioning, and the benefits of keeping the current treatment plan. It can also aid in ensuring that the woman feels supported as she struggles with her decision. It is also worth noting that some medications can be absorbed through the placenta so if the patient decides to discontinue her ADHD medication during pregnancy and breastfeeding, she must be aware that the effects of the medication could be transferred to the child.
Risk of Birth Defects
As the use of ADHD medications to treat symptoms of attention deficit hyperactivity disorder (ADHD) grows there are concerns about what impact the drugs could have on foetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge regarding this topic. Researchers utilized two massive data sets to study more than 4.3 million pregnancy and determine if stimulant medication use increased the risk of birth defects. Researchers discovered that, while the overall risk is low, the first trimester ADHD exposure to medication was associated with slightly higher risk of specific heart defects like ventriculoseptal defects.
The researchers of the study found no link between early medication use and other congenital anomalies, like facial clefting, or club foot. The results are in agreement with previous studies that have shown the existence of a slight, but significant increase in cardiac malformations for women who began taking ADHD medication prior to the time of the time of pregnancy. This risk increased in the later part of pregnancy, as many women begin to discontinue their ADHD medication.
Women who used ADHD medication in the first trimester of pregnancy were also more likely to undergo a caesarean section, a low Apgar score following delivery, and a baby who required help breathing at birth. However the authors of the study were unable to eliminate selection bias by limiting the study to women who didn't have any other medical issues that could be a contributing factor to these findings.
Researchers hope that their study will help doctors when they meet pregnant women. They suggest that although the discussion of the benefits and risks is important but the decision to stop or maintain treatment 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 alternative, it is not an option to consider due to the high incidence of depression and other mental health issues in women who are pregnant or post-partum. Further, the research suggests that women who choose to stop taking their medication are more likely to experience difficulties adjusting to life without them following the birth of their baby.
Nursing
It can be overwhelming to become a mom. Women who suffer from ADHD who have to deal with their symptoms while attending doctor appointments and preparing for the arrival of a child and getting used to new routines at home are often faced with a number of difficulties. As such, many women decide to continue taking their ADHD medications throughout the course of pregnancy.
The risk to breastfeeding infant is not too high since the majority of stimulant medications is absorbed through breast milk in low amounts. The rate of medication exposure can vary depending upon the dosage, frequency of administration and the time of the day. Additionally, different medications are introduced into 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 known.
Some physicians may discontinue stimulant medications during a woman's pregnancy due to the absence of research. This is a difficult choice for the patient, who must weigh the benefits of continuing her medication against the potential risks to the embryo. As long as there is no more information, GPs should ask all pregnant patients about their experience with ADHD and whether they are taking or planning to take medication during the perinatal period.
Many studies have shown that women can continue taking their ADHD medication in a safe manner while breastfeeding and during pregnancy. As a result, many patients opt to do this, and in consultation with their physician, they have discovered that the benefits of maintaining their current medication far outweigh any potential risks.
It's important for women with ADHD who are contemplating breastfeeding to seek a specialist psychiatrist's advice prior becoming pregnant. They should discuss the medication they are taking with their physician as well as the pros and cons of continuing treatment. This includes non-pharmacological methods. Psychoeducation is also necessary to help pregnant women with ADHD recognize the signs and the underlying disorder. adhd and medication should also learn about treatment options and strengthen coping mechanisms. This should be a multidisciplinary approach together with obstetricians, GPs, and psychiatrists. Pregnancy counselling should include discussion of a management plan for both mother and child, and monitoring for signs of deterioration and when necessary, making adjustments to the medication regimen.