ADHD Medication During Pregnancy and Breastfeeding
Women with ADHD have to make a difficult choice on whether to keep or stop taking ADHD medication during pregnancy and breastfeeding. Little data exists about how long-term exposure to these medications could affect the fetus.
A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus don't develop neurological disorders like hearing or vision impairment, febrile seizures, or IQ impairment. The authors acknowledge the need for higher-quality research.
Risk/Benefit Analysis
Women who are pregnant and taking ADHD medications must weigh the advantages of using them against the risks to the fetus. The doctors don't have the information to give clear advice however they can provide information on the risks and benefits to aid pregnant women in making informed decisions.
A study published in Molecular Psychiatry found that women who were taking ADHD medications during their early pregnancy did not have an increased risk of fetal cardiac 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 infants born to mothers who had taken stimulants during early pregnancy, as well as those who had not. Clinical geneticists and pediatric cardiologists examined the cases to ensure correct case classification and to minimize the chance 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 that is underlying. This makes it difficult for researchers to determine whether the small differences observed between the exposed groups were due to the use of medications or caused by the presence of comorbidities. The researchers did not study the long-term effects for the offspring.
The study showed that infants whose mother took ADHD medication during pregnancy were at a slightly greater risk of being admitted to the neonatal care unit (NICU) in comparison to mothers who didn't take any medication during pregnancy or had discontinued taking their medication prior to or during pregnancy. This was due to central nervous system disorders. The higher risk of admission was not influenced by the stimulant medications used during pregnancy.
Women who used stimulant ADHD medication during pregnancy also had an elevated risk of having a caesarean delivery or having a child with an low Apgar score (less than 7). These increases didn't appear to be affected 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 could be offset by the higher benefit to both the mother and child of continued treatment for the woman's condition. Physicians should discuss this with their patients and, when possible, assist them in developing strategies for improving their coping skills that can lessen the negative impact of her condition on her daily functioning and relationships.
Interactions with Medication
As more women than ever are being diagnosed with ADHD and being treated with medication, the issue of whether to keep or end treatment during pregnancy is one that more and more doctors face. adhd and medication are usually taken without clear and authoritative evidence. Instead, doctors have to consider their own expertise, the experience of other doctors and the research that has been conducted on the subject.
The issue of possible risks to the infant can be difficult to determine. The research that has been conducted on this topic is based on observations rather than controlled studies and the results are contradictory. Additionally, the majority of studies limit their analysis to live births, which can underestimate severe teratogenic effects that lead to abortion or termination of the pregnancy. The study discussed in the journal club addresses these issues by analyzing both the data from deceased and live births.
Conclusion Some studies have shown an association between ADHD medications and certain birth defects However, other studies haven't shown such a relationship. The majority of studies show an unintended, or slightly negative, impact. In the end, a careful risk/benefit assessment must be done in each situation.
For many women with ADHD and ADD, the decision to stop medication is difficult if not impossible. In a recent piece published in Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can increase depression and feelings of isolation. Furthermore, a loss of medication may affect the ability to do work-related tasks and safely drive that are crucial aspects of a normal life for many people with ADHD.
She suggests women who are unsure about whether to keep or discontinue medication due to their pregnancy should consider educating family members, friends, and coworkers on the condition, its effects on daily functioning, and the advantages of staying on the current treatment regimen. It will also help a woman feel more confident in her decision. Some medications can pass through the placenta. If the patient decides to stop taking her ADHD medication while breastfeeding, it's important to be aware that the medication could be transferred to the infant.
Risk of Birth Defects
As the use and use of ADHD medication to treat symptoms of attention deficit disorder hyperactivity disorder (ADHD) is increasing as does the concern about the potential effects of these drugs on foetuses. A study that was published in the journal Molecular Psychiatry adds to the body of information on this topic. Using two massive data sets researchers were able to look at more than 4.3 million pregnancies and see whether the use of stimulant medications increased the risk of birth defects. Although the risk overall remains low, the researchers discovered that the first-trimester exposure to ADHD medicines was associated with a slightly higher rate of certain heart defects, such as ventriculoseptal defect (VSD).
The researchers of the study found no association between early use of medication and other congenital anomalies, like facial clefting, or club foot. The results are in line with previous studies that have shown an increase, but not significant, in the risk of heart malformations among women who began taking ADHD medications prior to pregnancy. The risk was higher in the later part of pregnancy, when many women begin to discontinue their medication.
Women who took ADHD medications during the first trimester of their pregnancies were also more likely to have a caesarean section, a 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 selection bias by limiting the study to women who didn't have any other medical conditions that could be a contributing factor to these findings.
Researchers hope their research will provide doctors with information when they see pregnant women. They advise that while the discussion of the risks and benefits is crucial however, the decision to stop or keep treatment should be based on each woman's needs and the severity of her ADHD symptoms.
The authors caution that, while stopping the medication is an option to think about, it isn't recommended due to the high prevalence of depression and mental health issues for women who are pregnant or have recently given birth. Further, research shows that women who stop taking their medication will have a tough time adjusting to a life without them once the baby is born.
Nursing
It can be a stressful experience becoming a mother. Women with ADHD can face severe challenges when they must deal with their symptoms, go to doctor appointments and prepare for the birth of their child and adjust to a new routine. Many women choose to continue taking their ADHD medication during pregnancy.
The risk for breastfeeding infant is minimal because the majority of stimulant medications is absorbed through breast milk at low levels. However, the amount of medication exposure to the newborn can vary depending on the dosage, frequency it is administered and the time of day it is administered. In addition, individual medications enter the infant's system differently through the gastrointestinal tract and breast milk, and the effect of this on a newborn infant is not well known.
Due to the absence of research, some physicians may recommend stopping stimulant medications during the pregnancy of a woman. This is a complicated decision for the patient, who must balance the benefit of continuing her medication against the possible dangers to the fetus. In the meantime, until more information is available, doctors can inquire about pregnant patients whether they have a background of ADHD or if they plan to take medication during the perinatal period.
A growing number of studies have shown that most women can safely continue their ADHD medication during pregnancy and breastfeeding. This has led to more and more patients choose to do so, and in consultation with their physician, they have discovered that the benefits of continuing their current medication far outweigh any risks.
It is crucial for women suffering from ADHD who are thinking of breastfeeding to seek a specialist psychiatrist's advice prior becoming pregnant. They should discuss their medication with their physician and discuss the advantages and disadvantages of continuing treatment, including non-pharmacological management strategies. Psychoeducation should also be provided to help women with ADHD recognize their symptoms and underlying disorder, learn about available treatments and to reinforce existing strategies for coping. This should be a multidisciplinary effort with the GPs, obstetricians and psychiatry. The pregnancy counselling should consist of discussion of a management plan for both the mother as well as the child, monitoring for signs of deterioration and, if necessary, adjustments to the medication regimen.