ADHD Medication During Pregnancy and Breastfeeding
Women suffering from ADHD have to make a difficult choice about whether to continue or stop taking ADHD medication during pregnancy and breast-feeding. Little data exists about how long-term exposure to these medications may affect the foetus.
A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication in utero do not develop neurological developmental conditions like hearing loss or impaired vision, febrile seizures, or IQ impairment. The authors acknowledge that further high-quality studies are needed.
Risk/Benefit Analysis
Women who are pregnant and take ADHD medication must consider the benefits of taking it against the potential risks for the baby. Doctors don't have enough data to make unambiguous recommendations, but can provide information about risks and benefits to assist pregnant women to make informed choices.
A study published in Molecular Psychiatry found that women who took ADHD medications during their early pregnancy did not face a significantly increased risk of fetal cardiac malformations or major birth defects that are structural. Researchers conducted a massive sample-based case control study to compare the incidence of major structural defects in infants born to mothers who were taking stimulants during pregnancy. Pediatric cardiologists and clinical geneticists reviewed the cases to ensure correct case classification and to minimize the chance of bias.
The research conducted by the researchers was not without its limitations. The researchers were unable to, in the first place, to separate the effects of the medication from the disorder. This makes it difficult for researchers to establish whether the few associations observed between the exposed groups were due to the use of medications or affected by comorbidities. Researchers also did not look at long-term outcomes for the offspring.
The study did find that infants whose mothers took ADHD medications during pregnancy were at slightly more risk of being admitted to the neonatal intensive care unit (NICU) than infants whose mothers had not taken any medication or had stopped their medications before or during pregnancy. This was due to central nervous system disorders, and the increased risk for admission did not appear to be influenced by the stimulant medications were taken during pregnancy.
Women who took stimulant ADHD medications during pregnancy also had a higher likelihood of having an emergency caesarean section or having one whose baby scored low on the Apgar scale (less than 7). These increases appeared to be independent of the type of medication taken during pregnancy.
The researchers suggest that the small risk associated with the use of ADHD medications during the early stages of pregnancy may be offset by the greater 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 they are able, 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.
Medication Interactions
As more women than ever before are being diagnosed with ADHD and being treated with medication, the question of whether to continue or discontinue treatment during pregnancy is a question that more and more doctors confront. These decisions are frequently taken without clear and authoritative evidence. Instead, physicians must weigh their own knowledge and experience, as well as the experiences of other doctors and the research that has been conducted on the subject.
Particularly, the subject of potential risks to the baby can be a challenge. A lot of studies on this subject are based on observational data rather than controlled research, and their conclusions are often contradictory. In addition, most studies limit their analysis to live births, which may underestimate severe teratogenic effects that result in abortion or termination of the pregnancy. most effective adhd medication for adults that is discussed in the journal club addresses these shortcomings, by examining both information on deceased and live births.
The conclusion The conclusion: While some studies have found an association between ADHD medications and the possibility of certain birth defects, others have found no such relationship, and most studies have a neutral or slightly negative effect. In the end an accurate risk-benefit analysis must be done in each case.
It isn't easy, but not impossible, for women with 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 lead to increased depression, feelings of loneliness and family conflict for these patients. Furthermore, a loss of medication can interfere with the ability to do work-related tasks and safely drive that are crucial aspects of daily life for many people with ADHD.
She suggests that women who are unsure whether to take the medication or discontinue it due to pregnancy should educate family members, coworkers, and their friends about the condition, its impact on daily functioning and the benefits of keeping the current treatment. Educating them can also aid in ensuring that the woman feels supported in her struggle with her decision. It is also worth noting that some medications are able to pass through the placenta, so if a woman decides to stop taking her ADHD medication during pregnancy and breastfeeding, she should be aware that traces of the drug could be passed on to the baby.
Birth Defects and Risk of
As the use and abuse of ADHD drugs to treat symptoms of attention deficit disorder hyperactivity disorder (ADHD), increases the concern over the potential effects of these drugs on the fetuses. Recent research published in the journal Molecular Psychiatry has added to the body knowledge on this issue. Researchers utilized two massive data sets to examine more than 4.3 million pregnancies and determine if stimulant medication use caused birth defects. While the overall risk remains low, the researchers did find that first-trimester exposure to ADHD medicines was associated with an increased risk of certain heart defects, like ventriculo-septal defects (VSD).
The researchers of the study didn't discover any link between the use of early medications and congenital anomalies such as facial deformities or club feet. The results are in the same vein as previous studies that showed a small, but significant increase in the number of cardiac malformations among women who started taking ADHD medication prior to the time of the birth of their child. The risk increased in the latter half of pregnancy when many women stopped taking their medication.
Women who used ADHD medications during the first trimester of their pregnancies were also more likely to undergo caesarean sections, a low Apgar score after delivery and a baby who required help breathing at birth. However the researchers of the study were not able to eliminate bias due to selection by restricting the study to women who did not have any other medical issues that could have contributed to the findings.
Researchers hope that their research will inform physicians when they see pregnant women. The researchers advise that while discussing risks and benefits are important, the choice about whether to continue or stop medication should be according to the severity of each woman's ADHD symptoms and the needs of the woman.
The authors also warn that while discontinuing the medications is an option, it is not an option to consider due to the high rate of depression and other mental health problems for women who are expecting or recently postpartum. Furthermore, research suggests that women who choose to stop taking their medication are more likely to experience a difficult time adjusting to life without them after the baby's arrival.
Nursing
It can be overwhelming becoming a mother. Women who suffer from ADHD are often faced with a number of difficulties when they have to manage their symptoms, attend doctor appointments and prepare for the birth of their child and adjust to new routines. Many women choose to continue taking their ADHD medication during pregnancy.
The majority of stimulant medicines are absorbed by breast milk in very small quantities, so the risk to the nursing infant is very low. However, the rate of exposure to medications by the newborn may differ based on dosage, frequency it is administered and the time of the day it is administered. Additionally, different medications enter the infant's system differently through the gastrointestinal tract and breast milk and the impact of this on a newborn is not fully understood.
Some physicians may discontinue stimulant medications during a woman's pregnancy due to the lack of research. This is a complicated decision for the patient, who must weigh the benefit of continuing her medication against the potential risks to the foetus. As long as more information is available, doctors can inquire about pregnant patients if they have any history of ADHD or if they plan to take medication during the perinatal period.
Numerous studies have demonstrated that women can continue taking their ADHD medication safely during pregnancy and breast-feeding. As a result, more and more patients are choosing to do so and, in consultation with their doctor they have discovered that the benefits of maintaining their current medication far outweigh any potential risks.
It is essential for women with ADHD who are thinking of breastfeeding to seek a specialist psychiatrist's advice prior becoming pregnant. They should discuss their medication with their doctor and discuss the pros and cons of continued treatment, including non-pharmacological strategies. Psychoeducation is also necessary to help pregnant women suffering from ADHD recognize the signs and underlying disorder. They should also learn about treatment options and build the coping mechanisms. This should be a multidisciplinary approach including obstetricians, GPs, and psychiatrists. Pregnancy counseling should include a discussion of a treatment plan for the mother and the child, as well as monitoring for signs of deterioration and, if needed modifications to the medication regime.