ADHD Medication During Pregnancy and Breastfeeding
The decision to stop or continue ADHD medications during breastfeeding and pregnancy is a difficult decision for women suffering from the condition. There isn't much information on how long-term exposure to these drugs may affect the foetus.
A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus do not develop neurological developmental conditions 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 take ADHD medication need to consider the benefits of taking it against the potential dangers for the fetus. Physicians don't have the data to provide clear recommendations, but can provide information on the 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 early pregnancy did not face a significantly increased risk of fetal cardiac malformations or major structural birth defects. Researchers used a large sample-based case control study to examine the prevalence of major structural defects in infants who were born to mothers who were taking stimulants during pregnancy. Clinical geneticists, pediatric cardiologists and other experts examined the cases to ensure that the classification was accurate and to minimize any bias.
However, the researchers' study had its limitations. The researchers were unable in the beginning, to separate the effects of the medication from the disorder. This limitation makes it difficult for researchers to determine if the small differences observed between the exposed groups were due to the use of medications, or if they were affected by the presence of comorbidities. Additionally, the researchers did not examine long-term offspring outcomes.
The study did find that infants whose mothers took ADHD medications during pregnancy were at a 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 of admission was not found to be influenced by the stimulant medications were used during pregnancy.
Women who were taking stimulant ADHD medication during pregnancy also had an elevated risk of having a caesarean section or having a baby born with an low Apgar score (less than 7). These increases appear to be independent of the type of medication taken during pregnancy.
The research suggests that the small risk associated with the use of ADHD medications during early pregnancy may be offset by the greater benefit to both mother and child from continued treatment for the woman's condition. Physicians should discuss this with their patients and, when possible, help them develop strategies to improve coping skills which can reduce the impact of her disorder on her daily functioning and relationships.
Medication Interactions
More and more doctors are faced with the decision of whether to keep treatment or stop during pregnancy as more women are diagnosed with ADHD. These decisions are frequently made without clear and reliable evidence. Instead, doctors have to consider their own expertise, the experience of other doctors, and the research on the subject.
In particular, the issue of possible risks to the baby can be a challenge. A lot of studies on this subject are based on observational data instead of controlled research and their conclusions are often contradictory. In addition, most studies limit their analysis to live births, which may undervalue the serious teratogenic effects that can lead to abortion or termination of the pregnancy. The study discussed in the journal club addresses these shortcomings, by examining both information on deceased and live births.
Conclusion: While some studies have shown an association between ADHD medications and certain birth defects however, other studies haven't established a link. Most studies have shown an unintended, or slightly negative, effect. In all cases it is imperative to conduct a thorough analysis of the risks and benefits must be performed.
For a lot of women with ADHD, the decision to discontinue medication is difficult if not impossible. In adult attention deficit hyperactivity disorder medication in Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can lead to depression and feelings of being isolated. The loss of medication can also affect the ability to drive safely and perform work-related tasks, which are essential aspects of everyday life for those with ADHD.
She suggests that women who aren't sure whether to continue taking medication or stop it due to their pregnancy should educate family members, colleagues, and their friends about the condition, the impact on daily functioning and the benefits of continuing the current treatment plan. In addition, educating them can help the woman feel supported in her struggle with her decision. It is important to remember that some medications are able to pass through the placenta so if a woman decides to stop her ADHD medication during pregnancy and breastfeeding, she must be aware of the possibility that traces of the drug could be passed on to the baby.
Birth Defects and Risk of
As the use of ADHD medication to treat the symptoms of attention deficit hyperactivity disorder (ADHD) increases there are concerns about the effects that the medications could have on the fetuses. A recent study published in the journal Molecular Psychiatry adds to the body of knowledge on this subject. Researchers utilized two massive data sets to study more than 4.3 million pregnancies and determine if the use of stimulant medications increased the risk of birth defects. Researchers found that while the risk overall is low, the first trimester ADHD exposure to medication was associated with slightly higher risk of specific heart defects like ventriculoseptal defect.
The authors of the study found no link between early use of medication and other congenital abnormalities, like facial clefting, or club foot. The results are in line with previous studies that have shown an insignificant, but small increase in the number of cardiac malformations among women who started taking ADHD medication prior to pregnancy. This risk increased during the latter part of pregnancy when many women began to stop taking their medication.
Women who were taking ADHD medication during the first trimester were more likely to require a caesarean delivery and also have an insufficient Apgar after delivery and have a baby that needed help breathing when they were born. However, the authors of the study were not able to eliminate bias due to selection by restricting the study to women who did not have other medical issues that could have contributed to the findings.
Researchers hope that their research will inform physicians when they encounter pregnant women. The researchers advise that, while discussing risks and benefits are crucial, the decision on whether to continue or stop medication should be made based on the severity of each woman's ADHD symptoms and the needs of the woman.
The authors warn that, even though stopping the medication is an option to consider, it is not advised because of the high incidence of depression and mental health issues among women who are pregnant or have recently given birth. Additionally, research suggests that women who stop taking their medication will have a tough adjustment to life without them after the baby is born.
Nursing
It can be a challenge to become a mother. Women who suffer from ADHD can face severe challenges when they must manage their symptoms, go to doctor appointments, prepare for the birth of a child and adjust to new routines. Many women opt to continue taking their ADHD medication during pregnancy.
The risk to a nursing infant is low because the majority of stimulant medications passes through breast milk at low levels. The rate of medication exposure will vary based on the dosage the medication is administered, its frequency and the time of the day. In addition, different medications are introduced into the baby's system through the gastrointestinal tract, or through breast milk. The effect on the health of a newborn is not fully comprehended.
Some physicians may discontinue stimulant medications during a woman's pregnancy due to the lack of research. It is a difficult decision for the mother, who must weigh the benefits of her medication against the risk to the fetus. As long as more information is available, GPs can ask pregnant patients if they have a background of ADHD or if they are planning to take medication during the perinatal period.
Many studies have shown that women can continue to take their ADHD medication in a safe manner during pregnancy and while breast-feeding. As a result, more and more patients choose to do so, and in consultation with their physician, they have discovered that the benefits of keeping their current medication far outweigh any risks.
Women who suffer from ADHD who are planning to breastfeed should seek the advice of a specialist psychiatrist before becoming pregnant. They should review their medications with their doctor and discuss the advantages and disadvantages of continuing treatment, including non-pharmacological strategies. Psychoeducation is also needed to help pregnant women suffering from ADHD understand the symptoms and the underlying disorder. They should also be educated about treatment options and reinforce strategies for coping. This should be a multidisciplinary process including obstetricians, GPs, and psychiatry. Pregnancy counseling should include a discussion of a treatment plan for the mother and the child, and monitoring for signs of deterioration and, if necessary, adjustments to the medication regime.