ADHD Medication During Pregnancy and Breastfeeding
The choice of whether to stop or continue ADHD medications during breastfeeding and pregnancy is challenging for women with the condition. There is a lack of information about how long-term exposure to these medications can affect the foetus.
A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological problems like hearing loss or vision, febrile seizures, or IQ impairment. The authors acknowledge that more high-quality research is needed.
Risk/Benefit Analysis
Women who are pregnant and taking ADHD medication need to consider the benefits of taking it against the possible risks to the fetus. Physicians don't have the data to give clear advice but they can provide information on risks and benefits to aid pregnant women in making an informed decision.
A study published in Molecular Psychiatry concluded that women who were taking ADHD medication in early pregnancy were not at a greater risk of fetal malformations, or structural birth defects. Researchers used a large population-based study of case control to compare the incidence of structural defects that were major in infants who were born to mothers who took stimulants during pregnancy. Pediatric cardiologists, clinical geneticists and other experts reviewed the cases in order to ensure that the classification was correct and to reduce any bias.
The study of the researchers was not without its limitations. The most important issue was that they were not able to differentiate the effects of the medication from the effects of the disorder that is underlying. This makes it difficult for researchers to determine if the few associations observed between the groups exposed were due to the use of medication, or if they were affected by the presence of comorbidities. Researchers also did not look at long-term outcomes for offspring.
The study found that infants whose mother took ADHD medication during pregnancy had a higher chance of being admitted to the neonatal care unit (NICU) in comparison to mothers who didn't take any medication during pregnancy or quit taking the medication prior to 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 taken during pregnancy.
Women who were taking stimulant ADHD medications during pregnancy also had a higher chance of having to have an emergency caesarean section or having the baby was not scoring well on the Apgar scale (less than 7). These increases appear to be unrelated to the type of medication taken during pregnancy.
The research suggests that the small risk associated with the use of ADHD medications during the early stages of pregnancy may be offset by the greater benefits to both mother and child of 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 that can lessen the impact of her disorder on her daily life and relationships.
Medication Interactions
Doctors are increasingly faced with the decision of whether to maintain treatment or stop it during pregnancy as more women are diagnosed with ADHD. The majority of these decisions are made in the absence of clear and authoritative evidence in either case, which means that doctors must weigh their knowledge, the experiences of other doctors, and what the research suggests about the subject as well as their own best judgment for each patient.
The issue of risk for infants can be extremely difficult. The research on this subject is based on observations instead of controlled studies and many of the findings are conflicting. In addition, most studies limit their analysis to live births, which could underestimate severe teratogenic effects that result in abortion or termination of the pregnancy. The study presented in the journal club addresses these shortcomings by analyzing both the data from deceased and live births.
The conclusion is that while some studies have shown an association between ADHD medications and the risk of certain birth defects, other studies have found no such relationship, and most studies have a neutral or slight negative effect. As a result an accurate risk-benefit analysis must be done in each situation.
For women suffering from ADHD, the decision to discontinue medication is difficult, if not impossible. In a recent article published in the Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can cause depression and feelings of being isolated. In addition, a decrease in medication can affect the ability to complete job-related tasks and drive safely that are crucial aspects of daily life for many people suffering from ADHD.
She recommends women who are uncertain about whether to continue or stop taking medication because of their pregnancy, consider educating family members, friends, and coworkers on the condition, its impact on daily functioning, and on the benefits of keeping the current treatment plan. It can also help women feel more confident in her decision. It is also worth noting 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 get more info possibility that traces of the medication could be transferred to the child.
Birth Defects and Risk of
As the use of ADHD medication to treat the 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 on this topic. Researchers used two huge data sets to examine more than 4.3 million pregnancy and determine whether stimulant medications caused birth defects. Researchers discovered that, while the risk overall is low, the first trimester ADHD medication use was associated with slightly higher rates of specific heart defects like ventriculoseptal defect.
The researchers of the study found no association between early medication use and other congenital abnormalities, such as facial clefting or club foot. The results are in agreement with previous studies that showed the existence of a slight, but significant increase in cardiac malformations for women who started taking ADHD medication prior to pregnancy. The risk increased in the latter part of pregnancy when many women decided to stop taking their medication.
Women who took ADHD medications in the first trimester of their pregnancy were also more likely to undergo a caesarean section, a low Apgar score after delivery and a baby who required breathing assistance during birth. However the researchers of the study were not able to eliminate bias due to selection by restricting 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 provide doctors with information when they meet pregnant women. The researchers suggest that, while discussing the risks and benefits are crucial, the decision regarding whether or not to stop medication should be in light of the severity of each woman's ADHD symptoms and her requirements.
The authors also advise that while discontinuing the medications is an option, it is not an option that is recommended due to the high incidence of depression and other mental health problems among women who are pregnant or recently postpartum. Further, the research suggests that women who decide to stop taking their medications are more likely to experience difficulties adjusting to life without them following the baby's arrival.
Nursing
It can be a stressful experience to become a mother. Women who suffer from ADHD who must work through their symptoms while attending doctor appointments, getting ready for the arrival of a child and getting used to new routines at home can experience severe challenges. As such, many women elect to continue taking their ADHD medications throughout the course of pregnancy.
The majority of stimulant medicines are absorbed through breast milk in very small amounts, therefore the risk to breastfeeding infant is minimal. The amount of exposure to medications will vary based on the dosage the medication is administered, its frequency and time of day. In addition, different drugs enter the infant's system via the gastrointestinal tract, or through breast milk. The effect on a newborn's health is not completely comprehended.
Some physicians may discontinue stimulant medication during a woman's pregnancy due to the lack of research. This is a difficult decision for the mother, who must weigh the advantages of her medication against the risks to the foetus. In the meantime, until more information is available, doctors should ask all pregnant patients about their history of ADHD and whether they are planning or taking to take medication during the perinatal period.
A growing number of studies have proven that most women can safely continue taking their ADHD medication while they are pregnant and nursing. As a result, an increasing number of patients choose to do so and, in consultation with their physician, they have discovered that the benefits of continuing their current medication outweigh any potential risks.
It's important for women with ADHD who are considering breastfeeding to seek a specialist psychiatrist's advice prior to becoming pregnant. They should review their medications with their prescriber and discuss the advantages and disadvantages of continued treatment, including non-pharmacological management strategies. Psychoeducation is also required to help pregnant women with ADHD be aware of the symptoms and the underlying disorder. They should also learn about treatment options and reinforce the coping mechanisms. This should include a multidisciplinary approach, which includes the GP, obstetricians and psychiatry. Pregnancy counseling should consist of a discussion of a treatment plan for the mother as well as the child, and monitoring for signs of deterioration, and, if needed adjustments to the medication regime.