ADHD Medication During Pregnancy and Breastfeeding
The decision to stop or continue ADHD medication during breastfeeding and pregnancy is a challenge for women suffering from the condition. There is a lack of information about how long-term exposure to these drugs can affect the foetus.
A recent study published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological disorders such as hearing loss or vision, febrile seizures or IQ impairment. The authors acknowledge that more high-quality research is needed.
Risk/Benefit Analysis
Pregnant women who use ADHD medications need to balance the benefits of taking them against potential risks to the fetus. Doctors don't have the information needed to give clear guidelines however they can provide information regarding the risks and benefits to help pregnant women make informed choices.
A study published in Molecular Psychiatry concluded that women who were taking ADHD medication during early pregnancy were not at greater risk of fetal malformations, or structural birth defects. The researchers used a large population-based case-control study to determine the prevalence of major structural birth defects in babies born to mothers who had taken stimulants during the early stages of pregnancy and those who had not. Pediatric cardiologists, clinical geneticists and other experts examined the cases to ensure that the classification was correct and to reduce any bias.
However, the study had its limitations. The researchers were not able to, in the first place to differentiate the effects of the medication from the disorder. That limitation makes it difficult to know whether the small associations observed in the groups that were exposed are due to medication use or the confounding effect of comorbidities. Additionally the study did not study the long-term outcomes of offspring.
The study found that babies whose mothers took ADHD medication during pregnancy had a slightly higher risk of admission to the neonatal care unit (NICU) in comparison to those whose mothers did not take any medication during pregnancy, or had discontinued taking their medication prior to or during pregnancy. This increase was caused by central nervous system disorders. The higher risk of admission was not influenced by the stimulant medication that was used during pregnancy.
Women who used stimulant ADHD medication during pregnancy were also at an elevated risk of having a caesarean delivery or having a baby with an low Apgar score (less than 7). These increases did appear to be independent of the type of medication used during pregnancy.
Researchers suggest that the minor risks posed by the use of ADHD medications during early pregnancies could be offset by the greater benefits to both mother and baby from continuing treatment for the woman's condition. Doctors should discuss with their patients about this issue and as much as possible, assist them improve coping skills which could reduce the impact of her disorder in her daily functioning and her relationships.
Medication Interactions
Doctors are increasingly confronted with the dilemma of whether to keep treatment or stop during pregnancy as more women are diagnosed with ADHD. Most of the time, these decisions are taken in the absence of clear and authoritative evidence either way, so physicians must weigh what they know about their experiences, the experiences of other doctors, and what the research suggests about the subject as well as their own judgments for each individual patient.
In particular, the issue of possible risks to the baby can be tricky. The research on this subject is based on observations rather than controlled studies and a lot of the results are contradictory. In addition, most studies limit their analysis to live births, which can undervalue the serious teratogenic effects that can result in abortion or termination of the pregnancy. The study that is discussed in this journal club addresses these issues by analyzing data on live and deceased births.
The conclusion is that while some studies have found that there is a positive correlation between ADHD medications and the risk of certain birth defects, other studies have found no such relationship, and most studies have a neutral or slightly negative effect. In every case it is imperative to conduct a thorough analysis of the potential risks and benefits should be conducted.
It can be challenging, if not impossible for women with ADHD to stop taking their medication. 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 increase depression and feelings of loneliness. The loss of medication can also impact the ability to drive safely and perform work-related tasks, which are essential aspects of daily life for people with ADHD.
She suggests that women who aren't sure whether to take the medication or stop due to pregnancy should educate family members, coworkers and their friends about the condition, its effects on daily functioning, and the advantages of staying on the current treatment. It can also help women feel supported in her decision. Some medications can pass through the placenta. If a woman decides to stop taking her ADHD medication while breastfeeding, it is crucial to be aware that the drug could be transferred to the infant.
Risk of Birth Defects
As the use and abuse of ADHD medications to treat the symptoms of attention deficit hyperactivity disorder (ADHD) increases the concern over the potential effects of these drugs on fetuses. A study that was published in the journal Molecular Psychiatry adds to the existing knowledge on this subject. Utilizing two huge data sets researchers were able to analyze more than 4.3 million pregnancies and see whether the use of stimulant medications increased the risk of birth defects. Researchers discovered that, while the risk overall is low, first-trimester ADHD medication use was associated with slightly higher risk of specific heart defects like ventriculoseptal defect.
The authors of the study found no association between early use of medication and other congenital abnormalities, such as facial clefting or club foot. The findings are in line with previous studies that have shown an increase, but not significant, in the risk of heart malformations in women who started taking ADHD medications before pregnancy. This risk increased during the latter part of pregnancy when a large number of women stopped taking their medication.
medication for adhd adults who used ADHD medications in the first trimester of their pregnancies were also more likely to experience a caesarean section, a low Apgar score following delivery, and a baby that required breathing assistance at birth. However the authors 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.
The researchers hope that their research will serve to inform the clinical decisions of physicians who treat pregnant women. They recommend that, while the discussion of the risks and benefits is crucial, the decision to stop or maintain medication should be based on the woman's requirements and the severity of her ADHD symptoms.
The authors also advise that while discontinuing the medications is an option, it is not an option to consider due to the high prevalence of depression and other mental health issues for women who are expecting or postpartum. Further, research shows that women who stop taking their medications will have a harder transitioning to life without them once the baby is born.
Nursing
It can be overwhelming becoming 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 their child and adjust to new routines. Many women decide to continue taking their ADHD medication during pregnancy.
The majority of stimulant medicines are absorbed by breast milk in low amounts, therefore the risk to infant who is breastfeeding is low. The amount of exposure to medications can vary depending upon the dosage and frequency of administration as well as time of day. Additionally, different medications are introduced into the baby's system via the gastrointestinal tract or breast milk. The impact of these medications on the health of a newborn isn't fully known.
Due to the absence of research, some doctors may be inclined to discontinue stimulant medications during the course of pregnancy. This is a difficult decision for the patient, who must balance the benefits of keeping her medication against the potential dangers to the foetus. Until more information becomes available, doctors may inquire about pregnant patients if they have an background of ADHD or if they are planning to take medication in the perinatal phase.
Numerous studies have proven that women can continue taking their ADHD medication in a safe manner while breastfeeding and during pregnancy. This has led to more and more patients are choosing to do so and, after consulting with their doctor, they have found that the benefits of maintaining their current medication far outweigh any risks.
It is crucial for women suffering from ADHD who are considering breastfeeding to seek out a specialist psychiatrist's advice prior becoming pregnant. They should discuss their medication with their prescriber, and the pros and cons for continuing treatment. This includes non-pharmacological methods. Psychoeducation should also be provided to help women with ADHD understand their symptoms and the root cause Learn about the available treatment options and reinforce existing strategies for managing. This should involve an approach that is multidisciplinary, including the GP, obstetricians and psychiatry. Pregnancy counselling should include the discussion of a plan for management for both the mother as well as the child, monitoring for signs of deterioration and when necessary, making adjustments to the medication regimen.