ADHD Medication During Pregnancy and Breastfeeding
The decision to stop or continue ADHD medication during pregnancy and nursing is a challenge for women suffering from the condition. There aren't many studies on how long-term exposure may affect a pregnant fetus.
A recent study 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 further high-quality studies are needed.
Risk/Benefit Analysis
Women who are pregnant and take ADHD medication need to evaluate the benefits of using it against the potential dangers for the foetus. The doctors don't have the information to make unambiguous recommendations but they can provide information about risks and benefits to help pregnant women make informed decisions.
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. Researchers conducted 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 the early stages of pregnancy, as well as those who had not. Clinical geneticists, pediatric cardiologists and other experts looked over the cases to confirm that the classification was accurate and to minimize any bias.
The study conducted by the researchers was not without limitations. Researchers were unable to, in the first place, to separate the effects caused by the medication from the disorder. This makes it difficult for researchers to establish whether the few associations observed between the groups exposed were due to the use of medications or affected by the presence of comorbidities. In addition the study did not study the long-term outcomes of offspring.
The study did find that infants whose mothers took ADHD medications during pregnancy were at slightly greater risk of being admitted to the neonatal intensive care unit (NICU) than those whose mothers had not taken any medication or stopped their medications before or during pregnancy. This increase was caused by central nervous system disorders. The higher risk of admission was not affected by the stimulant medications used during pregnancy.
Women who took stimulant ADHD medication during pregnancy also had an elevated chance of having a caesarean section or having a child with an low Apgar score (less than 7). These increases appeared to be independent of the type of medication taken during pregnancy.
The research suggests that the low risk associated with the use of ADHD medications during early pregnancy could be offset by the greater benefit for both mother and child of continuing treatment for the woman's condition. Doctors should discuss with their patients about this and as much as possible, assist them develop coping skills that may reduce the effects of her disorder on her daily life and relationships.
Medication Interactions
As more women than ever are diagnosed with ADHD and being treated with medication, the issue of whether to keep or discontinue treatment during pregnancy is one that more and more doctors face. These decisions are frequently taken without clear and authoritative evidence. Instead, doctors must weigh their own knowledge, the experience of other doctors, and the research on the subject.
The issue of possible risks to infants is difficult to determine. Many studies on this subject are based on observations rather than controlled research and their conclusions are often contradictory. The majority of studies limit their analysis to live births, which may underestimate the teratogenic impact which can cause terminations or abortions of pregnancy. The study presented in the journal club addresses these shortcomings by analyzing both information on deceased and live births.
Conclusion Some studies have found a positive correlation between ADHD medications and certain birth defects however, other studies haven't found a correlation. Most studies show that there is a neutral, or slight negative impact. In every case it is imperative to conduct a thorough evaluation of the risks and benefits should be conducted.
It can be challenging, if not impossible for women with ADHD to stop taking their medication. In fact, in a recent article in the Archives of Women's Mental Health, psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can cause depression, feelings of isolation and family conflict for patients with ADHD. A decrease in medication could also impact the ability to drive safely and to perform work-related tasks which are vital aspects of everyday life for those with ADHD.
She suggests that women who are unsure whether to continue taking medication or stop it due to their pregnancy educate family members, coworkers and friends about the condition, its impact on daily functioning and the benefits of continuing the current treatment plan. Educating them can also make the woman feel more comfortable as she struggles with her decision. It is also worth noting that some drugs can pass through the placenta, therefore, if a patient decides to discontinue her ADHD medication during pregnancy and breastfeeding, she should be aware of the possibility that traces of the drug could be transferred to the infant.
Birth Defects and Risk of
As the use and misuse of ADHD medication to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases the concern over the possible effects of the drugs on fetuses. A recent study published in the journal Molecular Psychiatry adds to the existing knowledge on this subject. Using two massive data sets, researchers were able to analyze more than 4.3 million pregnancies and determine whether stimulant medications increased the risk of birth defects. Although the risk overall is low, the researchers found that exposure in the first trimester to ADHD medicines was associated with an increase in the risk of specific heart defects, such as ventriculo-septal defect (VSD).
The researchers behind the study found no link between early use of medication and other congenital abnormalities, like facial clefting, or club foot. medication for add adults are in line with previous studies that have shown an increase, but not significant, in the risk of cardiac malformations among women who began taking ADHD medications before pregnancy. The risk was higher in the latter half of pregnancy, as many women are forced to stop taking their ADHD medication.
Women who took ADHD medications in the first trimester of pregnancy were also more likely to undergo a caesarean section, a low Apgar score following delivery, and a baby that required help breathing at birth. However, the authors of the study were unable to eliminate bias due to selection by restricting the study to women who did not have any other medical conditions that could have contributed to the findings.
Researchers hope that their research will provide doctors with information when they see pregnant women. They recommend that, while discussing the risks and benefits is crucial however, the decision to stop or maintain medication should be based on the woman's requirements and the severity of her ADHD symptoms.
The authors warn that, while stopping the medication is a possibility to think about, it isn't recommended due to the high prevalence of depression and mental health issues in women who are expecting or recently gave birth. Additionally, research suggests that women who stop taking their medications will have a tough transitioning to life without them once the baby is born.
Nursing
The responsibilities of being a new mother can be overwhelming. Women suffering from ADHD are often faced with a number of difficulties when they must manage their symptoms, go to doctor appointments and prepare for the birth of a baby and adjust to new routines. Therefore, many women elect to continue taking their ADHD medication throughout the pregnancy.
The majority of stimulant medications are absorbed through breast milk in small amounts, so the risk to nursing infant is very low. The rate of medication exposure will vary based on the dosage the medication is administered, its frequency and the time of day. In addition, different drugs enter the infant's system through the gastrointestinal tract, or through breast milk. The effect on the health of a newborn isn't completely known.
Some doctors may decide to stop stimulant medication during a woman's pregnancy due to the lack of research. This is a difficult decision for the patient, who must weigh the benefit of continuing her medication with the potential dangers to the fetus. As long as more information is available, doctors may inquire about pregnant patients whether they have an background of ADHD or if they intend to take medication in the perinatal period.
A increasing number of studies have proven that the majority of women are able to safely continue to take their ADHD medication during pregnancy and breastfeeding. In the end, an increasing number of patients choose to do so and in consultation with their doctor they have discovered that the benefits of maintaining their current medication outweigh any risks.
It is essential for women with ADHD who are contemplating breastfeeding to seek out a specialist psychiatrist's advice prior to becoming pregnant. They should discuss their medication with their prescriber and discuss the pros and cons of continued treatment, including non-pharmacological management strategies. Psychoeducation is also needed to help pregnant women with ADHD recognize the signs and the underlying disorder. They should also be informed about treatment options and strengthen coping mechanisms. This should be a multidisciplinary effort together with obstetricians, GPs and psychiatrists. Pregnancy counselling should include the discussion of a plan for management for both the mother and child, monitoring for signs of deterioration and, if necessary, adjustments to the medication regimen.