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. There aren't enough data regarding how exposure over time may affect a foetus.
A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological problems such as 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 taking ADHD medication should evaluate the benefits of using it against the potential risks for the baby. Physicians do not have the information needed to give clear guidelines but they can provide information on risks and benefits that aid pregnant women in making informed decisions.
A study published in Molecular Psychiatry found that women who used ADHD medications during their early pregnancy did not face an increased risk of fetal heart malformations or major birth defects that are structural. The researchers used a large population-based study of case-control to determine the prevalence of major structural birth defects in infants born to mothers who had taken stimulants during early pregnancy, as well as those who had not. Clinical geneticists and pediatric cardiologists reviewed the cases to ensure accurate case classification and to minimize the chance of bias.
However, the researchers' study was not without its flaws. In particular, they were unable to distinguish the effects of the medication from the effects of the underlying disorder. That limitation makes it difficult to determine whether the small associations observed in the groups that were exposed are due to medication use or confounding by comorbidities. In addition the researchers did not study the long-term effects of offspring on their parents.
The study revealed that babies whose mothers took ADHD medication during pregnancy were at a slightly higher risk of admission to the neonatal care unit (NICU) as compared to mothers who didn't take any medication during pregnancy or had discontinued taking their medication prior to or during pregnancy. The reason for this was central nervous system disorders, and the higher risk of admission did not appear to be influenced by the stimulant medications were used during pregnancy.
Women who took stimulant ADHD medication during pregnancy also had an elevated chance of having a caesarean birth or having a baby with an low Apgar score (less than 7). These increases appeared to be unrelated to the type of medication taken during pregnancy.
The researchers suggest that the low risk associated with the use of ADHD medications during the early stages of pregnancy may be offset by the greater benefit for both mother and child from continued treatment for the woman's disorder. Physicians should discuss the issue with their patients and, if they are able, assist them in developing strategies to improve coping skills that can lessen the effects of her disorder on her daily life and relationships.
Interactions with Medication
As more women than ever before are being diagnosed with ADHD and treated with medication, the dilemma of whether or not to end treatment during pregnancy is one that doctors are having to have to face. These decisions are often made without clear and reliable evidence. Instead, doctors have to weigh their own knowledge and experience, as well as the experiences of other physicians and the research that has been conducted on the subject.
Particularly, the subject of potential risks to the baby can be tricky. The research that has been conducted on this topic is based on observation instead of controlled studies and a lot of the results are contradictory. In addition, most studies limit their analysis to live births, which could underestimate the severity of teratogenic effects that could result in abortion or termination of the pregnancy. The study discussed in this journal club addresses these limitations by examining data on both live and deceased births.
The conclusion: While some studies have shown a positive association between ADHD medications and the risk of certain birth defects, others have found no such relationship and the majority of studies demonstrate a neutral or slightly negative effect. In each case, a careful evaluation of the benefits and risks should be conducted.
For a lot of women with ADHD who suffer from ADHD, the decision to stop taking 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 increase depression and feelings of isolation. The loss of medication can also affect the ability to drive safely and perform work-related tasks, which are crucial aspects of daily life for people with ADHD.
She recommends women who are unsure about whether or not to stop medication in light of their pregnancy should consider informing family members, friends and colleagues on the condition, its effects 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 important to remember that some drugs can pass through the placenta, so if the patient decides to stop her ADHD medication during pregnancy and breastfeeding, she should be aware that traces of the drug can be transferred to the child.
Birth Defects and Risk of
As the use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) grows there are concerns about what impact the drugs might have on the fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge regarding this subject. With two massive data sets researchers were able look at more than 4.3 million pregnancies to determine whether stimulant medication use increased the risk of birth defects. Researchers found that while the overall risk is low, first-trimester ADHD medication exposure was associated with slightly higher risk of certain heart defects, like ventriculoseptal defects.
The researchers of the study didn't find any association between early use of medication and other congenital anomalies like facial deformities, or club feet. The results are consistent with previous studies showing an increase, but not significant, in the risk of developing cardiac malformations among women who began taking ADHD medications prior to the time of the birth of their child. This risk increased during the latter stages of pregnancy, when a lot of women decided to stop taking their medication.
Women who took ADHD medication in the first trimester were more likely require a caesarean delivery or have an insufficient Apgar after delivery, and have a baby that needed breathing assistance when they were born. The researchers of the study could not eliminate selection bias because they limited their study to women who did not have any other medical conditions that could have contributed to the findings.
Researchers hope that their study will help doctors when they see pregnant women. They advise that while discussing risks and benefits is important, the decision to stop or keep medication should be based on the woman's needs and the severity of her ADHD symptoms.
The authors caution that, even though stopping the medication is an option to think about, it isn't advised because of the high incidence of depression and mental health issues for women who are pregnant or who have recently given birth. Additionally, research suggests that women who stop taking their medication will have a difficult transitioning to life without them after the baby is born.
Nursing
The responsibilities of a new mother can be overwhelming. Women suffering from ADHD may face a lot of challenges when they must deal with 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 majority of stimulant medicines are absorbed by breast milk in small amounts, therefore the risk to infant who is breastfeeding is low. However, the amount of medication exposure to the newborn can vary depending on dosage, how often it is taken and the time of day it is administered. In addition, individual medications enter the infant's system differently through the gastrointestinal tract and breast milk, and the effect of this on a newborn infant is not well known.
Some physicians may discontinue stimulant medication during a woman’s pregnancy due to the lack of research. This is a complicated decision for the patient, who must balance the benefit of continuing her medication with the potential risks to the fetus. In the meantime, until more information is available, GPs read more should ask all pregnant patients about their experience with ADHD and if they are planning or taking to take medication during the perinatal time.
A increasing number of studies have proven that the majority of women are able to safely continue their ADHD medication during pregnancy and breastfeeding. In response, a rising number of patients are opting to do so. They have discovered through consultation with their doctors, that the benefits of keeping their current medication outweigh any potential risks.
It's important for women with ADHD who are contemplating breastfeeding to seek out a specialist psychiatrist's guidance prior to becoming pregnant. They should discuss their medication with their prescriber and discuss the pros and cons for continuing treatment. This includes non-pharmacological strategies. Psychoeducation is also required to help pregnant women suffering from ADHD understand their symptoms and underlying disorder Learn about the available treatments and to reinforce existing strategies for managing. This should be a multidisciplinary effort with the GPs, obstetricians and psychiatry. Pregnancy counseling should consist of a discussion of a treatment plan for the mother and the child, monitoring of indicators of deterioration, and, if needed adjustments to the medication regime.