ADHD Medication During Pregnancy and Breastfeeding
The decision to stop or keep ADHD medications during pregnancy and nursing is challenging for women with the condition. There aren't many studies on how long-term exposure may affect a foetus.
A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication during utero do not develop neurological developmental disorders such as impaired vision or hearing seizures, febrile seizures or IQ impairment. The authors acknowledge the need for more high-quality research.
Risk/Benefit Analysis
Pregnant women who use ADHD medications need to balance the benefits of taking them against the potential risks to the foetus. Doctors don't have enough data to give clear advice, but can provide information on the risks and benefits to help pregnant women make informed choices.
A study published in Molecular Psychiatry concluded that women who took ADHD medication during their early pregnancy were not at higher risk of fetal malformations or structural birth defects. Researchers conducted a large population-based study of case control to examine the prevalence 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 examined the cases to make sure that the classification was accurate and to eliminate any bias.
The study conducted by the researchers was not without its limitations. Researchers were unable in the beginning, to separate the effects of the medication from the disorder. That limitation makes it difficult to determine whether the small associations observed in the groups that were exposed result from medication use or confounding by comorbidities. The researchers did not study long-term outcomes for offspring.
The study did reveal that infants whose mothers took ADHD medication during pregnancy were at slightly more risk of being admitted to the neonatal intensive care unit (NICU) than those whose mothers had not taken any medication or had cut back on their medications prior to or during pregnancy. The reason for this was central nervous system disorders. The increased risk of admission was not influenced by the stimulant medications used during pregnancy.
Women who were taking stimulant ADHD medication during pregnancy also had an elevated risk of having a caesarean delivery or having a baby born with low Apgar score (less than 7). These increases did not appear to be influenced by the type of medication that was used during pregnancy.
The research suggests that the risk of a small amount with the use of ADHD medications during the early stages of pregnancy could be offset by the greater benefits to both the mother and child of continued treatment for the woman's disorder. Physicians should speak with their patients about this and as much as possible, assist them develop coping strategies that can lessen the impact of her disorder in her daily life and relationships.
Medication Interactions
As more women than ever before are being diagnosed with ADHD and treated with medication, the dilemma of whether to continue or end treatment during pregnancy is a question that more and more doctors have to face. These decisions are frequently made without clear and reliable evidence. Instead, doctors have to weigh their own knowledge, the experience of other physicians and the research on the topic.
The issue of possible risks to infants is particularly tricky. The research that has been conducted on this topic is based on observation rather than controlled studies and many of the findings are in conflict. Most studies restrict their analysis to live births, which may underestimate the teratogenic impact that can lead to terminations or abortions of pregnancy. The study that is discussed in this journal club addresses these issues by analyzing data on live and deceased births.
Conclusion Some studies have revealed a positive correlation between ADHD medications and certain birth defects, other studies have not shown such a relationship. The majority of studies show an unintended, or somewhat negative, effect. In the end, a careful risk/benefit analysis must be conducted in every case.
For many women with ADHD, the decision to stop medication is difficult, if not impossible. In a recent article in Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can cause depression and feelings of loneliness. The loss of medication can also impact the ability to safely drive and complete work-related tasks, which are crucial aspects of everyday life for people with ADHD.
She suggests that women who are not sure whether to continue taking medication or stop it due to their pregnancy educate family members, coworkers, and their friends about the condition, its impact on daily functioning and the benefits of keeping the current treatment. It will also help a woman feel confident about her decision. Certain medications can pass through the placenta. If a woman decides to stop taking read more her ADHD medication while pregnant and breastfeeding, it is crucial to be aware that the drug may be transferred to her baby.
Birth Defects and Risk of
As the use and use of ADHD drugs to treat symptoms of attention deficit disorder hyperactivity disorder (ADHD), increases as does the concern about the potential effects of these drugs on foetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge regarding this subject. Using two massive data sets researchers were able analyze more than 4.3 million pregnancies to determine whether stimulant medications increased the risk of birth defects. Although the risk overall remains low, the scientists discovered that the first-trimester exposure to ADHD medications was associated with an increase in the risk of specific heart defects, such as ventriculo-septal defect (VSD).
The authors of the study didn't discover any connection between the use of early medications and other congenital anomalies, such as facial deformities or club feet. 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 began taking ADHD medication prior to the time of pregnancy. The risk increased in the latter stages of pregnancy when many women began to stop taking their medication.
Women who used ADHD medications in the first trimester of their pregnancies were also more likely to undergo caesarean section, low Apgar score following delivery, and a baby that required breathing assistance during birth. The authors of the study were unable to eliminate selection bias because they limited the study to women without other medical conditions that might have contributed to the findings.
Researchers hope their research will inform physicians when they meet pregnant women. They recommend that, while the discussion of risks and benefits is important but the decision to stop or maintain medication should be based on each woman's needs and the severity of her ADHD symptoms.
The authors caution that, although stopping the medication is an option to look into, it is not advised because of the high incidence of depression and other mental disorders among women who are pregnant or who have recently given birth. Further, the research suggests that women who choose to stop taking their medication are more likely to have difficulties adjusting to life without them after the birth of their baby.
Nursing
The responsibilities of being a new mom can be overwhelming. Women who suffer from ADHD who have to deal with their symptoms while attending physician appointments as well as getting ready for the arrival of a child and getting used to new routines at home can experience severe challenges. Therefore, many women elect to continue taking their ADHD medication throughout the pregnancy.
The majority of stimulant medicines pass through breast milk in small amounts, so the risk to the breastfeeding infant is minimal. The amount of exposure to medications can vary depending upon the dosage and frequency of administration as well as time of day. In addition, various medications are introduced into the baby's system through the gastrointestinal tract or through breast milk. The impact of these medications on the health of a newborn is not fully known.
Because of the lack of evidence, some doctors might be tempted to stop taking stimulant medications during the pregnancy of a woman. This is a complicated decision for the patient, who must weigh the benefit of continuing her medication against the potential dangers to the embryo. Until more information is available, doctors should ask all pregnant patients about their experience with ADHD and whether 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 while they are pregnant and nursing. As a result, an increasing number of patients are choosing to do so and in consultation with their physician, they have found that the benefits of keeping their current medication far outweigh any potential risks.
It is essential for women with ADHD who are considering breastfeeding to seek a specialist psychiatrist's advice prior becoming pregnant. They should discuss their medication with their doctor and discuss the pros and cons of continued treatment, including non-pharmacological strategies. Psychoeducation should also be provided to help pregnant women suffering from ADHD recognize their symptoms and the underlying disorder and learn about treatment options and reinforce existing strategies for managing. This should include a multidisciplinary approach with the GP, obstetricians and psychiatry. Counselling for pregnancy should include the discussion of a treatment plan for both mother and child, monitoring for signs of deterioration and when necessary, making adjustments to the medication regimen.