ADHD Medication During Pregnancy and Breastfeeding
Women suffering from ADHD must make a difficult decision on whether to keep or stop taking ADHD medication during pregnancy and breast-feeding. There aren't enough add adult medications on how long-term exposure may affect the pregnant fetus.
A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication during the uterus don't develop neurological developmental conditions like hearing or vision impairment, febrile seizures, or IQ impairment. The authors acknowledge that more high-quality studies are needed.
Risk/Benefit Analysis
Women who are pregnant and taking ADHD medication must weigh the benefits of taking it against the potential risks for the foetus. Physicians don't have the data to provide clear recommendations but they can provide information about risks and benefits to help pregnant women make an informed decision.
A study published in Molecular Psychiatry found that women who were taking ADHD medications during early pregnancy did not face an increased risk of fetal heart malformations or major structural birth defects. Researchers conducted a large population-based study of case-control to assess the risk of major structural birth defects in babies born to mothers who took stimulants during the early stages of pregnancy, as well as those who had not. Pediatric cardiologists and clinical geneticists looked over the cases to ensure correct case classification and to minimize the chance of bias.
The study conducted by the researchers was not without its limitations. The researchers were unable in the beginning to distinguish the effects of the medication from the disorder. This makes it difficult to know whether the small differences 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 outcomes of offspring.
The study did reveal that infants whose mothers had taken ADHD medication during pregnancy were at slightly greater risk of being admitted to the neonatal intensive care unit (NICU) than infants who whose mothers did not take any medication or stopped their medications before or during pregnancy. This was due to central nervous system-related disorders, and the increased risk for admission was not found to be affected by the type of stimulant medication was used during pregnancy.
Women who took stimulant ADHD medications during pregnancy also had a higher likelihood of having an emergency caesarean section or having a baby that scored low on the Apgar scale (less than 7). These increases appeared to be unrelated to the type of medication taken during pregnancy.
Researchers suggest that the small risk of using ADHD medications in early pregnancies can be offset by greater benefits for mother and baby of continuing treatment for the woman's condition. Physicians should discuss this with their patients and, if possible, help them develop strategies for improving their coping skills that may minimize the effects of her disorder on her daily life and relationships.
Medication Interactions
As more women than ever are being diagnosed with ADHD and treated with medication, the question of whether or not to stop treatment during pregnancy is one that more and more physicians face. These decisions are usually made without clear and authoritative evidence. Instead, physicians must consider their own expertise and experience, as well as the experiences of other doctors, and the research on the topic.
Particularly, the subject of potential risks for the baby can be tricky. A lot of studies on this topic are based on observational evidence rather than controlled research, and their conclusions are often contradictory. In addition, most studies limit their analysis to live births, which can underestimate the severity of teratogenic effects that could result in abortion or termination of the pregnancy. The study that is discussed in this journal club addresses these shortcomings by analyzing data on live and deceased births.
The conclusion The conclusion: While certain studies have demonstrated an association between ADHD medications and the risk of certain birth defects, others have not found any evidence of a link and the majority of studies show a neutral or even slightly negative effect. In each case an in-depth evaluation of the benefits and risks should be conducted.
It can be difficult, if not impossible for women with ADHD to stop taking their medication. In a recent article in 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. The loss of medication can affect the ability to safely drive and to perform work-related tasks which are crucial aspects of normal life for people with ADHD.
She suggests that women who aren't sure whether to continue taking medication or stop due to pregnancy should educate family members, coworkers, and acquaintances about the condition, its impact on daily functioning and the advantages of staying on the current treatment plan. In addition, educating them can aid in ensuring that the woman feels supported in her struggle with her decision. Certain medications can pass through the placenta. If a woman decides to not take her ADHD medication while breastfeeding, it is crucial to be aware that the medication could be passed on to her baby.
Birth Defects and Risk of
As the use of ADHD medication to treat the symptoms of attention deficit hyperactivity disorder (ADHD) increases there are concerns about what impact the drugs could have on the fetuses. A recent study published in the journal Molecular Psychiatry adds to the body of information on this topic. Using two massive data sets, researchers were able to analyze more than 4.3 million pregnancies and determine whether the use of stimulant medications increased the risk of birth defects. Although the risk overall remains low, the researchers did find that first-trimester exposure to ADHD medications was associated with an increased risk of certain heart defects such as ventriculo-septal defect (VSD).
The authors of the study didn't find any association between early medication usage and other congenital anomalies, like 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 started taking ADHD medication prior to the birth of their child. The risk increased in the latter stages of pregnancy when a large number of women stopped taking their medication.
Women who used ADHD medications during the first trimester of pregnancy were also more likely to have a caesarean section, a low Apgar score following delivery, and a baby that required breathing assistance during birth. However, the authors of the study were unable to eliminate selection bias by limiting the study to women who didn't have any other medical conditions that could be a contributing factor to these findings.
The researchers hope their research will aid in the clinical decisions of doctors who see pregnant women. They recommend that, while the discussion of risks and benefits is important, the decision to stop or maintain medication should be based on each woman's needs and the severity of her ADHD symptoms.
The authors warn that, although stopping the medication is an option to look into, it is not advised due to the high rate depression and other mental problems in women who are expecting or who have recently given birth. Research has also shown that women who stop taking their medications will have a tough transitioning to life without them after the baby is born.
Nursing
It can be a stressful experience to become a mom. Women who suffer from ADHD can face severe challenges when they must manage their symptoms, attend doctor appointments, prepare for the birth of their child and adjust to a new routine. Therefore, many women elect to continue taking their ADHD medications throughout the course of pregnancy.
The risk to breastfeeding infant is minimal because the majority of stimulant medications is absorbed through breast milk at a low level. However, the frequency of exposure to medications by the newborn may differ based on dosage, how often it is administered, and the time of the day the medication is administered. Additionally, different drugs enter the infant's system through the gastrointestinal tract or through breast milk. The impact of these medications on the health of a newborn is not completely known.
Some doctors may decide to stop stimulant medications during a woman's pregnancy due to the absence of research. This is a difficult choice for the patient, who must balance the benefit of continuing her medication against the possible risks to the foetus. In the meantime, until more information is available, doctors should inquire with all pregnant patients about their experience with ADHD and if they plan or are taking to take medication during the perinatal period.
A growing number of studies have revealed that the majority of women are able to safely continue to take their ADHD medication during pregnancy and while breastfeeding. This has led to more and more patients opt to do this and in consultation with their physician, they have discovered that the benefits of continuing their current medication outweigh any potential risks.
Women who suffer from ADHD who plan to breastfeed should seek the advice of a specialist psychiatrist prior to becoming pregnant. They should discuss the medication they are taking with their physician and discuss the pros and cons for continuing treatment. This includes non-pharmacological methods. Psychoeducation is also required to help women with ADHD recognize their symptoms and underlying disorder, learn about available treatments and to reinforce existing strategies for managing. This should include a multidisciplinary approach with the GP as well as obstetricians, psychiatry and obstetricians. Pregnancy counseling should consist of a discussion of a treatment plan for the mother and child, and monitoring for indicators of deterioration, and, if necessary adjustments to the medication regimen.