ADHD Medication During Pregnancy and Breastfeeding
The decision to stop or keep ADHD medication during pregnancy and nursing is challenging for women with the condition. There aren't many studies regarding how exposure over time may affect a fetus.
A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication in utero do not develop neurological developmental conditions like hearing loss or impaired vision seizures, febrile seizures or IQ impairment. The authors acknowledge that more high quality studies are required.
Risk/Benefit Analysis
Pregnant women who use ADHD medications need to balance the benefits of taking them against the potential risks to the foetus. Physicians don't have the data to provide clear recommendations, but can provide information about risks and benefits to assist pregnant women to make informed decisions.
A study published in Molecular Psychiatry found that women who used ADHD medications during early pregnancy did not face an increased risk of fetal heart malformations or major structural birth defects. The researchers used a large population-based case-control study to evaluate the incidence 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, pediatric cardiologists and other experts reviewed the cases in order to confirm that the classification was accurate and to minimize any bias.
The study conducted by the researchers was not without its limitations. Researchers were unable, in the first place to differentiate the effects triggered by the medication from the disorder. This makes it difficult for researchers to determine if the few associations observed between the groups exposed were due to the use of medication, or if they were confounded by co-morbidities. In addition, the researchers did not examine 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 chance of being admitted to the neonatal care unit (NICU) in comparison to those whose mothers did not use any medication during pregnancy, or had stopped taking their medication before or during pregnancy. This was due to central nervous system disorders, and the increased risk for admission did not appear to be affected by the type of stimulant medications were used during pregnancy.
Women who were taking stimulant ADHD medication during pregnancy were also at an elevated risk of having a caesarean section or having a child with low Apgar score (less than 7). These increases didn't appear to be influenced by the kind of medication used during pregnancy.
The research suggests that the low risk associated with the use of ADHD medications during the early stages of pregnancy could be offset by the greater benefits for both mother and child from continued treatment for the woman's disorder. Physicians should discuss this with their patients and, if they are able, assist them in developing strategies to improve their coping abilities that may minimize the impact of her disorder on her daily functioning and relationships.
Medication Interactions
As more women than ever are being diagnosed with ADHD and being treated with medication, the dilemma of whether to keep or stop treatment during pregnancy is one that more and more doctors face. The majority of these decisions are made without any evidence that is clear and definitive in either case, which means that doctors must weigh their knowledge from their own experiences, those of other doctors, and what the research suggests on the subject as well as their own judgments for each patient.
In particular, the issue of potential risks for the baby can be a challenge. A lot of studies on this topic are based on observational evidence rather than controlled research, and their conclusions are often contradictory. Furthermore, most studies restrict their analysis to live births, which can underestimate the severity of teratogenic effects that could lead to abortion or termination of the pregnancy. The study presented in the journal club addresses these limitations, by examining both information on deceased and live births.
The conclusion The conclusion: While some studies have found a positive association between ADHD medications and the risk of certain birth defects, others have found no connection, and most studies have a neutral or slight negative effect. In each case it is imperative to conduct a thorough evaluation of the benefits and risks is required.
It isn't easy, but not impossible for women suffering from ADHD to stop taking their medication. In a recent piece 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. Additionally, the loss of medication may affect the ability to complete jobs and drive safely, which are important aspects of a normal life for many people suffering from ADHD.
She suggests women who are unsure about whether to keep or discontinue medication due to their pregnancy, consider the possibility of educating friends, family members and colleagues about the condition, its effects on daily functioning, and the benefits of keeping the current treatment regimen. In addition, educating them can aid in ensuring that the woman feels supported when she is struggling with her decision. Some medications can pass through the placenta. If the patient decides to stop taking her ADHD medication while pregnant and breastfeeding, it's important to be aware that the drug may be transferred to her infant.
Birth Defects and Risk of
As the use of ADHD medication to treat the symptoms of attention deficit hyperactivity disorder (ADHD) grows there are concerns over the impact that these drugs could have on fetuses. Recent research published in the journal Molecular Psychiatry has added to the body knowledge on this subject. With two massive data sets researchers were able to examine more than 4.3 million pregnancies to determine whether stimulant medication use increased the risk of birth defects. While the overall risk remains low, the researchers found that exposure in the first trimester to ADHD medications was linked to a slightly higher rate of certain heart defects such as ventriculoseptal defect (VSD).
The authors of the study found no link between the use of early medications and other congenital anomalies, such as facial clefting or club foot. The results are in the same vein as previous studies which showed a small, but significant increase in cardiac malformations for women who started taking ADHD medication before pregnancy. The risk increased in the latter part of pregnancy when a large number of women stopped 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 after delivery and a baby who needed breathing assistance during birth. The authors of the study were not able to eliminate selection bias because they restricted the study to women without other medical conditions that could have contributed to the findings.
The researchers hope their study will serve to inform the clinical decisions of doctors who see pregnant women. They advise that while a discussion of risks and benefits is important but the decision to stop or continue treatment should be based on the woman's needs and the severity of her ADHD symptoms.
The authors warn that, although stopping the medication is a possibility to consider, it is not advised due to the high prevalence of depression and mental health issues 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 difficult adjustment to life without them after the baby is born.
Nursing
The responsibilities of being a here new mother can be overwhelming. Women who suffer from ADHD who have to manage their symptoms while attending physician appointments and getting ready for the arrival of a baby and getting used to new routines at home may face a lot of challenges. Many women decide to continue taking their ADHD medication during pregnancy.
The risk to breastfeeding infant is minimal because the majority of stimulant medications is absorbed through breast milk at low levels. However, the rate of exposure to medication by the newborn may differ based on dosage, frequency it is administered and at what time the medication is administered. In addition, various 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 fully known.
Some physicians may discontinue stimulant medication during a woman’s pregnancy due to the absence of research. This is a complicated decision for the patient, who must weigh the benefits of keeping her medication with the potential dangers to the foetus. Until more information is available, doctors should inquire with all pregnant patients about their experience with ADHD and if they are planning or taking to take medication during the perinatal period.
A increasing number of studies have proven that the majority of women are able to safely continue their ADHD medication during pregnancy and breastfeeding. As a result, many patients opt to do this and in consultation with their physician, they have found that the benefits of continuing their current medication far outweigh any potential risks.
It is essential for women with ADHD who are contemplating breastfeeding to seek a specialist psychiatrist's advice prior to becoming pregnant. They should discuss their medication with their doctor, and the pros and cons of continuing treatment. This includes non-pharmacological methods. Psychoeducation is also necessary to help pregnant women with ADHD recognize the signs and underlying disorder. They should also learn about treatment options and reinforce coping mechanisms. This should be a multidisciplinary process together with obstetricians, GPs, and psychiatry. Pregnancy counseling should include a discussion of a treatment plan for the mother and the child, and monitoring for indicators of deterioration, and, if necessary, adjustments to the medication regimen.