ADHD Medication During Pregnancy and Breastfeeding
Women with ADHD must make a difficult decision about whether to continue or stop taking ADHD medication during pregnancy and breastfeeding. There aren't enough data on how exposure to ADHD for a long time could affect a fetus.
A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication in utero do not develop neurological disorders like impaired vision or hearing, febrile seizures, or IQ impairment. The authors acknowledge the need for more high-quality studies.
Risk/Benefit Analysis
Women who are pregnant and take ADHD medication need to weigh the benefits of taking it against the possible dangers for the foetus. Doctors don't have the data needed to give clear guidelines, but they can provide information regarding risks and benefits that help pregnant women make informed choices.
A study published in Molecular Psychiatry concluded that women who were taking ADHD medication during early pregnancy were not at a greater risk of fetal malformations, or structural birth defects. 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 in early pregnancy and those who had not. Clinical geneticists and pediatric cardiologists looked over the cases to ensure an accurate case classification and to limit the possibility of bias.
However, adhd medication adults was not without its flaws. Most important, they were unable to separate the effects of the medication from the effects of the disorder that is underlying. This limitation makes it difficult to determine whether the limited associations observed in the groups that were exposed are due to the use of medication or comorbidities that cause confusion. Additionally the study did not look at the long-term outcomes of offspring.
The study did find that babies whose mothers had taken ADHD medication during pregnancy were at a greater risk of being admitted to the neonatal intensive care unit (NICU) than those whose mothers had not taken any medication or taken off their medication prior to or during pregnancy. This was due to central nervous system-related disorders, and the increased risk of admission did not appear to be influenced by the stimulant medication was used during pregnancy.
Women who took stimulant ADHD medications during pregnancy also had a higher chance of having caesarean sections or a baby that scored low on the Apgar scale (less than 7). These increases did not seem to be influenced by the kind of medication used during pregnancy.
The researchers suggest that the risk of a small amount with the use of ADHD medications during the early stages of pregnancy may be offset by the greater benefit to both mother and child from continued treatment for the woman's condition. Physicians should speak with their patients about this and try to help them improve coping skills which can lessen the impact of her disorder in her daily life and relationships.
Medication Interactions
Many doctors are faced with the decision of whether to keep treatment or stop during pregnancy as more women are diagnosed with ADHD. These decisions are usually made without clear and authoritative evidence. Instead, doctors must consider their own expertise, the experience of other physicians and the research on the topic.
Particularly, the issue of potential risks for the baby can be tricky. The research that has been conducted on this topic is based on observations rather than controlled studies, and the results are in conflict. Additionally, adhd medication adults of studies limit 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 that is discussed in the journal club addresses these issues by analyzing both the data from deceased and live births.
Conclusion: While some studies have shown a positive correlation between ADHD medications and certain birth defects However, other studies haven't shown such a relationship. The majority of studies show a neutral, or even somewhat negative, impact. In every case it is imperative to conduct a thorough evaluation of the benefits and risks must be performed.
For women suffering from ADHD and ADD, the decision to stop medication is difficult, if not impossible. In an article recently published 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 these patients. A loss of medication may also affect the ability to safely drive and to perform work-related tasks which are essential aspects of daily life for those with ADHD.
She recommends women who are unsure about whether to continue or discontinue medication due to their pregnancy, consider educating family members, friends, and coworkers on the condition, its effects on daily life, and the advantages of staying on the current treatment plan. It can also help women feel more confident in her decision. Certain medications can pass through the placenta. If a woman decides to not take her ADHD medication while breastfeeding, it is important to be aware that the drug could be passed on 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 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 to examine more than 4.3 million pregnancies to determine whether the use of stimulant medications increased the risk of birth defects. Researchers discovered that, while the overall risk is low, first-trimester ADHD medication exposure was associated with slightly higher rates of certain heart defects, like ventriculoseptal defect.
The researchers of the study didn't discover any connection between the use of early medications and other congenital anomalies, like facial deformities or club feet. The results are in line with previous studies showing an increase, but not significant, in the risk of cardiac malformations among women who began taking ADHD medications prior to pregnancy. The risk was higher during the latter part of pregnancy, when many women begin to discontinue their medication.
Women who used ADHD medications in the first trimester of their pregnancy were also more likely to experience a caesarean section, a low Apgar score after delivery and a baby that required breathing assistance at birth. The researchers of the study were not able to eliminate bias due to selection because they limited their study to women with no other medical conditions that might have contributed to the findings.
Researchers hope that their research will provide doctors with information when they meet pregnant women. They suggest that although discussing the risks and benefits is crucial but the decision to stop or keep 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 recommended because of the high incidence of depression and mental health issues among women who are pregnant or who have recently given birth. Additionally, research suggests that women who stop taking their medication will have a harder transitioning to life without them after the baby is born.
Nursing
The responsibilities of being a new mother can be overwhelming. Women suffering from ADHD can face severe challenges when they have to manage their symptoms, go to doctor appointments, prepare for the birth of a child and adjust to new routines. As such, many women elect to continue taking their ADHD medication throughout the pregnancy.
The majority of stimulant drugs are absorbed by breast milk in very small quantities, so the risk for nursing infant is very low. However, the frequency of exposure to medication by the newborn can vary depending on dosage, frequency it is administered, and the time of day the medication is administered. Additionally, different medications enter the baby's system differently through the gastrointestinal tract as well as breast milk, and the effect of this on a newborn is not yet fully known.
Some physicians may discontinue stimulant medication during a woman’s pregnancy due to the absence of research. This is a difficult decision for the woman, who must weigh the benefits of taking her medication as well as the potential risks to the foetus. Until more information is available, doctors should ask all pregnant patients about their history of ADHD and whether they are taking or planning to take medication during the perinatal period.
A growing number of studies have proven that the majority of women are able to safely continue to take their ADHD medication while they are pregnant and nursing. This has led to many patients opt to do this and, in consultation with their doctor they have found that the benefits of continuing their current medication far exceed any risk.
It's important for women with ADHD who are thinking of breastfeeding to seek out a specialist psychiatrist's advice prior becoming pregnant. They should discuss their medication with their doctor and discuss the advantages and disadvantages of continuing treatment, including non-pharmacological management strategies. Psychoeducation is also needed to help pregnant women with ADHD be aware of the symptoms and underlying disorder. They should also be educated about treatment options and build strategies for coping. This should be a multidisciplinary approach together with obstetricians, GPs and psychiatrists. Pregnancy counseling should include a discussion of a treatment plan for the mother as well as the child, monitoring of signs of deterioration and, if needed modifications to the medication regimen.