ADHD Medication During Pregnancy and Breastfeeding
The decision to stop or keep ADHD medications during pregnancy and nursing is a challenge for women suffering from the condition. There aren't enough data on how exposure to ADHD for a long time could affect a pregnant fetus.
A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological problems like hearing loss or vision, febrile seizures or IQ impairment. The authors acknowledge the need for higher-quality research.
Risk/Benefit Analysis
Women who are pregnant and taking ADHD medications need to balance the advantages of taking them against potential risks to the fetus. Physicians do not have the data needed to provide clear recommendations, but they can provide information about the risks and benefits to 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 greater risk of fetal malformations, or structural birth defects. Researchers conducted a large sample-based case control study to compare the incidence of structural defects that were major in infants born to mothers who took stimulants during pregnancy. Pediatric cardiologists, clinical geneticists and other experts reviewed the cases in order to ensure that the classification was accurate and to minimize any bias.
However, the study had its limitations. The researchers were unable, in the first place to distinguish the effects of the medication from the disorder. This makes it difficult for researchers to establish whether the few associations observed between the exposed groups were due to medication use or if they were confounded by the presence of comorbidities. Researchers also did not look at long-term outcomes for offspring.
The study did find that babies whose mothers had taken ADHD medication during pregnancy were at a slightly greater risk of being admitted to the neonatal intensive care unit (NICU) than those whose mothers had not taken any medication or had stopped their medications before or during pregnancy. This increase was caused by 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 medications during pregnancy also had a higher likelihood of having an emergency caesarean section or having one whose baby scored low on the Apgar scale (less than 7). These increases appeared to be unrelated to the type 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 could be offset by the greater benefits to both mother and child of continuing treatment for the woman's condition. Physicians should talk to their patients about this issue and try to help them develop coping strategies that can lessen the impact of her disorder in her daily functioning and her relationships.
Medication Interactions
Doctors are increasingly faced with the decision of whether to keep treatment or stop it during pregnancy as more women are diagnosed with ADHD. These decisions are often made without clear and reliable evidence. Instead, doctors must take into account their own experience, the experience of other physicians and the research that has been conducted on the subject.
The issue of possible risks to infants is extremely difficult. The research on this subject is based on observations rather than controlled studies, and a lot of the results are conflicting. 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 discussed in this journal club addresses these limitations by examining data on both live and deceased births.
The conclusion: While some studies have shown an association between ADHD medications and the possibility of certain birth defects, others have found no such relationship and the majority of studies have a neutral or slightly negative impact. Therefore, a careful risk/benefit analysis must be conducted in every instance.
It can be challenging, if not impossible for women suffering from ADHD to stop taking their medication. In a recent article published in Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can increase depression and feelings of being isolated. In addition, a decrease in medication may affect the ability to do work-related tasks and safely drive which are essential aspects of daily life for many people with ADHD.
She recommends women who are uncertain about whether to keep or stop medication in light of their pregnancy should consider the possibility of educating friends, family members and colleagues on the condition, its effects on daily functioning, and the benefits of keeping the current treatment regimen. It will also help a woman feel more confident in her decision. It is important to note that some medications are able to pass through the placenta so if a woman decides to stop taking her ADHD medication during pregnancy and breastfeeding, she must be aware of the possibility that traces of the drug could be transferred to the child.
Risk of Birth Defects
As the use and use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) is increasing the concern over the potential effects of these drugs on fetuses. A study that was published in the journal Molecular Psychiatry adds to the existing knowledge on this subject. Researchers used two massive data sets to study more than 4.3 million pregnant women and determine if stimulant medication use caused birth defects. Researchers discovered that although the overall risk is low, the first trimester ADHD medication exposure was associated with slightly higher rates of specific heart defects like ventriculoseptal defects.
The researchers behind the study found no link between the use of early medications and other congenital abnormalities, like facial clefting, or club foot. The results are in line with previous studies revealing a small but significant increase in the risk of developing cardiac malformations among women who started taking ADHD medications before the birth of their child. The risk increased in the latter stages of pregnancy when many women stopped taking their medication.
Women who took ADHD medication in the first trimester were more likely require a caesarean delivery or have a low Apgar after delivery, and had a baby that required breathing assistance at birth. However the researchers of the study were not able to eliminate bias due to selection 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 serve to inform the clinical decisions of physicians who treat pregnant women. They recommend that, while discussing the benefits and risks is important, the decision to stop or maintain treatment should be based on the woman's requirements and the severity of her ADHD symptoms.
The authors caution that, although stopping the medication is an option to think about, it isn't recommended due to the high rate depression and mental health issues for women who are pregnant or who have recently given birth. Additionally, the research suggests that women who decide to stop taking their medications are more likely to have a difficult time getting used to life without them following the baby's arrival.
Nursing
It can be a challenge becoming a mother. Women with ADHD who have to manage their symptoms while attending doctor appointments and preparing for the arrival of a child and adapting to new routines in the home may face a lot of challenges. Many women decide to continue taking their ADHD medication during pregnancy.
The majority of stimulant medicines are absorbed by breast milk in small quantities, so the risk for breastfeeding infant is minimal. The amount of exposure to medications will differ based on dosage the medication is administered, its frequency and time of day. In addition, different drugs enter the infant's system via the gastrointestinal tract or through breast milk. The effect on the health of a newborn is not completely known.
Due to the absence of research, some physicians may be inclined to discontinue stimulant drugs during the course of pregnancy. This is a difficult decision for the woman who must weigh the advantages of taking her medication as well as the risks to the foetus. Until more information becomes available, GPs can ask pregnant patients if they have an background of ADHD or if they are planning to take medication during the perinatal phase.
A increasing number of studies have revealed that most women can safely continue their ADHD medication during pregnancy and while breastfeeding. As a result, many patients choose to do so and after consulting with their doctor, they have found 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 a specialist psychiatrist's advice prior to becoming pregnant. They should discuss the medication they are taking with their physician, and the pros and cons of continuing treatment. This includes non-pharmacological strategies. Psychoeducation is also required to help pregnant women suffering from ADHD be aware of the symptoms and the underlying disorder. They should also be educated about treatment options and strengthen coping mechanisms. This should be a multidisciplinary process together with obstetricians, GPs and psychiatry. The pregnancy counselling should consist of discussion of a management plan for both mother and child, monitoring for signs more info of deterioration and, if necessary, adjustments to the medication regimen.