ADHD Medication During Pregnancy and Breastfeeding
The choice of whether to stop or continue ADHD medication during pregnancy and nursing is challenging for women with the condition. There isn't much information on how long-term exposure to these medications could affect the foetus.
A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological disorders such as hearing loss or vision, febrile seizures or IQ impairment. The authors acknowledge that more high-quality research is needed.
Risk/Benefit Analysis
Women who are pregnant and taking ADHD medication need to evaluate the benefits of using it against the possible dangers for the baby. Physicians don't have the data to give clear advice but they can provide information on the risks and benefits to help pregnant women make informed choices.
A study published in Molecular Psychiatry found that women who took ADHD medications in early pregnancy did not have a significantly higher risk of fetal cardiac malformations or major birth defects that are structural. Researchers conducted a large population-based study of case-control to evaluate the incidence of major structural birth defects in infants born to mothers who had taken stimulants during the early stages of pregnancy, as well as those who had not. Clinical geneticists and pediatric cardiologists reviewed the cases to ensure an accurate case classification and to minimize the chance of bias.
The research conducted by the researchers had some limitations. Most important, they were not able to differentiate the effects of the medication from the disorder at hand. This limitation makes it difficult to know whether the small differences observed in the exposed groups are due to medication use or comorbidities that cause confusion. medications for adhd in adults did not study long-term outcomes for the offspring.
The study showed that infants whose mothers took ADHD medication during pregnancy were at a slightly higher risk of admission to the neonatal care unit (NICU) as compared to mothers who did not use any medication during pregnancy or stopped taking their medication before or during pregnancy. The reason for this was central nervous system disorders, and the increased risk for admission did not appear to be influenced by which stimulant medications were taken during pregnancy.
Women who took stimulant ADHD medications during pregnancy also had a higher likelihood of having a caesarean section or the baby was not scoring well on the Apgar scale (less than 7). These increases did appear to be independent of 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 may be offset by the greater benefit to both the mother and child of continuing treatment for the woman's condition. Physicians should talk to their patients about this issue and as much as possible, assist them develop coping skills that could reduce the impact of her disorder in her daily life and relationships.
Medication Interactions
As more women than ever are being diagnosed with ADHD and treated with medication, the issue of whether or not to discontinue treatment during pregnancy is a question that doctors are having to confront. Often, these decisions are taken in the absence of solid and reliable evidence in either case, which means that doctors must weigh what they know, the experiences of other doctors, and what research suggests on the subject and their best judgment for each individual patient.
Particularly, the issue of potential risks to the infant can be difficult. A lot of studies on this topic are based on observational evidence rather than controlled research and their findings are often contradictory. Furthermore, most studies restrict their analysis to live births, which could 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 analyzing data on live and deceased births.
Conclusion Some studies have revealed an association between ADHD medications and certain birth defects However, other studies haven't found a correlation. Most studies show an unintended, or somewhat negative, impact. In every case it is imperative to conduct a thorough analysis of the potential risks and benefits must be performed.
It isn't easy, but 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 increase depression, feelings of isolation and family conflict for these patients. A decrease in medication could also impact the ability to drive safely and perform work-related tasks, which are vital aspects of everyday life for those with ADHD.
She suggests that women who aren't sure whether to take the medication or stop it due to their pregnancy should educate family members, coworkers, and acquaintances about the condition, its impact on daily functioning and the benefits of continuing the current treatment. It can also help the woman feel supported in her struggle with her decision. It is important to remember that some medications can pass through the placenta so if the patient decides to discontinue her ADHD medication during pregnancy and breastfeeding, she must be aware of the possibility that traces of the medication could be passed on to the baby.
Risk of Birth Defects
As the use and use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD), increases as does the concern about the potential effects of these drugs on foetuses. A study that was published in the journal Molecular Psychiatry adds to the existing information on this topic. With two massive data sets, researchers were able to analyze more than 4.3 million pregnancies and see whether stimulant medications increased the risk of birth defects. Researchers found that while the risk overall is low, first-trimester ADHD medication use was associated with slightly higher rates of certain heart defects, such as ventriculoseptal defect.
The authors of the study found no link between early medication use and other congenital abnormalities, such as facial clefting or club foot. The results are in line with previous studies that have shown the presence of a small, but significant increase in the risk of developing cardiac malformations among women who began taking ADHD medications before the time of pregnancy. The risk grew in the later part of pregnancy, when many women begin to discontinue their ADHD medications.
Women who were taking ADHD medication during the first trimester were more likely need a caesarean, have a low Apgar after delivery, and have a baby that needed help breathing at birth. The authors of the study were not able to eliminate bias due to selection because they limited the study to women without other medical conditions that might have contributed to the findings.
The researchers hope their study will serve to inform the clinical decisions of physicians who treat pregnant women. They recommend that, while a discussion of risks and benefits is important, the decision to stop or continue treatment must be based on each woman's needs and the severity of her ADHD symptoms.
The authors caution that, even though stopping the medication is a possibility to think about, it isn't recommended due to the high rate depression and mental health issues among women who are pregnant or who have recently given birth. Furthermore, research suggests that women who decide to stop taking their medication are more likely to experience a difficult time adjusting to life without them after the baby's arrival.
Nursing
It can be overwhelming becoming a mother. Women who suffer from ADHD who have to manage their symptoms while attending physician appointments, preparing for the arrival of their child and adapting to new routines in the home may face a lot of challenges. As such, many women elect to continue taking their ADHD medications throughout pregnancy.
The majority of stimulant medicines are absorbed by breast milk in very small quantities, so the risk to nursing infant is very low. However, the rate of medication exposure to the newborn can vary depending on the dosage, frequency it is taken and at what time the medication is administered. In addition, 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 isn't completely understood.
Because of the lack of research, some doctors may recommend stopping stimulant medications during the course of pregnancy. It is a difficult decision for the woman who must weigh the advantages of continuing her medication against the risks to the fetus. In the meantime, until more information is available, GPs can inquire about pregnant patients whether they have any background of ADHD or if they intend to take medication in the perinatal stage.
A increasing number of studies have shown that women can continue their ADHD medication while they are pregnant and nursing. In response, a growing number of patients are opting to do this. They have found through consultation with their doctor, that the benefits of retaining their current medication outweigh any possible risks.
It's important for women with ADHD who are contemplating breastfeeding to seek a specialist psychiatrist's guidance prior to becoming pregnant. They should discuss their medication with their doctor and discuss the pros and cons for continuing treatment. This includes non-pharmacological strategies. Psychoeducation should also be offered to help women with ADHD be aware of their symptoms and the root cause and learn about treatment options and strengthen existing coping strategies. This should be a multidisciplinary approach, which includes the GP doctors, obstetricians and psychiatrists. Pregnancy counseling should consist of a discussion of a treatment plan for the mother and child, monitoring of indicators of deterioration, and, if needed, adjustments to the medication regime.