ADHD Medication During Pregnancy and Breastfeeding
Women with ADHD face a difficult decision regarding whether or not to stop taking ADHD medication during pregnancy and breastfeeding. Little data exists about how long-term exposure to these drugs may affect the foetus.
A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication in utero do not develop neurological disorders such as impaired vision or hearing seizures, 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 must evaluate the benefits of using it versus the risks for the foetus. Physicians don't have the data to provide clear recommendations however they can provide information on the risks and benefits to aid pregnant women in making an informed decision.
A study published in Molecular Psychiatry concluded that women who were taking ADHD medication during their early pregnancy did not have a greater risk of fetal malformations, or structural birth defects. Researchers conducted a large sample-based case control study to assess the frequency of major structural defects in infants born to mothers who took stimulants during pregnancy. Clinical geneticists, pediatric cardiologists and other experts looked over the cases to confirm that the classification was accurate and to reduce any bias.
However, the study had its limitations. Most important, they were unable to separate the effects of the medication from those of the disorder at hand. This makes it difficult for researchers to determine whether the small differences observed between the groups exposed were due to the use of medication or caused by co-morbidities. In addition the researchers did not examine long-term offspring outcomes.
The study did show that infants whose mothers took ADHD medications during pregnancy were at a more risk of being admitted to the neonatal intensive care unit (NICU) than infants whose mothers had not taken any medication or had taken off their medication prior to or during pregnancy. This increase was due to central nervous system-related disorders and the higher risk of admission was not found to be affected by the type of stimulant medications were used during pregnancy.
Women who took stimulant ADHD medications during pregnancy also had a higher risk of having to have an emergency caesarean section or having the baby was not scoring well on the Apgar scale (less than 7). These increases did appear to be unrelated to the type of medication taken during pregnancy.
The researchers suggest that the low risk associated 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 continued treatment for the woman's disorder. Doctors should discuss with their patients about this issue and as much as possible, assist them develop coping strategies that may reduce the impact of her disorder in her daily life and relationships.
Medication Interactions
More and more doctors are faced with the decision of whether to keep treatment or stop it during pregnancy as more women are diagnosed with ADHD. Most of the time, these decisions are taken in the absence of solid and reliable evidence either way, so physicians have to weigh their experience from their own experiences, those of other doctors, and what the research suggests about the subject as well as their own best judgment for each patient.
In particular, the issue of possible risks to the infant can be difficult. The research that has been conducted on this topic is based on observations rather than controlled studies and the results are conflicting. Additionally, the majority of studies limit their analysis to live births, which may underestimate the severity of teratogenic effects that could result in abortion or termination of the pregnancy. The study that is discussed in the journal club addresses these issues, by examining both the data from deceased and live births.
Conclusion: While some studies have shown an association between ADHD medications and certain birth defects However, other studies haven't found a correlation. Most studies have shown a neutral, or even somewhat negative, impact. In all cases, a careful study of the potential risks and benefits is required.
It can be challenging, if not impossible for women with ADHD to stop taking their medication. In a recent article published in the Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can lead to depression and feelings of being isolated. Furthermore, a loss of medication may affect the ability to do work-related tasks and safely drive, which are important aspects of daily life for a lot of people with ADHD.
She suggests women who are unsure about whether or not to stop taking medication because of their pregnancy, consider the possibility of educating friends, family members and colleagues about the condition, its effects on daily functioning, and the advantages of continuing the current treatment regimen. It can also aid in ensuring that the woman feels supported in her struggle with her decision. It is important to note that certain medications are able to pass through the placenta, so if the patient decides to discontinue her ADHD medication during pregnancy and breastfeeding, she should be aware of the possibility that traces of the drug 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) is increasing, so does concern about the possible effects of the drugs on foetuses. A recent study published in the journal Molecular Psychiatry adds to the existing knowledge on this subject. Utilizing two huge data sets, researchers were able to examine more than 4.3 million pregnancies and determine whether stimulant medications increased the risk of birth defects. Researchers discovered that, while the risk overall is low, first-trimester ADHD exposure to medication was associated with slightly higher rates of certain heart defects, like ventriculoseptal defect.
The researchers of the study could not discover any connection between early use of medication and other congenital anomalies like facial deformities, or club feet. The results are in agreement with previous studies which showed a small, but significant increase in the number of cardiac malformations among women who started taking ADHD medication prior to pregnancy. The risk increased in the latter stages of pregnancy when many women stopped taking their medication.
Women who used ADHD medications in the first trimester of their pregnancy were also more likely to experience caesarean sections, a low Apgar score following delivery, and a baby who needed help breathing at birth. The authors of the study were unable to eliminate selection bias because they restricted the study to women without other medical conditions that might have contributed to the findings.
Researchers hope their research read more will help doctors when they meet pregnant women. They suggest that although discussing the risks and benefits is crucial, the decision to stop or continue medication should be based on the woman's requirements and the severity of her ADHD symptoms.
The authors caution that, although stopping the medication is a possibility to think about, it isn't recommended due to the high prevalence of depression and mental health issues among women who are pregnant or recently gave birth. Furthermore, research suggests that women who decide to stop 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 overwhelming to become a mom. Women suffering from ADHD may face a lot of challenges when they must manage their symptoms, attend doctor appointments, prepare for the birth of a baby and adjust to a new routine. Many women decide to continue taking their ADHD medication during pregnancy.
The risk to breastfeeding infant is minimal because the majority of stimulant medications passes through breast milk in low amounts. However, the frequency of exposure to medications by the newborn may differ based on the dosage, frequency it is taken and the time of day it is administered. Additionally, different medications enter the infant's system differently through the gastrointestinal tract as well as breast milk and the impact of this on a newborn is not fully understood.
Some physicians may discontinue stimulant medications during a woman's pregnancy due to the lack 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. As long as there is no more information, GPs should ask all pregnant patients about their experience with ADHD and whether they are planning or taking to take medication during the perinatal time.
Numerous studies have demonstrated that women can continue to take their ADHD medication safely during pregnancy and breast-feeding. In the end, many patients choose to do so and after consulting with their doctor, they have discovered that the benefits of maintaining their current medication far outweigh any 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 review their medications with their physician and discuss the advantages and disadvantages of continued treatment, including non-pharmacological strategies. Psychoeducation is also required to help pregnant women suffering from ADHD recognize the signs and the underlying disorder. They should also learn about treatment options and reinforce coping mechanisms. This should be a multidisciplinary effort together with obstetricians, GPs and psychiatry. Counselling for pregnancy should include discussion of a management plan for both the mother as well as the child, monitoring for signs of deterioration, and when necessary, making adjustments to the medication regimen.