ADHD Medication During Pregnancy and Breastfeeding
Women suffering from ADHD must make a difficult decision about whether to continue or stop taking ADHD medication during pregnancy and breast-feeding. There is a lack of information about how long-term exposure to these drugs may affect the fetus.
A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication during the uterus don't develop neurological developmental disorders like hearing or vision impairment seizures, febrile seizures, or IQ impairment. The authors acknowledge that further high-quality studies are required.
Risk/Benefit Analysis
Women who are pregnant and take ADHD medication should consider the benefits of taking it versus the risks to the fetus. Physicians don't have the data to provide clear recommendations, but can provide information about 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 their early pregnancy were not at greater risk of fetal malformations or structural birth defects. Researchers conducted a large population-based study of case-control to evaluate the incidence of major structural birth defects in babies born to mothers who took stimulants during the early stages of pregnancy and those who had not. Pediatric cardiologists, clinical geneticists and other experts looked over the cases to ensure that the classification was accurate and to minimize any bias.
However, the study was not without its flaws. In particular, they were unable to separate the effects of the medication from the disorder at hand. This limitation makes it difficult to determine whether the limited associations observed in the groups that were exposed result from medication use or the confounding effect of comorbidities. In addition the researchers did not study the long-term outcomes of offspring.
The study revealed that babies whose mothers took ADHD medication during pregnancy had a greater risk of being admitted to the neonatal care unit (NICU) as compared to mothers who did not take any medication during pregnancy or had stopped taking their medication before or during pregnancy. The reason for this was 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 were taking stimulant ADHD medication during pregnancy also had an increased chance of having a caesarean delivery or having a baby with an low Apgar score (less than 7). These risks did not seem to be influenced by the type of medication that was used during pregnancy.
Researchers suggest that the small risks associated with the use ADHD medications in early pregnancies can be offset by more beneficial outcomes for both mother and baby from continuing treatment for the woman's condition. Physicians should discuss the issue with their patients and, if possible, help them develop strategies for improving their coping skills that can lessen the impact of her disorder on her daily life and relationships.
Medication Interactions
Many doctors are faced with the decision of whether to continue treatment or stop it during pregnancy as more women are diagnosed with ADHD. The majority of these decisions are made without solid and reliable evidence regardless, so doctors have to weigh their experience about their experiences, the experiences of other doctors, and what research suggests on the subject, along with their best judgment for each individual patient.
The issue of possible risks for infants can be extremely difficult. Many of the studies on this subject are based on observational data rather than controlled research and their conclusions are often contradictory. Additionally, the majority of studies limit their analysis to live births, which could underestimate the severity of teratogenic effects that could result in abortion or termination of the pregnancy. The study presented in this journal club addresses these shortcomings by examining data on both live and deceased births.
The conclusion: While some studies have shown that there is a positive correlation between ADHD medications and the risk of certain birth defects, other studies have found no such relationship, and most studies demonstrate a neutral or slightly negative impact. In the end, a careful risk/benefit analysis is required in every situation.
For a lot of women with ADHD, the decision to stop medication is difficult if not impossible. In a recent piece published in 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. Additionally, the loss of medication can interfere with the ability to do jobs and drive safely that are crucial aspects of daily life for a lot of people with ADHD.
She suggests that women who are unsure whether to continue taking the medication or discontinue it due to pregnancy educate family members, colleagues, and acquaintances about the condition, its effects on daily functioning, and the benefits of continuing the current treatment regimen. It can also make the woman feel more comfortable in her struggle with her decision. Certain medications can be passed through the placenta. If a woman decides not to take her ADHD medication while breastfeeding, it is important to be aware that the medication could be passed on to her infant.
Birth Defects Risk
As the use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases, so do concerns over the impact that these drugs might have on the fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge on this subject. Using two massive data sets, researchers were able to analyze more than 4.3 million pregnancies and determine whether stimulant medications increased the risk of birth defects. While the overall risk is low, the researchers found that exposure in the first trimester to ADHD medicines was associated with a slightly higher rate of specific heart defects, like ventriculo-septal defects (VSD).
The researchers of the study could not discover any link between early use of medication and congenital anomalies such as facial deformities or club feet. The results are in agreement with previous studies which showed an insignificant, but small increase in cardiac malformations for women who started taking ADHD medication before the birth of their child. This risk increased during the latter half of pregnancy, when a lot of women decided to stop 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 following delivery, and a baby who needed breathing assistance during birth. The researchers of the study were unable to eliminate selection bias because they limited the study to women without other medical conditions that could have contributed to the findings.
Researchers hope that their study will help doctors when they encounter pregnant women. They recommend that, while discussing risks and benefits is important but the decision to stop or maintain treatment must be based on each woman's needs and the severity of her ADHD symptoms.
The authors also caution that, while stopping the medication is an alternative, it is not an option that is recommended due to the high incidence of depression and other mental health issues in women who are pregnant or who are recently post-partum. Furthermore, research suggests that women who choose to stop taking their medication are more likely to have difficulties adapting to life without them after the birth of their baby.
Nursing
The responsibilities of a new mother can be overwhelming. Women suffering from ADHD may face a lot of challenges when they must manage their symptoms, attend doctor appointments, prepare for the birth of their child and adjust to a new routine. Many women choose to continue taking their ADHD medication during pregnancy.
The majority of stimulant medicines pass through breast milk in very small amounts, therefore the risk to the nursing infant is very low. However, the frequency of medication exposure to the newborn may differ based on dosage, frequency it is administered and at what time the medication is administered. Additionally, different medications enter the infant's system differently through the gastrointestinal tract as well as breast milk. The impact of this on a newborn is not yet fully known.
best adhd medication for adults uk may discontinue stimulant medications during a woman's pregnancy due to the lack of research. This is a complicated decision for the patient, who must balance the benefits of keeping her medication with the potential dangers to the foetus. In the meantime, until more information is available, GPs should ask all pregnant patients about their experience with ADHD and whether they plan or are taking to take medication during the perinatal period.
Numerous studies have proven that women can continue taking their ADHD medication without risk during pregnancy and breast-feeding. In response, a rising number of patients are choosing to continue their medication. They have concluded after consulting with their doctor that the benefits of continuing their current medication outweigh potential risks.
Women with ADHD who plan to breastfeed should seek the advice of an expert psychiatrist prior to becoming pregnant. They should discuss the medication they are taking with their physician and discuss 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 be educated about treatment options and build strategies for coping. This should be a multidisciplinary effort together with obstetricians, GPs, and psychiatry. Pregnancy counseling should include discussion of a treatment plan for the mother as well as the child, and monitoring for signs of deterioration, and, if needed, adjustments to the medication regimen.