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 breast-feeding. There aren't many studies on how long-term exposure may affect the fetus.
A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication during utero do not develop neurological conditions like hearing or vision impairment seizures, febrile seizures or IQ impairment. The authors acknowledge that more high quality studies are required.
Risk/Benefit Analysis
Pregnant women who take ADHD medications must weigh the benefits of taking them against the potential risks to the fetus. Physicians do not have the information needed to provide clear recommendations, but they can provide information about benefits and risks that can assist pregnant women in making informed decisions.
A study published in Molecular Psychiatry found that women who were taking ADHD medications during their early pregnancy did not have an increased risk of fetal heart malformations or major birth defects that are structural. Researchers conducted a massive population-based study of case control to examine the prevalence of structural defects that were major in infants born to mothers who used stimulants during pregnancy. Pediatric cardiologists, clinical geneticists and other experts looked over the cases to make sure that the classification was accurate and to eliminate any bias.
The study conducted by the researchers was not without its limitations. Most important, they were unable to distinguish the effects of the medication from the underlying disorder. This limitation makes it difficult for researchers to determine whether the small associations observed among the groups that were exposed to the use of medications or if they were caused by co-morbidities. In addition the researchers did not look at the long-term outcomes of offspring.
The study did find that babies whose mothers had taken ADHD medications 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 cut back on their medications prior to or during pregnancy. This increase was caused by central nervous system disorders. The increased risk of admission was not affected by the stimulant medication used during pregnancy.
Women who were taking stimulant ADHD medication during pregnancy also had an increased chance of having a caesarean section or having a baby born with an low Apgar score (less than 7). These increases did appear to be independent of the type of medication used during pregnancy.
The research suggests that the low risk associated with the use of ADHD medications during early pregnancy could be offset by the greater benefit to both mother and child from continued treatment for the woman's disorder. Physicians should discuss the issue with their patients and, where they are able, assist them in developing strategies for improving their coping skills that may minimize the effects of her disorder on her daily life and relationships.
Medication Interactions
Many doctors are confronted with the dilemma of whether to maintain treatment or stop during pregnancy as more women are diagnosed with ADHD. These decisions are often made without clear and authoritative evidence. Instead, doctors have to weigh their own knowledge, the experience of other doctors and the research that has been conducted on the subject.
The issue of possible risks for infants can be extremely difficult. The research on this issue is based on observations rather than controlled studies, and a lot of the results are conflicting. The majority of studies focus on live births, which can underestimate the teratogenic impact leading to abortions or terminations of pregnancy. The study discussed in the journal club addresses these limitations by analyzing data on live and deceased births.
The conclusion The conclusion: While some studies have found a positive association between ADHD medications and the possibility of certain birth defects, others have found no connection, and most studies demonstrate a neutral or slightly negative effect. In the end an accurate risk-benefit analysis is required in every situation.
For a lot of women with ADHD and ADD, the decision to stop taking medication is difficult if not impossible. In an article published in the Archives of Women's Mental Health, psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can increase depression, feelings of loneliness, and family conflict for patients with ADHD. The loss of medication can affect the ability to safely drive and to perform work-related tasks which are crucial aspects of daily life for those suffering from ADHD.
She suggests that women who are not sure whether to continue taking the medication or stop due to pregnancy educate family members, coworkers, and their friends about the condition, the impact on daily functioning and the benefits of keeping the current treatment regimen. It will also help a woman feel confident about her decision. Certain medications can pass through the placenta. If a woman decides to not take her ADHD medication while breastfeeding, it's important to be aware that the medication could be passed on to her baby.
Birth Defects Risk
As the use of ADHD more info drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases there are concerns about what impact the medications could have on fetuses. A recent study published in the journal Molecular Psychiatry adds to the body of knowledge about this subject. Researchers used two massive data sets to study more than 4.3 million pregnancy and determine whether stimulant medications increased birth defects. Although the risk overall remains low, the researchers did find that first-trimester exposure to ADHD medicines was associated with an increased risk of certain heart defects, such as ventriculo-septal defect (VSD).
The authors of the study did not find any association between early use of medication and other congenital anomalies, like facial deformities, or club feet. The results are in line with previous studies that have shown an increase, but not significant, in the risk of cardiac malformations in women who started taking ADHD medications prior to the time of pregnancy. This risk increased during the latter part of pregnancy when a large number of women began to stop taking their medication.
Women who took ADHD medication in the first trimester were more likely to require a caesarean birth or have an insufficient Apgar after delivery and have a baby who needed breathing assistance at birth. The authors of the study could not eliminate bias due to selection because they limited their study to women with no other medical conditions that could have contributed to the findings.
The researchers hope their research will serve to inform the clinical decisions of doctors who encounter pregnant women. The researchers advise that while discussing risks and benefits are crucial, the decision regarding whether or not to stop medication should be made in light of the severity of each woman's ADHD symptoms and her needs.
The authors also warn that, while stopping the medication is an alternative, it is not a recommended practice because of the high incidence of depression and other mental health issues in women who are pregnant or who are recently postpartum. Further, research shows that women who stop taking their medications will have a tough transitioning to life without them after the baby is born.
Nursing
It can be a stressful experience to become a mom. Women with ADHD who must work through their symptoms while attending doctor appointments, preparing for the arrival of a child and adjusting to new household routines are often faced with a number of difficulties. Many women choose to continue taking their ADHD medication during pregnancy.
The majority of stimulant medications are absorbed by breast milk in very small quantities, so the risk for breastfeeding infant is minimal. However, the frequency of exposure to medication by the newborn can vary depending on the dosage, frequency it is administered and the time of the day it is administered. Additionally, individual medications enter the infant's system differently through the gastrointestinal tract and breast milk and the impact of this on a newborn infant is not well understood.
Due to the absence of research, some doctors may recommend stopping stimulant drugs during a woman's pregnancy. It's a difficult choice for the woman who must weigh the benefits of taking her medication as well as the risks to the foetus. As long as there is no more information, doctors should ask all pregnant patients about their history of ADHD and whether they are planning or taking to take medication during the perinatal period.
Numerous studies have demonstrated that women can continue taking their ADHD medication safely during pregnancy and breast-feeding. As a result, an increasing number of patients choose to do so and after consulting with their doctor, they have discovered that the benefits of keeping their current medication far outweigh any risks.
It is crucial for women suffering from ADHD who are considering breastfeeding to seek out a specialist psychiatrist's advice prior becoming pregnant. They should discuss their medication with their doctor and discuss the pros and cons of continued treatment, including non-pharmacological strategies. Psychoeducation should also be offered to help pregnant people with ADHD recognize their symptoms and underlying disorder and learn about treatment options and strengthen existing strategies for managing. This should be a multidisciplinary process with the GPs, obstetricians and psychiatrists. The pregnancy counselling should consist of the discussion of a treatment plan for both the mother and child, and monitoring for signs of deterioration, and, if necessary, adjustments to the medication regimen.