ADHD Medication During Pregnancy and Breastfeeding
The choice of whether to stop or continue ADHD medications during pregnancy and nursing is challenging for women with the condition. There isn't much information on how long-term exposure to these medications may affect the foetus.
A recent study published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological issues such as impaired hearing or vision, 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 weigh the benefits of taking it against the potential dangers for the foetus. Physicians do not have the data needed to make unequivocal recommendations, but they can provide information on risks and benefits that assist pregnant women in making 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 massive population-based case control study to compare the incidence of structural defects that were major in infants who were born to mothers who were taking stimulants during pregnancy. Clinical geneticists, pediatric cardiologists and other experts examined the cases to confirm that the classification was correct and to eliminate any bias.
The research conducted by the researchers was not without limitations. Most important, they were unable to separate the effects of the medication from the effects of the disorder at hand. That limitation makes it difficult to determine whether the small associations observed in the groups that were exposed are due to medication use or comorbidities that cause confusion. In addition the researchers did not examine the long-term effects of offspring on their parents.
The study did find that infants whose mothers had taken ADHD medication during pregnancy were at a slightly higher risk of being admitted to the neonatal intensive care unit (NICU) than infants who whose mothers did not take any medication or stopped their medications before or during pregnancy. This was due to central nervous system-related disorders and the increased risk for admission did not appear to be influenced by which stimulant medications were taken during pregnancy.
Women who were taking stimulant ADHD medication during pregnancy were also at an increased chance of having a caesarean section or having a baby born with low Apgar score (less than 7). These increases did not appear to be influenced by the kind of medication used during pregnancy.
Researchers suggest that the minor risk of using ADHD medications in early pregnancies can be offset by greater benefits to both mother and baby of continuing treatment for the woman's disorder. Physicians should talk to their patients about this issue and try to help them improve coping skills which can lessen the impact of her disorder in her daily life and relationships.
Interactions with Medication
Many doctors are faced with the decision of whether to maintain treatment or stop it during pregnancy as more women are diagnosed with ADHD. These decisions are frequently taken without clear and authoritative evidence. Instead, doctors must weigh their own knowledge and experience, as well as the experiences of other physicians and the research on the subject.
In particular, the issue of possible risks to the baby can be tricky. Many of the studies on this topic are based on observational data rather than controlled research and their findings are often contradictory. In addition, most studies limit their analysis to live births, which can underestimate severe teratogenic effects that lead to abortion or termination of the pregnancy. The study that is discussed in this journal club addresses these issues by analyzing data on live and deceased births.
The conclusion is that while some studies have shown a positive association between ADHD medications and the risk of certain birth defects, other studies have found no such relationship and the majority of studies have a neutral or slightly negative impact. In every case, a careful evaluation of the benefits and risks is required.
For many women with ADHD, the decision to discontinue medication can be difficult, if not impossible. 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. A loss of medication may also affect the ability to safely drive and complete work-related tasks, which are vital aspects of everyday life for people with ADHD.
She recommends women who are unsure about whether to continue or stop medication in light of their pregnancy, consider educating family members, friends and colleagues about the condition, its impact on daily functioning, and the advantages of continuing the current treatment regimen. Educating them can also make the woman feel more comfortable as she struggles with her decision. Certain medications can pass through the placenta. If a woman decides to not take her ADHD medication while breastfeeding, it is important to be aware that the drug may be transferred to her infant.
Risk of Birth Defects
As the use and abuse of ADHD medications to treat the symptoms of attention deficit disorder hyperactivity disorder (ADHD) is increasing as does the concern about the possible effects of the drugs on fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge regarding this subject. Researchers utilized two massive data sets to study more than 4.3 million pregnancy and determine if the use of stimulant medications increased birth defects. Researchers discovered that, while the risk overall is low, the first trimester ADHD medication use was associated with slightly higher rates of specific heart defects like ventriculoseptal defect.
The authors of the study found no connection between early use of medication and congenital abnormalities like facial clefting, or club foot. The results are consistent with previous studies that have shown an increase, but not significant, in the risk of heart malformations among women who began taking ADHD medications before the birth of their child. This risk increased during the latter stages of pregnancy when a large number of women began to stop taking their medication.
Women who took ADHD medication in the first trimester of their pregnancy were also more likely to experience caesarean section, low Apgar score after delivery and a baby who needed help breathing at birth. The researchers of the study were unable to remove bias in selection since they limited the study to women with no other medical conditions that might have contributed to the findings.
The researchers hope their research will aid in the clinical decisions of doctors who encounter pregnant women. The researchers suggest that while discussing benefits and risks are crucial, the decision about whether to continue or stop medication should be in light of the severity of each woman's ADHD symptoms and the needs of the woman.
The authors also advise that even though stopping the medication is an alternative, it is not an option to consider due to the high incidence of depression and other mental health issues among women who are pregnant or who are recently postpartum. Additionally, research suggests that women who stop taking their medications will have a harder adjustment to life without them once the baby is born.
Nursing
It can be a challenge becoming a mother. Women who suffer from ADHD can face severe challenges when they must deal with their symptoms, attend doctor appointments and prepare for the birth of their child and adjust to new routines. Many women choose to continue taking their ADHD medication during pregnancy.
The majority of stimulant medicines are absorbed through breast milk in small amounts, therefore the risk to breastfeeding infant is minimal. However, the rate of exposure to medication by the newborn may differ based on dosage, frequency it is administered, and the time of day it is administered. In addition, different medications are introduced into the baby's system via the gastrointestinal tract, or through breast milk. The effect on a newborn's health is not completely known.
Because of the lack of research, some physicians might be tempted to stop taking stimulant medications during the course of pregnancy. This is a difficult decision for the patient, who must balance the benefits of continuing her medication against the potential dangers to the fetus. In the meantime, until more information is available, doctors should inquire with all pregnant patients about their history of ADHD and whether they are taking or planning to take medication during the perinatal period.
Numerous studies have proven that women can continue to take their ADHD medication in a safe manner during pregnancy and breast-feeding. In response, a rising number of patients are opting to do so. They have discovered, in consultation with their doctors that the benefits of retaining their current medication outweigh risk.
Women who suffer from ADHD who plan to breastfeed should seek advice from a specialist psychiatrist before becoming pregnant. They should discuss the medication they are taking with their physician as well as the pros and cons of continuing treatment. This includes non-pharmacological strategies. Psychoeducation should also be provided to help pregnant women suffering from ADHD recognize their symptoms and the underlying disorder and learn about treatment options and reinforce existing strategies for managing. This should include a multidisciplinary approach with the GP doctors, obstetricians and psychiatrists. medication for adhd in adults should include discussion of a treatment plan for the mother as well as the child, and monitoring for indicators of deterioration, and, if needed modifications to the medication regime.