ADHD Medication During Pregnancy and Breastfeeding
Women suffering from ADHD must make a difficult decision on whether to keep or stop taking ADHD medication during pregnancy and breast-feeding. There aren't many studies regarding how exposure over time may affect a fetus.
A recent study published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological problems such as hearing loss or vision, febrile seizures, or IQ impairment. The authors acknowledge the need for more high-quality research.
Risk/Benefit Analysis
Pregnant women who use ADHD medications must weigh the advantages of taking them against the potential risks to the fetus. Physicians don't have the necessary data to provide clear recommendations, but they can provide information on benefits and risks that can assist pregnant women in making informed decisions.
A study published in Molecular Psychiatry found that women who took ADHD medications in early pregnancy did not face a significantly increased risk of fetal heart malformations or major structural birth defects. Researchers used a large sample-based case control study to examine the prevalence of major structural defects in infants born to mothers who were taking stimulants during pregnancy. Pediatric cardiologists and clinical geneticists looked over the cases to ensure an accurate case classification and to limit the possibility of bias.
However, the study was not without its flaws. In particular, they were unable to distinguish the effects of the medication from the underlying disorder. That limitation makes it difficult to know whether the limited associations observed in the groups that were exposed are due to the use of medication or comorbidities that cause confusion. Researchers also did not study long-term outcomes for offspring.
The study found that infants whose mothers had taken ADHD medication during pregnancy had a slightly higher risk of admission to the neonatal care unit (NICU) as compared to those whose mothers 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 disorders, and the higher risk of admission did not appear to be influenced by which stimulant medications were taken during pregnancy.
Women who were taking stimulant ADHD medications during pregnancy also had a higher risk of having to have a caesarean section or the baby was not scoring well on the Apgar scale (less than 7). These increases did not appear to be influenced by the type of medication that was 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 mother and child of continued treatment for the woman's condition. Physicians should speak with their patients about this issue and as much as possible, assist them develop coping strategies that could reduce the impact of her disorder in her daily functioning and her relationships.
Medication Interactions
Doctors are increasingly confronted with the dilemma of whether to keep treatment or stop during pregnancy as more women are diagnosed with ADHD. The majority of these decisions are taken in the absence of clear and authoritative evidence either way, so physicians must weigh their knowledge from their own experiences, those of other doctors, and what research says on the topic as well as their best judgment for each patient.
The issue of possible risks for infants can be extremely difficult. Many of the studies on this topic are based on observations rather than controlled research, and their conclusions are often contradictory. Additionally, the majority of studies limit their analysis to live births, which may underestimate severe teratogenic effects that cause abortion or termination of the pregnancy. The study discussed in this journal club addresses these limitations by examining data on both live and deceased births.
Conclusion: While some studies have shown an association between ADHD medications and certain birth defects, other studies have not established a link. Most studies have shown that there is a neutral, or slight negative effect. In all cases an in-depth study of the potential risks and benefits should be conducted.
For women suffering from ADHD and ADD, the decision to stop medication is difficult, if not impossible. In a recent article in Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can cause depression and feelings of isolation. Additionally, the loss of medication can interfere with the ability to perform work-related tasks and safely drive that are crucial aspects of a normal life for a lot of people with ADHD.
She recommends women who are unsure about whether to continue or discontinue medication due to their pregnancy should consider educating family members, friends and colleagues about the condition, its effects on daily life, and the advantages of continuing the current treatment regimen. It can also make the woman feel more comfortable as she struggles with her decision. It is important to remember that some medications can pass through the placenta, so if the patient decides to stop her ADHD medication during pregnancy and breastfeeding, she should be aware that traces of the drug could be transferred to the child.
Birth Defects and Risk of
As the use of ADHD medication to treat the symptoms of attention deficit hyperactivity disorder (ADHD) increases as do concerns over the impact that these drugs could have on fetuses. A recent study published in the journal Molecular Psychiatry adds to the body of information on this topic. Researchers used two massive data sets to study more than 4.3 million pregnancy and determine whether stimulant medications caused birth defects. Click On this website found that while the risk overall is low, first-trimester ADHD medication exposure was associated with slightly higher rates of certain heart defects, like ventriculoseptal defects.
The researchers of the study didn't find any association between early medication usage and congenital anomalies such as facial deformities or club feet. The findings are in line with previous studies that have shown the presence of a small, but significant increase in the risk of cardiac malformations in women who started taking ADHD medications before the time of pregnancy. The risk grew during the latter part of pregnancy, when a lot of women begin to discontinue their ADHD medications.
Women who used ADHD medication in the first trimester of pregnancy were also more likely to experience caesarean section, low Apgar score following delivery, and a baby who needed help breathing at birth. The researchers of the study could not eliminate bias due to selection because they limited the study to women without other medical conditions that might have contributed to the findings.
Researchers hope their research will provide doctors with information when they encounter pregnant women. They advise that while the discussion of risks and benefits is important, the decision to stop or keep medication must be based on each woman's needs and the severity of her ADHD symptoms.
The authors warn that, even though stopping the medication is an option to think about, it isn't advised due to the high rate depression and other mental problems for women who are pregnant or have recently given birth. Further, research shows that women who stop taking their medication will have a harder adjustment to life without them once the baby is born.
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 a child and adjust to a new routine. Many women choose to continue taking their ADHD medication during pregnancy.
The majority of stimulant drugs pass through breast milk in low amounts, so the risk to the breastfeeding infant is minimal. However, the frequency of medication exposure to the newborn can vary depending on the dosage, frequency it is administered and the time of day it is administered. Additionally, different medications enter the baby’s system via the gastrointestinal tract or breast milk. The impact of these medications on the health of a newborn is not fully understood.
Some doctors may decide to stop stimulant medications during a woman's pregnancy due to the absence of research. This is a difficult decision for the woman who must weigh the advantages of continuing her medication against the potential risks to the embryo. As long as there is no more information, doctors should inquire with all pregnant patients about their history of ADHD and if they are planning or taking to take medication during the perinatal period.
Numerous studies have demonstrated that women can continue to take their ADHD medication in a safe manner during pregnancy and while breast-feeding. In response, an increasing number of patients are choosing to continue their medication. They have discovered after consulting with their physicians that the benefits of continuing their current medication outweigh possible risks.
It's important for women with ADHD who are considering breastfeeding to seek out a specialist psychiatrist's advice prior becoming pregnant. They should review their medications with their physician and discuss the pros and cons of continued treatment, including non-pharmacological management strategies. Psychoeducation should also be offered to help pregnant people with ADHD recognize their symptoms and the underlying disorder and learn about treatment options and strengthen existing strategies for managing. This should include a multidisciplinary approach, which includes the GP, obstetricians and psychiatry. Counselling for pregnancy should include the discussion of a plan for management for both the mother as well as the child, as well as monitoring for signs of deterioration, and, if necessary, adjustments to the medication regimen.