ADHD Medication During Pregnancy and Breastfeeding
The choice of whether to stop or continue ADHD medication during pregnancy and nursing is a difficult decision for women suffering from the condition. There aren't enough data regarding how exposure over time may affect the pregnant fetus.
related internet page published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological issues such as hearing loss or vision, febrile seizures or IQ impairment. The authors acknowledge the need for higher-quality studies.
Risk/Benefit Analysis
Pregnant women who take ADHD medications need to balance the advantages of using them against the risks to the foetus. Doctors don't have enough data to provide clear recommendations however they can provide information on risks and benefits to help pregnant women make informed decisions.
A study published in Molecular Psychiatry concluded that women who took ADHD medication in early pregnancy were not at higher risk of fetal malformations or structural birth defects. Researchers used a vast population-based study of case-control to determine the prevalence of major structural birth defects in babies born to mothers who had taken stimulants during early pregnancy and those who had not. Pediatric cardiologists, clinical geneticists and other experts reviewed the cases in order to ensure that the classification was accurate and to minimize any bias.
However, the study had its limitations. The most important issue was that they were unable to distinguish the effects of the medication from those of the disorder that is underlying. This makes it difficult for researchers to determine if the few associations observed between the groups that were exposed to the use of medications or confounded by co-morbidities. Additionally the researchers did not examine long-term offspring outcomes.
The study found that infants whose mothers had taken ADHD medication during pregnancy were at a slightly higher chance of being admitted to the neonatal care unit (NICU) as compared to those whose mothers did not use any medication during pregnancy or had quit taking the medication prior to or during pregnancy. The reason for this was central nervous system disorders. The increased risk of admission was not affected by the stimulant medications used during pregnancy.
Women who were taking stimulant ADHD medications during pregnancy also had a higher likelihood of having to have caesarean sections or one whose baby scored low on the Apgar scale (less than 7). These increases did not appear to be affected 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 may be offset by the more beneficial outcomes for both mother and baby from continuing treatment for the woman’s disorder. Physicians should discuss the issue with their patients and, when possible, assist them in developing strategies to improve coping skills that may minimize the effects of her disorder on her daily life and relationships.
Medication Interactions
More and more doctors are confronted with the dilemma of whether to continue 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 in either case, which means that doctors must weigh their knowledge about their experiences, the experiences of other doctors, and what the research suggests about the subject and their best judgment for each patient.
Particularly, the subject of potential risks for the infant can be difficult. Many studies on this topic are based on observational evidence rather than controlled research and their conclusions are often contradictory. The majority of studies limit their analysis to live births, which can underestimate the severity of teratogenic effects leading to abortions or terminations of pregnancy. The study that is discussed in this journal club addresses these issues by examining data on both live and deceased births.
Conclusion A few studies have shown a positive correlation between ADHD medications and certain birth defects however, other studies haven't found a correlation. The majority of studies show an unintended, or slight negative effect. In every case, a careful evaluation of the risks and benefits is required.
It can be difficult, if not impossible, for women with ADHD to stop taking their medication. 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 increase depression and feelings of being isolated. Additionally, the loss of medication can affect the ability to do jobs and drive safely, which are important 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 should educate family members, coworkers, and their friends about the condition, the impact on daily functioning and the benefits of keeping the current treatment. It can also help women feel supported in her decision. Certain medications can pass through the placenta. If the patient decides not to take her ADHD medication while breastfeeding, it is important to be aware that the drug may be transferred to her baby.
Birth Defects and Risk of
As the use and abuse of ADHD medication to treat symptoms of attention deficit disorder hyperactivity disorder (ADHD) is increasing the concern over the potential effects of these drugs on fetuses. A study that was published in the journal Molecular Psychiatry adds to the existing knowledge about this subject. Researchers used two huge data sets to examine more than 4.3 million pregnancy and determine if stimulant medication use increased birth defects. Researchers found that while the overall risk is low, the first trimester ADHD exposure to medication was associated with slightly higher risk of certain heart defects, such as ventriculoseptal defect.
The researchers behind the study found no association between the use of early medications and other congenital abnormalities, such as facial clefting or club foot. The results are in the same vein as previous studies which showed an insignificant, but small increase in cardiac malformations for women who started taking ADHD medication before the time of pregnancy. The risk was higher during the latter part of pregnancy, when a lot of women are forced to stop taking their ADHD medication.
Women who were taking ADHD medication in the first trimester were more likely need a caesarean, have an insufficient Apgar after birth and have a baby that needed breathing assistance when they were born. The authors of the study were unable to remove bias in selection since they limited their study to women without other medical conditions that might have contributed to the findings.
Researchers hope that their study will help doctors when they meet pregnant women. They recommend that, while the discussion of 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 caution that, even though stopping the medication is an option to look into, it is not recommended due to the high prevalence of depression and other mental disorders in women who are expecting or recently gave birth. Furthermore, research suggests that women who decide to stop their medications are more likely to have difficulties getting used to life without them after the birth of their baby.
Nursing
The responsibilities of being a new mom can be overwhelming. Women with ADHD may face a lot of challenges when they must manage their symptoms, go to doctor appointments and 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 risk to a nursing infant is low because the majority of stimulant medications passes through breast milk at a low level. The amount of exposure to medications can vary depending upon the dosage, frequency of administration and time of day. In addition, individual medications enter the infant's system differently through the gastrointestinal tract and breast milk, and the effect of this on a newborn is not yet fully known.
Because of the lack of research, some doctors may be inclined to discontinue stimulant medication during the course of pregnancy. This is a difficult choice for the patient, who must balance the benefits of continuing her medication against the potential risks to the embryo. Until more information is available, GPs should ask all pregnant patients about their experience with 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 while breast-feeding. As a result, many patients opt to do this, and after consulting with their doctor, they have found that the benefits of continuing their current medication outweigh any potential risks.
Women with ADHD who are planning to nurse should seek the advice of a specialist psychiatrist prior to becoming pregnant. They should discuss the medication they are taking with their physician, and the pros and cons for continuing treatment. This includes non-pharmacological strategies. Psychoeducation is also necessary to help pregnant women with ADHD understand the symptoms and the underlying disorder. They should also be informed about treatment options and reinforce coping mechanisms. This should be a multidisciplinary effort including obstetricians, GPs and psychiatry. Pregnancy counseling should consist of a discussion of a treatment plan for the mother and child, and monitoring for signs of deterioration, and, if needed, adjustments to the medication regime.