ADHD Medication During Pregnancy and Breastfeeding
Women with ADHD must make a difficult decision regarding whether or not to stop taking ADHD medication during pregnancy and breastfeeding. There are few data on how long-term exposure may affect the foetus.
A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus do not develop neurological developmental disorders such as hearing loss or impaired vision, febrile seizures, or IQ impairment. The authors acknowledge that more high quality studies are required.
Risk/Benefit Analysis
Pregnant women who take ADHD medications need to balance the benefits of using them against the risks to the fetus. Physicians don't have the data to make unambiguous recommendations but they can provide information on the risks and benefits to aid pregnant women in making informed decisions.
A study published in Molecular Psychiatry found that women who used ADHD medications during their early pregnancy did not face a significantly increased risk of fetal cardiac malformations or major birth defects that are structural. Researchers conducted a large, population-based case-control study to determine the prevalence of major structural birth defects in infants born to mothers who had taken stimulants in early pregnancy, and those who did not. Clinical geneticists, pediatric cardiologists and other experts examined the cases to ensure that the classification was correct and to eliminate any bias.
However, the researchers' study was not without its flaws. Most important, they were unable to separate the effects of the medication from those of the underlying disorder. This limitation makes it difficult to know whether the limited associations observed in the exposed groups are due to the use of medication or confounding by comorbidities. Researchers also did not study long-term outcomes for offspring.
The study did reveal that infants whose mothers took ADHD medication during pregnancy were at slightly higher risk of being admitted to the neonatal intensive care unit (NICU) than those who were born without any medication or had taken off their medication prior to or during pregnancy. This increase was caused by central nervous system disorders. The increased risk of admission was not influenced by the stimulant medication that was used during pregnancy.
Women who were taking stimulant ADHD medication during pregnancy also had an increased risk of having a caesarean birth or having a baby born with an low Apgar score (less than 7). These increases didn't appear to be affected by the type of medication that was used during pregnancy.
Researchers suggest that the minor risk of using ADHD medications during early pregnancies can be offset by greater benefits for mother and baby of continuing treatment for the woman's condition. Doctors should discuss with their patients about this issue and try to help them develop coping skills that could reduce the effects of her disorder on her daily life and relationships.
Interactions with Medication
As more women than ever before are being diagnosed with ADHD and treated with medication, the issue of whether or not to stop treatment during pregnancy is a question that doctors are having to face. Most of the time, these decisions are made without clear and authoritative evidence regardless, so doctors have to weigh their experience, the experiences of other doctors, and what research says on the topic and their own judgments for each patient.
In particular, the issue of possible risks to the baby can be a challenge. Many studies on this topic are based on observational evidence rather than controlled research and their conclusions are often contradictory. Most studies limit their analysis to live births, which can underestimate the severity of teratogenic effects which can cause abortions or terminations of pregnancy. The study presented in this journal club addresses these limitations by examining data on both live and deceased births.
Conclusion Some studies have revealed a positive correlation between ADHD medications and certain birth defects, other studies have not found a correlation. The majority of studies show an unintended, or slight negative impact. In medication for add adults -benefit analysis must be done in each instance.
For women suffering from ADHD who suffer from ADHD, the decision to discontinue 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 these patients. The loss of medication can affect the ability to drive safely and to perform work-related tasks which are crucial aspects of daily life for those with ADHD.
She recommends women who are unsure about whether or not to discontinue medication due to their pregnancy, consider informing family members, friends and colleagues about the condition, its impact on daily life, and the advantages of staying on the current treatment plan. It can also help a woman feel supported in her decision. It is also worth noting that some drugs can be absorbed through the placenta so if a woman decides to discontinue her ADHD medication during pregnancy and breastfeeding, she must be aware that the effects of the drug can be transferred to the infant.
Birth Defects and Risk of
As the use and abuse of ADHD medication to treat symptoms of attention deficit hyperactivity disorder (ADHD) is increasing as does the concern about the potential adverse effects of the drugs on the fetuses. medication for add in adults published in the journal Molecular Psychiatry adds to the body of knowledge on this subject. Researchers used two massive datasets to analyze more than 4.3 million pregnancies and determine if stimulant medication use increased the risk of birth defects. Although the risk overall remains low, the researchers discovered that the first-trimester exposure to ADHD medications was linked to an increase in the risk of certain heart defects, such as ventriculoseptal defect (VSD).
The authors of 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 consistent with previous studies revealing an increase, but not significant, in the risk of developing cardiac malformations among women who started taking ADHD medications before pregnancy. The risk grew in the later part of pregnancy, as many women are forced to stop taking their ADHD medications.
Women who were taking ADHD medication during the first trimester were more likely require a caesarean delivery and also have a low Apgar after delivery, and have a baby who needed breathing assistance when they were born. However the authors of the study were not able to eliminate selection bias by limiting the study to women who didn't have other medical issues that could be a contributing factor to these findings.
The researchers hope their study will serve to inform the clinical decisions of physicians who treat pregnant women. The researchers advise that, while discussing benefits and risks are important, the choice regarding whether or not to stop medication should be in light of the severity of each woman's ADHD symptoms and the needs of the woman.
The authors also caution that even though stopping the medication is an option, it is not an option that is recommended due to the high rate of depression and other mental health problems in women who are pregnant or post-partum. Further, the research suggests that women who choose to stop taking their medication are more likely to experience difficulties adapting to life without them following the baby's arrival.
Nursing
The responsibilities that come with being a new mom can be overwhelming. Women who suffer from ADHD who have to deal with their symptoms while attending doctor appointments and making preparations for the arrival of a child and adjusting to new household routines can experience severe challenges. This is why many women choose to continue taking their ADHD medications throughout the course of pregnancy.
The risk for breastfeeding infant is minimal because the majority of stimulant medication is absorbed through breast milk at a low level. However, the rate of exposure to medications by the infant can differ based on dosage, how often it is administered and the time of the day the medication is administered. Additionally, individual medications enter the body of the baby differently through the gastrointestinal tract and breast milk, and the effect of this on a newborn is not yet fully understood.
Some doctors may stop taking stimulant medication during a woman's pregnancy due to the lack of research. This is a complicated decision for the patient, who must weigh the benefit of continuing her medication against the possible risks to the fetus. Until more information is available, doctors should inquire with all pregnant patients about their history of ADHD and whether they plan or are taking to take medication during the perinatal time.
Numerous studies have proven that women can continue to take their ADHD medication safely during pregnancy and breast-feeding. In response, an increasing number of patients are opting to do this. They have discovered after consulting with their physicians that the benefits of continuing their current medication outweigh any possible risks.
It is crucial for women suffering from ADHD who are considering breastfeeding to seek a specialist psychiatrist's advice prior becoming pregnant. They should discuss their medication with their prescriber and discuss the advantages and disadvantages of continuing treatment, including non-pharmacological management strategies. Psychoeducation should also be offered to help women with ADHD understand their symptoms and underlying disorder and learn about treatments and to reinforce existing strategies for managing. This should be an approach that is multidisciplinary, including the GP doctors, obstetricians and psychiatrists. Pregnancy counseling should include a discussion of a treatment plan for the mother and child, monitoring of signs of deterioration and, if necessary adjustments to the medication regimen.