ADHD Medication During Pregnancy and Breastfeeding
The choice of whether to stop or continue ADHD medications during breastfeeding and pregnancy is a challenge for women suffering from the condition. There aren't enough data on how exposure to ADHD for a long time could affect a pregnant fetus.
A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus don't develop neurological conditions like hearing or vision impairment seizures, febrile seizures, or IQ impairment. The authors acknowledge that more high quality research is needed.
Risk/Benefit Analysis
Pregnant women who use ADHD medications need to balance the benefits of taking them against potential risks to the foetus. Physicians do not have the data needed to make unequivocal recommendations but they can provide information about the risks and benefits to assist pregnant women in making informed choices.
A study published in Molecular Psychiatry found that women who took ADHD medications during early pregnancy did not face an increased risk of fetal heart malformations or major birth defects that are structural. Researchers used a large population-based case control study to assess the frequency of major structural defects in infants who were born to mothers who used stimulants during pregnancy. Pediatric cardiologists, clinical geneticists and other experts reviewed the cases in order to ensure that the classification was correct and to eliminate any bias.
The study conducted by the researchers was not without its limitations. In particular, they were not able to differentiate the effects of the medication from those of the disorder at hand. This limitation makes it difficult to determine whether the limited associations observed in the groups that were exposed are due to medication use or comorbidities that cause confusion. The researchers did not look at long-term outcomes for the offspring.
The study found that infants whose mothers took ADHD medication during pregnancy were at a slightly higher risk of admission to the neonatal care unit (NICU) in comparison to those whose mothers did not take any medication during pregnancy or had discontinued taking their medication prior to or during pregnancy. This increase was due to central nervous system-related disorders, and the increased risk for admission was not found to be affected by the type of stimulant medications were used during pregnancy.
Women who used stimulant ADHD medication during pregnancy were also at an elevated risk of having a caesarean delivery or having a baby with a low Apgar score (less than 7). These increases did appear to be unrelated to the type of medication taken during pregnancy.
The researchers suggest that the small risk associated with the use of ADHD medications during the early stages of pregnancy may be offset by the greater benefit for both mother and child of continued treatment for the woman's disorder. Physicians should speak with their patients about this issue and, if possible, help them improve coping skills which could reduce the impact of her disorder in her daily functioning and her relationships.
Medication Interactions
Doctors are increasingly faced with the decision of whether to continue treatment or stop it during pregnancy as more women are diagnosed with ADHD. These decisions are often made without clear and authoritative evidence. Instead, doctors have to take into account their own experience, the experience of other doctors and the research on the subject.
The issue of risk to the infant can be difficult to determine. A lot of studies on this subject are based on observations instead of controlled research and their conclusions are often contradictory. Additionally, the majority of studies limit their analysis to live births, which can underestimate severe teratogenic effects that cause abortion or termination of the pregnancy. The study discussed in the journal club addresses these shortcomings by analyzing information on deceased and live births.
The conclusion: While certain studies have demonstrated an association between ADHD medications and the possibility of certain birth defects, others have not found any evidence of a link, and most studies demonstrate a neutral or slight negative effect. In the end an accurate risk-benefit analysis must be conducted in every instance.
For many women with ADHD, the decision to stop taking medication is difficult, if not impossible. In a recent article in the Archives of Women's Mental Health psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can increase depression, feelings of isolation and family conflict for patients with ADHD. Additionally, the loss of medication may affect the ability to perform job-related tasks and drive safely that are crucial aspects of a normal life for many people with ADHD.
She suggests that women who aren't sure whether to continue taking the medication or stop it due to their pregnancy, educate their family members, coworkers, and their friends about the condition, the effects on daily functioning, and the advantages of staying on the current treatment. It will also help a woman feel confident about her decision. It is also worth noting that some drugs can pass through the placenta, so if a woman decides to stop her ADHD medication during pregnancy and breastfeeding, she must be aware that the effects of the medication could be transferred to the infant.
Risk of Birth Defects
As the use of ADHD medications to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases, so do concerns over the impact that these drugs could have on the fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge regarding this topic. Utilizing two huge data sets, researchers were able to analyze more than 4.3 million pregnancies and see whether stimulant medications increased the risk of birth defects. Although the risk overall remains low, the researchers discovered that the first-trimester exposure to ADHD medicines was associated with an increased risk of certain heart defects like ventriculo-septal defects (VSD).
The authors of the study found no link between early medication use and 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. This risk increased during the latter part of pregnancy when a large number of women stopped taking their medication.
Women who took ADHD medication during the first trimester were more likely to need a caesarean or have check here an insufficient Apgar after delivery and have a baby who needed breathing assistance at birth. However the authors of the study were not able to eliminate selection bias by restricting the study to women who didn't have other medical issues that could be a contributing factor to these findings.
The researchers hope their research will help inform the clinical decisions of doctors who see pregnant women. They suggest that although discussing the risks and benefits is crucial, the decision to stop or continue medication must be based on each woman's requirements 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 advised due to the high rate depression and other mental disorders for women who are pregnant or who have recently given birth. Research has also shown that women who stop taking their medications will have a tough time adjusting to a life without them once the baby is born.
Nursing
It can be a challenge to become a mother. Women with ADHD are often faced with a number of difficulties when they have to manage their symptoms, attend doctor appointments, prepare for the birth of a baby and adjust to new routines. Many women decide to continue taking their ADHD medication during pregnancy.
The majority of stimulant medicines pass through breast milk in very small amounts, therefore the risk for nursing infant is very low. The rate of exposure to medication will differ based on dosage, frequency of administration and time of day. In addition, individual medications enter the body of the baby differently through the gastrointestinal tract and breast milk and the impact of this on a newborn is not well 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 complicated decision for the patient, who must weigh the benefits of keeping her medication against the possible risks to the embryo. As long as more information is available, doctors can inquire about pregnant patients if they have a history of ADHD or if they intend to take medication during the perinatal phase.
Numerous studies have proven that women can continue taking their ADHD medication safely during pregnancy and while breast-feeding. In the end, an increasing number of patients choose to do so and in consultation with their doctor they have discovered that the benefits of continuing their current medication far outweigh any risks.
Women who suffer from ADHD who are planning to breastfeed should seek the advice of a specialist psychiatrist prior to 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 is also necessary to help pregnant women with ADHD understand the symptoms and underlying disorder. They should also be educated about treatment options and reinforce strategies for coping. This should include an approach that is multidisciplinary, including the GP, obstetricians and psychiatry. Pregnancy counseling should include discussion of a treatment plan for the mother and the child, monitoring of signs of deterioration and, if necessary, adjustments to the medication regimen.