ADHD Medication During Pregnancy and Breastfeeding
Women suffering from ADHD face a difficult decision regarding whether or not to stop taking ADHD medication during pregnancy and breast-feeding. There isn't much information on how long-term exposure to these medications can affect the fetus.
A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication during the uterus don't develop neurological disorders like hearing loss or impaired vision seizures, febrile seizures, or IQ impairment. The authors acknowledge that more high quality research is needed.
Risk/Benefit Analysis
Women who are expecting and taking ADHD medication should evaluate the benefits of using it versus the dangers for the baby. Doctors don't have enough data to make unambiguous recommendations but they can provide information on risks and benefits to aid pregnant women in making informed choices.
A study published in Molecular Psychiatry found that women who used ADHD medications during their early pregnancy did not have a significantly increased risk of fetal cardiac malformations or major birth defects that are structural. Researchers conducted a massive population-based study of case control to assess the frequency of structural defects that were major in infants who were born to mothers who were taking stimulants during pregnancy. Clinical geneticists and pediatric cardiologists examined the cases to ensure accurate case classification and to limit the possibility of bias.
However, the researchers' study had its limitations. Most important, they were unable to separate the effects of the medication from the underlying disorder. This limitation makes it difficult for researchers to determine whether the few associations observed between the groups that were exposed to medication use or if they were caused by the presence of comorbidities. The researchers also did not study the long-term effects for the offspring.
The study showed that infants whose mother took ADHD medication during pregnancy had a slightly higher risk of admission to the neonatal care unit (NICU), compared to those whose mothers did not use any medication during pregnancy or had stopped taking their medication before or during pregnancy. The reason for this was central nervous system-related disorders and the increased risk of admission did not appear to be influenced by the stimulant medications were used during pregnancy.
Women who took stimulant ADHD medications during pregnancy also had a higher chance of having a caesarean section or the baby was not scoring well on the Apgar scale (less than 7). These increases didn't appear to be influenced by the type of medication that was used during pregnancy.
The researchers suggest that the small risk associated with the use of ADHD medications during early pregnancy may be offset by the greater benefit to both the mother and child of continued treatment for the woman's disorder. Physicians should talk to their patients about this and, if possible, help them improve coping skills which can lessen the impact of her disorder in her daily functioning and her relationships.
Medication Interactions
As more women than ever are diagnosed with ADHD and treated with medication, the issue of whether to continue or stop treatment during pregnancy is a question that doctors are having to confront. These decisions are often taken without clear and authoritative evidence. Instead, physicians must consider their own expertise, the experience of other doctors, and the research on the topic.
Particularly, medication for adult add 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 may underestimate the severity of teratogenic effects that could lead to abortion or termination of the pregnancy. The study discussed in this journal club addresses these shortcomings by looking at data from both live and deceased births.
The conclusion: While certain studies have demonstrated a positive association between ADHD medications and the risk of certain birth defects, other studies have found no such relationship, and most studies demonstrate a neutral or slightly negative effect. Therefore an accurate risk-benefit analysis must be conducted in every situation.
It can be difficult, if not impossible, for women suffering from ADHD to stop taking their medication. In medication for adult adhd published in Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can lead to depression and feelings of isolation. In addition, a decrease in medication can affect the ability to complete jobs and drive safely that are crucial aspects of a normal life for a lot of people with ADHD.
She suggests that women who aren't sure whether to continue taking medication or stop due to pregnancy, educate their family members, coworkers and acquaintances about the condition, the effects on daily functioning, and the advantages of staying on the current treatment. It can also help women feel confident about her decision. It is important to note that certain medications are able to pass through the placenta, so if a woman decides to discontinue her ADHD medication during pregnancy and breastfeeding, she must be aware of the possibility that traces of the medication could be transferred to the infant.
Birth Defects and Risk of
As the use and use of ADHD medication to treat symptoms of attention deficit disorder hyperactivity disorder (ADHD) increases as does the concern about the possible effects of the drugs on foetuses. A recent study published in the journal Molecular Psychiatry adds to the existing knowledge on this subject. Researchers used two massive datasets to analyze more than 4.3 million pregnancies and determine whether stimulant medications increased birth defects. While the overall risk remains low, the researchers found that exposure in the first trimester to ADHD medications was linked to an increased risk of certain heart defects, like ventriculo-septal defects (VSD).
The authors of the study did not discover any link between early medication usage and other congenital anomalies, like facial deformities or club feet. The results are in the same vein as previous studies that showed the existence of a slight, but significant increase in cardiac malformations for women who started taking ADHD medication prior to pregnancy. This risk increased in the later part of pregnancy, as many women decide to stop taking their ADHD medication.
Women who used ADHD medications during the first trimester of their pregnancies were also more likely to have caesarean section, low Apgar score following delivery, and 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 any other medical issues that could have contributed to these findings.
Researchers hope that their research will provide doctors with information when they see pregnant women. They suggest that although discussing the benefits and risks is important but the decision to stop or continue medication must be based on each woman's requirements and the severity of her ADHD symptoms.
The authors also warn that even though stopping the medication is an option, it isn't an option that is recommended due to the high incidence of depression and other mental health issues for women who are expecting or post-partum. Additionally, research suggests that women who stop taking their medications will have a harder time adjusting to a life without them after the baby is born.
Nursing
The responsibilities of being a new mom can be overwhelming. Women suffering from ADHD may face a lot of challenges when they must manage their symptoms, attend doctor appointments and prepare for the birth of their child and adjust to new routines. This is why many women elect to continue taking their ADHD medications throughout the course of pregnancy.
The majority of stimulant drugs are absorbed through breast milk in very small quantities, so the risk to infant who is breastfeeding is low. However, the rate of medication exposure to the infant can differ based on dosage, frequency it is administered and at what time it is administered. Additionally, different medications enter the infant's system differently through the gastrointestinal tract as well as breast milk. The impact of this on a newborn is not yet fully understood.
Some physicians may discontinue stimulant medications during a woman's pregnancy due to the lack of research. This is a difficult decision for the woman who must weigh the benefits of taking her medication as well as the risk to the embryo. In the meantime, until more information is available, GPs should ask all pregnant patients about their experience with ADHD and if they plan or are taking to take medication during the perinatal time.
Numerous studies have demonstrated that women can continue to take their ADHD medication in a safe manner during pregnancy and breast-feeding. In response, an increasing number of patients are opting to do so. They have discovered after consulting with their doctor, that the benefits of keeping their current medication far outweigh any risk.
Women with ADHD who plan to breastfeed should seek the advice of a specialist psychiatrist prior to becoming pregnant. They should discuss their medication with their prescriber as well as the pros and cons for continuing treatment. This includes non-pharmacological methods. Psychoeducation should also be offered to help women with ADHD understand their symptoms and the root cause Learn about the available treatment options and reinforce existing strategies for managing. This should be an approach that is multidisciplinary, including the GP, obstetricians and psychiatry. Pregnancy counseling should include discussion of a treatment plan for the mother as well as the child, monitoring of indicators of deterioration, and, if needed modifications to the medication regime.