ADHD Medication During Pregnancy and Breastfeeding
Women suffering from ADHD face a difficult decision on whether to keep or stop taking ADHD medication during pregnancy and breast-feeding. There is a lack of information about how long-term exposure to these drugs can affect the fetus.
A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication during utero do not develop neurological developmental disorders such as hearing loss or impaired vision seizures, febrile seizures or IQ impairment. The authors acknowledge the need for more high-quality studies.
Risk/Benefit Analysis
Women who are expecting and taking ADHD medication should consider the benefits of taking it versus the risks to the baby. Physicians do not have the data needed to give clear guidelines however they can provide information on risks and benefits that help pregnant women make informed decisions.
A study published in Molecular Psychiatry concluded that women who took ADHD medication during their early pregnancy were not at a higher risk of fetal malformations, or structural birth defects. Researchers used a vast, population-based case-control study to evaluate the incidence of major structural birth defects in babies born to mothers who had taken stimulants in the early stages of pregnancy, and those who did not. Pediatric cardiologists and clinical geneticists examined the cases to ensure accurate classification of the cases and to reduce 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 disorder at hand. That limitation makes it difficult to know whether the limited associations observed in the exposed groups result from medication use or the confounding effect of comorbidities. The researchers did not examine the long-term effects for the offspring.
The study did find that babies whose mothers had taken ADHD medication during pregnancy were at a more risk of being admitted to the neonatal intensive care unit (NICU) than those whose mothers had not taken any medication or stopped their medications before or during pregnancy. This was due to central nervous system disorders. The increased risk of admission was not affected by the stimulant medications used during pregnancy.
Women who used stimulant ADHD medication during pregnancy were also at an increased risk of having a caesarean birth or having a baby born with low Apgar score (less than 7). These increases did appear to be unrelated to the type of medication used during pregnancy.
The researchers suggest that the small risk associated with the use of ADHD medications during the early stages of pregnancy could be offset by the greater benefits to both the mother and child of continued treatment for the woman's disorder. Physicians should talk to their patients about this issue and as much as possible, assist them develop coping skills that can lessen the effects of her disorder on her daily life and relationships.
Medication Interactions
As more women than ever are being diagnosed with ADHD and being treated with medication, the dilemma of whether to continue or end treatment during pregnancy is one that more and more doctors face. Most of the time, these decisions are taken in the absence of clear and authoritative evidence in either case, which means that doctors must weigh what they know about their experiences, the experiences of other doctors, and what the research says on the topic and their best judgment for each patient.
In particular, the issue of possible risks to the baby can be a challenge. The research that has been conducted on this topic is based on observations instead of controlled studies and many of the findings are in conflict. Additionally, the majority of 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 that is discussed in this journal club addresses these limitations by examining data on both live and deceased births.
The conclusion is that while some studies have found that there is a positive correlation between ADHD medications and the risk of certain birth defects, other studies have not found any evidence of a link and the majority of studies show a neutral or even slightly negative impact. In every case it is imperative to conduct a thorough evaluation of the potential risks and benefits should be conducted.
For a lot of women with ADHD and ADD, 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 lead to increased depression, feelings of loneliness, and family conflict for those suffering from the disorder. A decrease in medication could affect the ability to drive safely and complete work-related tasks, which are crucial aspects of daily life for those with ADHD.
She recommends women who are uncertain about whether or not to stop taking medication because of their pregnancy consider the possibility of educating friends, family members, and coworkers on the condition, its effects on daily life, and the benefits of keeping the current treatment plan. It can also help women feel confident about her decision. Some 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 could be passed on to her baby.
Birth Defects Risk
As the use and use of ADHD drugs to treat symptoms of attention deficit disorder hyperactivity disorder (ADHD) is increasing, so does concern about the possible effects of the drugs on the fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge regarding this issue. Researchers utilized two massive data sets to examine more than 4.3 million pregnancies and determine if stimulant medication use increased birth defects. Although the risk overall remains low, the researchers discovered that the first-trimester exposure to ADHD medicines was associated with a slightly higher rate of certain heart defects, such as ventriculo-septal defect (VSD).
The authors of the study found no link between early use of medication and congenital abnormalities like facial clefting, or club foot. The results are in agreement with previous studies which showed an insignificant, but small increase in the number of cardiac malformations among women who began taking ADHD medication prior to the time of the birth of their child. adhd for adults medication 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 require a caesarean birth, have an insufficient Apgar after delivery and had a baby that required breathing assistance when they were born. However the researchers of the study were unable to eliminate selection bias by restricting the study to women who did not have any other medical issues that could have contributed to the findings.
The researchers hope their research will help inform the clinical decisions of doctors who see pregnant women. They advise that while a discussion of risks and benefits is important but the decision to stop or keep medication should be based on each woman's needs and the severity of her ADHD symptoms.
The authors also caution that even though stopping the medication is an option, it isn't an option to consider due to the high rate of depression and other mental health problems in women who are pregnant or who are recently post-partum. Further, the research suggests that women who choose to stop their medications are more likely to have a difficult time getting used to life without them after the baby's arrival.
Nursing
It can be a challenge to become a mother. Women suffering from ADHD are often faced with a number of difficulties when they must deal with their symptoms, go to doctor appointments and prepare for the birth of a child and adjust to new routines. Many women opt to continue taking their ADHD medication during pregnancy.
The risk to a breastfeeding infant is minimal because the majority of stimulant medication is absorbed through breast milk at low levels. The rate of medication exposure will differ based on dosage the medication is administered, its frequency and the time of day. In addition, various medications enter the baby’s system through the gastrointestinal tract, or through breast milk. The impact of these medications on the health of a newborn isn't fully comprehended.
Because of the lack of evidence, some doctors may be inclined to discontinue stimulant medication during the pregnancy of a woman. This is a difficult decision for the patient, who must balance the benefit of continuing her medication against the possible risks to the embryo. As long as there is no more information, doctors should inquire with all pregnant patients about their experience with ADHD and if they are taking or planning to take medication during the perinatal period.
A growing number of studies have proven that women can continue to take their ADHD medication during pregnancy and breastfeeding. In response, an increasing number of patients are opting to do so. They have found, in consultation with their physicians that the benefits of continuing their current medication outweigh risk.
It is crucial for women suffering from ADHD who are contemplating breastfeeding to seek out a specialist psychiatrist's guidance prior to becoming pregnant. adhd in adults medication should discuss their medication with their prescriber and discuss the pros and cons of continued treatment, including non-pharmacological management strategies. Psychoeducation is also required to help pregnant women suffering from ADHD understand the symptoms and underlying disorder. They should also learn about treatment options and build the coping mechanisms. This should be a multidisciplinary approach with the GP, obstetricians and psychiatry. Pregnancy counseling should consist of a discussion of a treatment plan for the mother as well as the child, and monitoring for indicators of deterioration, and, if necessary modifications to the medication regimen.