ADHD Medication During Pregnancy and Breastfeeding
Women with ADHD face a difficult decision on whether to keep or stop taking ADHD medication during pregnancy and breastfeeding. Little data exists about how long-term exposure to these medications may affect the foetus.
A recent study published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological issues like hearing loss or 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 taking them against the potential risks to the fetus. Physicians don't have the information needed to give clear guidelines, but they can provide information regarding the risks and benefits to help pregnant women make informed choices.
A study published in Molecular Psychiatry found that women who were taking ADHD medications in early pregnancy did not have a significantly increased risk of fetal heart malformations or major structural birth defects. medications for adhd uk 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 had not. Clinical geneticists and pediatric cardiologists examined the cases to ensure an accurate case classification and to limit the chance of bias.
The study of the researchers had some limitations. Most important, they were unable to separate the effects of the medication from the effects of the disorder at hand. This makes it difficult for researchers to determine if the small associations observed among the exposed groups were due to the use of medications, or if they were caused by the presence of comorbidities. Additionally the study did not look at the long-term effects of offspring on their parents.
The study did find that infants whose mothers had taken ADHD medication during pregnancy were at a slightly higher risk of being admitted to the neonatal intensive care unit (NICU) than infants who were born without any medication or had cut back on their medications prior to or during pregnancy. adhd and depression medication for this was central nervous system disorders. The higher risk of admission was not affected by the stimulant medication used during pregnancy.
Women who were taking stimulant ADHD medications during pregnancy also had a higher chance of having caesarean sections or the baby was not scoring well on the Apgar scale (less than 7). These increases did appear to be unrelated to the type of medication taken during pregnancy.
Researchers suggest that the small risk of using ADHD medications during early pregnancies can be offset by greater benefits to both mother and baby of continuing treatment for the woman's condition. Physicians should discuss this with their patients and, when possible, assist them in developing strategies to improve coping skills which can reduce the negative impact of her condition on her daily functioning and relationships.
Medication Interactions
Many doctors are faced with the decision of whether to maintain treatment or stop as more women are diagnosed with ADHD. These decisions are often taken without clear and authoritative evidence. Instead, doctors have to consider their own expertise, the experience of other doctors and the research that has been conducted on the subject.
Particularly, the subject of potential risks to the baby can be a challenge. A lot of studies on this issue are based on observational data rather than controlled research, and their findings are often contradictory. Furthermore, most studies restrict their analysis to live births, which could underestimate severe teratogenic effects that result in abortion or termination of the pregnancy. The study discussed in the journal club addresses these limitations by analyzing data on live and deceased births.
The conclusion is that while some studies have found that there is a positive correlation between ADHD medications and the possibility of certain birth defects, other studies have not found any evidence of a link, and most studies demonstrate a neutral or slight negative effect. In every case, a careful study of the benefits and risks should be conducted.
For many women with ADHD, the decision to discontinue medication is difficult if not impossible. In a recent piece published in the 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 loneliness. Furthermore, a loss of medication may affect the ability to complete work-related tasks and safely drive that are crucial aspects of daily life for a lot of people with ADHD.
She suggests that women who are unsure whether to take the medication or stop due to pregnancy should educate family members, coworkers and their friends about the condition, its impact on daily functioning and the benefits of continuing the current treatment plan. It can also help women feel supported in her decision. Certain medications can pass through the placenta. If a patient decides not to take her ADHD medication while pregnant and breastfeeding, it's important to be aware that the drug could be passed on to her infant.
Risk of Birth Defects
As the use and abuse of ADHD medication to treat symptoms of attention deficit disorder hyperactivity disorder (ADHD) increases, so does concern about the potential adverse effects of the drugs on fetuses. Recent research published in the journal Molecular Psychiatry has added to the body knowledge on this topic. Researchers used two massive data sets to study over 4.3 million pregnancies and determine if the use of stimulant medications caused birth defects. Researchers discovered that, while the risk overall is low, first-trimester ADHD medication use was associated with slightly higher rates of certain heart defects, like ventriculoseptal defects.
The researchers of the study found no link between early medication use and other congenital anomalies, such as facial clefting or club foot. The findings are in line with previous studies that have shown an increase, but not significant, in the risk of developing cardiac malformations in women who started taking ADHD medications prior to pregnancy. The risk increased in the latter stages of pregnancy when many women began to stop taking their medication.
Women who took ADHD medications in the first trimester of pregnancy were also more likely to have caesarean section, low Apgar score following delivery, and a baby who required breathing assistance during birth. However the authors of the study were unable to eliminate selection bias by restricting the study to women who didn't have any other medical conditions that could have contributed to the findings.
The researchers hope their research will help inform the clinical decisions of physicians who see pregnant women. They advise that while discussing the benefits and risks is important but the decision to stop or maintain medication should be based on each woman's needs and the severity of her ADHD symptoms.
The authors also caution that while discontinuing the medications is an option, it is not an option to consider due to the high rate of depression and other mental health problems for women who are expecting or post-partum. Further, research shows that women who stop taking their medication will have a harder time adjusting to a life without them once the baby is born.
Nursing
It can be a challenge becoming a mother. Women with ADHD who must work through their symptoms while attending physician appointments, making preparations for the arrival of a baby and adapting to new routines in the home may face a lot of challenges. This is why many women elect to continue taking their ADHD medications throughout pregnancy.
The majority of stimulant medications pass through breast milk in very small amounts, so the risk to nursing infant is very low. The rate of exposure to medication will differ based on dosage the medication is administered, its frequency and time of day. Additionally, individual medications enter the body of the baby differently through the gastrointestinal tract as well as breast milk. The impact of this on a newborn infant is not well understood.
Due to the absence of research, some physicians may be inclined to discontinue stimulant medication during the course of pregnancy. It is a difficult decision for the woman, who must weigh the advantages of continuing her medication against the risks to the fetus. In the meantime, until more information is available, doctors should ask all pregnant patients about their history of ADHD and if they are planning or taking to take medication during the perinatal period.
Numerous studies have demonstrated that women can continue taking their ADHD medication without risk during pregnancy and while breast-feeding. In the end, many patients choose to do so, and in consultation with their physician, they have found that the benefits of maintaining their current medication far exceed any risk.
It's important for women with ADHD who are considering breastfeeding to seek a specialist psychiatrist's advice prior becoming pregnant. They should discuss their medication with their doctor and discuss the advantages and disadvantages of continuing treatment, including non-pharmacological management strategies. Psychoeducation is also necessary to help pregnant women suffering from ADHD recognize the signs and underlying disorder. They should also be informed about treatment options and strengthen strategies for coping. This should involve a multidisciplinary approach with the GP as well as obstetricians, psychiatry and obstetricians. Pregnancy counseling should consist of a discussion of a treatment plan for the mother and the child, as well as monitoring for signs of deterioration, and, if necessary modifications to the medication regimen.