ADHD Medication During Pregnancy and Breastfeeding
Women with ADHD must make a difficult decision on whether to keep or stop taking ADHD medication during pregnancy and breastfeeding. There aren't enough data on how exposure to ADHD for a long time could affect a fetus.
A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological problems such as impaired hearing or vision, febrile seizures or IQ impairment. The authors acknowledge the need for higher-quality research.
Risk/Benefit Analysis
Women who are pregnant and taking ADHD medication should consider the benefits of taking it against the potential dangers for the foetus. Doctors don't have enough data to make unambiguous recommendations but they can provide information on the risks and benefits to assist pregnant women to make informed choices.
A study published in Molecular Psychiatry found that women who took ADHD medications during their early pregnancy did not face an increased risk of fetal heart malformations or major structural birth defects. Researchers conducted a large population-based study of case-control to determine the prevalence of major structural birth defects in infants born to mothers who had taken stimulants during early pregnancy, and those who did not. Clinical geneticists and pediatric cardiologists reviewed the cases to ensure correct classification of the cases and to reduce the chance of bias.
The study conducted by the researchers was not without limitations. The most important issue was that they were not able to differentiate the effects of the medication from the disorder that is underlying. This makes it difficult to know whether the small associations observed in the groups that were exposed are due to medication use or confounding by comorbidities. The researchers did not look at long-term outcomes for offspring.
The study did find that infants whose mothers took ADHD medication during pregnancy were at a more risk of being admitted to the neonatal intensive care unit (NICU) than those who were born without any medication or taken off their medication prior to or during pregnancy. The reason for this was central nervous system disorders. adhd medication online increased risk of admission was not influenced by the stimulant medication that was used during pregnancy.
Women who took stimulant ADHD medications during pregnancy also had a higher likelihood of having to have caesarean sections or the baby was not scoring well on the Apgar scale (less than 7). These increases did not seem to be influenced by the kind of medication used during pregnancy.
The researchers suggest that the low risk associated with the use of ADHD medications during the early stages of pregnancy may be offset by the higher benefit 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 strategies that may reduce the effects of her disorder on her daily functioning and her relationships.
Medication Interactions
Many doctors are faced with the decision of whether to keep treatment or stop it during pregnancy as more women are diagnosed with ADHD. Most of the time, these decisions are made in the absence of any evidence that is clear and definitive either way, so physicians must weigh what they know about their experiences, the experiences of other doctors, and what the research says on the topic as well as their best judgment for each individual patient.
The issue of risk to the infant can be extremely difficult. Many of the studies on this topic are based on observations 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 lead to abortion or termination of the pregnancy. The study that is discussed in this journal club addresses these shortcomings by examining data on both live and deceased births.
Conclusion Some studies have revealed an association between ADHD medications and certain birth defects However, other studies haven't shown such a relationship. Most studies have shown that there is a neutral, or somewhat negative, effect. In all cases, a careful study of the risks and benefits must be performed.
For many women with ADHD and ADD, the decision to stop 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 isolation and family conflict for those suffering from the disorder. Furthermore, a loss of medication may affect the ability to perform work-related tasks and safely drive which are essential aspects of a normal life for many people suffering from ADHD.
adhd treatment without medication suggests that women who are unsure about whether or not to stop taking medication because of their pregnancy should consider informing family members, friends and colleagues on the condition, its impact on daily life, and the benefits of keeping the current treatment regimen. It can also help the woman feel supported as she struggles with her decision. Some medications can pass through the placenta. If the patient decides to not take her ADHD medication while pregnant and breastfeeding, it's important to be aware that the drug could be transferred to the baby.
Birth Defects Risk
As the use of ADHD medications to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases, so do concerns over the impact that these medications could have on fetuses. A recent study published in the journal Molecular Psychiatry adds to the existing information on this topic. Researchers utilized two massive data sets to examine over 4.3 million pregnancies and determine if the use of stimulant medications increased birth defects. Researchers discovered that although the overall risk is low, the first trimester ADHD exposure to medication was associated with slightly higher risk of certain heart defects, such as ventriculoseptal defect.
The researchers of the study didn't discover any link between the use of early medications and other congenital anomalies such as facial deformities or club feet. The results are consistent with previous studies that have shown a small but significant increase in the risk of heart malformations among women who started taking ADHD medications prior to the time of pregnancy. This risk increased during the latter stages of pregnancy when many women decided to stop taking their medication.
Women who took ADHD medication in the first trimester were more likely need a caesarean, have a low Apgar after delivery and have a baby who needed help breathing when they were born. However the researchers of the study were unable 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.
Researchers hope that their study will provide doctors with information when they meet pregnant women. They suggest that although a discussion of the benefits and risks is important however, the decision to stop or maintain treatment must be based on each woman's requirements and the severity of her ADHD symptoms.
The authors caution that, although stopping the medication is a possibility to look into, it is not recommended due to the high prevalence of depression and other mental disorders among women who are pregnant or recently gave birth. Furthermore, research suggests that women who choose to stop taking their medications are more likely to experience difficulties adjusting to life without them after the birth of their baby.
Nursing
The responsibilities of a new mom can be overwhelming. Women with ADHD who have to deal with their symptoms while attending physician appointments and preparing for the arrival of a child and getting used to new routines at home are often faced with a number of difficulties. Therefore, many women elect to continue taking their ADHD medications throughout pregnancy.
The risk to breastfeeding infant is minimal because the majority of stimulant medications is absorbed through breast milk in low amounts. However, the frequency of exposure to medication by the newborn may differ based on dosage, how often it is administered, and the time of the day the medication is administered. Additionally, different medications enter the infant's system differently through the gastrointestinal tract as well as breast milk, and the effect of this on a newborn is not fully known.
Due to the absence of research, some doctors may recommend stopping stimulant drugs during a woman's pregnancy. This is a difficult decision for the patient, who must balance the benefits of keeping her medication against the potential risks to the embryo. Until more information is available, doctors should ask all pregnant patients about their history of ADHD and if they are taking or planning to take medication during the perinatal period.
A increasing number of studies have proven that women can continue taking their ADHD medication during pregnancy and breastfeeding. In response, a rising number of patients are choosing to do this. They have discovered, in consultation with their doctors, that the benefits of retaining their current medication outweigh potential risks.
Women who suffer from ADHD who are planning to nurse should seek advice from a specialist psychiatrist before becoming pregnant. They should discuss their medication with their prescriber and discuss the advantages and disadvantages of continued treatment, including non-pharmacological management strategies. Psychoeducation should also be provided to help women with ADHD recognize their symptoms and the underlying disorder Learn about the available treatment options and strengthen existing strategies for managing. This should be a multidisciplinary effort with the GPs, obstetricians, and psychiatrists. Counselling for pregnancy should include the discussion of a treatment plan for both the mother and child, and monitoring for signs of deterioration, and the need for adjustments to the medication regimen.