ADHD Medication During Pregnancy and Breastfeeding
The decision to stop or keep ADHD medication during breastfeeding and pregnancy is a challenge for women suffering from the condition. There is a lack of information about how long-term exposure to these medications could affect the fetus.
A recent study published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological issues such as impaired hearing or vision, febrile seizures, or IQ impairment. The authors acknowledge that further high-quality studies are needed.
Risk/Benefit Analysis
Women who are pregnant and taking ADHD medications need to balance the advantages of taking them against the potential risks to the fetus. Doctors don't have enough data to give clear advice however they can provide information on the risks and benefits to help pregnant women make an informed decision.
A study published in Molecular Psychiatry found that women who used ADHD medications during their early pregnancy did not have an increased risk of fetal heart 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 born to mothers who were taking stimulants during pregnancy. Pediatric cardiologists, clinical geneticists and other experts reviewed the cases in order to confirm that the classification was accurate and to eliminate any bias.
The study conducted by the researchers had some limitations. The researchers were not able in the beginning to distinguish the effects of the medication from the disorder. This makes it difficult for researchers to determine if the few associations observed between the exposed groups were due to medication use or confounded by co-morbidities. Researchers also did not study long-term outcomes for offspring.
The study did show that infants whose mothers took ADHD medication during pregnancy were at a slightly more risk of being admitted to the neonatal intensive care unit (NICU) than those who whose mothers did not take any medication or stopped their medications before or during pregnancy. This increase was caused by central nervous system disorders. The increased risk of admission was not affected by the stimulant medications used during pregnancy.
Women who were taking stimulant ADHD medications during pregnancy also had a higher likelihood of having an emergency caesarean section or having the baby was not scoring well on the Apgar scale (less than 7). These increases appeared to be unrelated to the type of medication used during pregnancy.
The research suggests that the low risk associated with the use of ADHD medications during the early stages of pregnancy could be offset by the greater benefit to both the mother and child from continued treatment for the woman's disorder. Doctors should discuss with their patients about this issue and as much as possible, assist them develop coping skills that could reduce the impact of her disorder in her daily functioning and her relationships.
Medication Interactions
As more women than ever before are being diagnosed with ADHD and treated with medication, the dilemma of whether to keep or discontinue treatment during pregnancy is a question that more and more physicians confront. Often, these decisions are taken in the absence of solid and reliable evidence regardless, so doctors have to weigh their experience, the experiences of other doctors, and what research suggests on the subject as well as their own best judgment for each individual patient.
In particular, the issue of potential risks for the infant can be difficult. Many studies on this issue are based on observational evidence rather than controlled research, and their findings are often contradictory. The majority of studies restrict their analysis to live births, which can underestimate the severity of teratogenic effects leading to terminations or abortions of pregnancy. The study discussed in the journal club addresses these shortcomings by analyzing the data from deceased and live births.
Conclusion Some studies have shown a positive correlation between ADHD medications and certain birth defects however, other studies haven't established a link. The majority of studies show a neutral, or even slight negative impact. In all cases it is imperative to conduct a thorough study of the benefits and risks must be performed.
For a lot of women with ADHD and ADD, the decision to stop taking medication is difficult if not impossible. In a recent article in Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can increase depression and feelings of isolation. Furthermore, a loss of medication may affect the ability to complete jobs and drive safely that are crucial aspects of daily life for a lot of people with ADHD.
She recommends women who are uncertain about whether to continue or stop taking medication because of their pregnancy consider informing family members, friends and colleagues about the condition, its effects on daily functioning, and on the advantages of staying on the current treatment regimen. It will also help a woman feel confident about her decision. Certain medications can pass through the placenta. If a woman decides to stop taking her ADHD medication while pregnant and breastfeeding, it is important to be aware that the medication could be transferred to the baby.
Birth Defects and Risk of
As the use and abuse of ADHD medications to treat the symptoms of attention deficit disorder hyperactivity disorder (ADHD) is increasing as does the concern about the potential effects of these drugs on fetuses. A study that was published in the journal Molecular Psychiatry adds to the body of knowledge on this subject. With two massive data sets, researchers were able to analyze more than 4.3 million pregnancies and see whether stimulant medication use increased the risk of birth defects. While the overall risk is low, the researchers found that exposure in the first trimester to ADHD medicines was associated with a slightly higher rate of specific heart defects, such as ventriculoseptal defect (VSD).
The authors of the study found no association between the use of early medications and congenital abnormalities such as facial clefting or club foot. The results are consistent with previous studies revealing a small but significant increase in the risk of heart malformations in women who started taking ADHD medications prior to pregnancy. This risk increased in the latter half of pregnancy, when many women begin to discontinue their ADHD medication.
Women who were taking ADHD medication during the first trimester were more likely to need a caesarean, have an insufficient Apgar after delivery and have a baby that needed help breathing after birth. However, the authors of the study were unable to eliminate selection bias by restricting the study to women who did not have other medical issues that could have contributed to these findings.
Researchers hope their research will help doctors when they see pregnant women. They recommend that, while discussing the benefits and risks is important however, the decision to stop or continue medication should be based on each woman's needs and the severity of her ADHD symptoms.
The authors warn that, while stopping the medication is an option to consider, it is not advised due to the high prevalence of depression and other mental disorders for women who are pregnant or recently gave birth. Further, research shows that women who stop taking their medication will have a tough transitioning to life without them once the baby is born.
Nursing
The responsibilities of being a new mother can be overwhelming. Women who suffer from ADHD are often faced with a number of difficulties when they must deal with their symptoms, attend doctor appointments, prepare for the birth of a child and adjust to a new routine. Therefore, many women decide to continue taking their ADHD medications throughout pregnancy.
The majority of stimulant drugs pass through breast milk in small quantities, so the risk to infant who is breastfeeding is low. However, the amount of exposure to medications by the newborn can vary depending best adhd medication for adults on dosage, frequency it is administered, and the time of day the medication is administered. Additionally, different medications enter the baby's system differently through the gastrointestinal tract as well as breast milk, and the effect of this on a newborn isn't fully understood.
Some doctors may decide to stop stimulant medication during a woman’s pregnancy due to the absence of research. It is a difficult decision for the woman who must weigh the advantages of her medication against the potential risks to the embryo. As long as there is no more information, doctors should inquire with all pregnant patients about their history of ADHD and whether they plan or are taking to take medication during the perinatal period.
A increasing number of studies have shown that the majority of women are able to safely continue their ADHD medication during pregnancy and breastfeeding. In the end, more and more patients are choosing to do so and in consultation with their physician, they have found that the benefits of keeping their current medication far outweigh any risks.
Women who suffer from ADHD who plan to breastfeed should seek the advice of a specialist psychiatrist before becoming pregnant. They should discuss the medication they are taking with their physician as well as the pros and cons of continuing treatment. This includes non-pharmacological methods. Psychoeducation is also required to help pregnant women with ADHD be aware of the symptoms and the underlying disorder. They should also be informed about treatment options and reinforce strategies for coping. This should be a multidisciplinary effort together with obstetricians, GPs, and psychiatry. Pregnancy counseling should include discussion of a treatment plan for the mother and child, and monitoring for signs of deterioration and, if necessary adjustments to the medication regime.