ADHD Medication During Pregnancy and Breastfeeding
The decision to stop or keep ADHD medications during pregnancy and breastfeeding is a difficult decision for women suffering from the condition. There aren't many studies on how long-term exposure may affect a fetus.
A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication during the uterus do not develop neurological conditions like hearing or vision impairment seizures, febrile seizures or IQ impairment. The authors acknowledge the need for higher-quality studies.
Risk/Benefit Analysis
Pregnant women who use ADHD medications must weigh the advantages of using them against the risks to the fetus. The doctors don't have the information to give clear advice, but can provide information on risks and benefits to assist pregnant women to make informed decisions.
A study published in Molecular Psychiatry found that women who were taking ADHD medications during early pregnancy did not have an increased risk of fetal heart malformations or major structural birth defects. Researchers conducted a massive population-based case control study to compare the incidence of structural defects that were major in infants who were born to mothers who were taking stimulants during pregnancy. Clinical geneticists, pediatric cardiologists and other experts examined the cases to ensure that the classification was correct and to eliminate any bias.
However, the researchers' study had its limitations. The most important issue was that they were unable to separate the effects of the medication from the disorder at hand. That limitation makes it difficult to determine whether the small associations observed in the exposed groups result from medication use or comorbidities that cause confusion. Additionally the study did not study long-term offspring outcomes.
The study did reveal that babies 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 those who were born without any medication or cut back on their medications prior to or during pregnancy. The reason for this was central nervous system-related disorders, and the higher risk of admission was not found to be affected by the type of stimulant medication was used during pregnancy.
Women who used stimulant ADHD medication during pregnancy also had an increased chance of having a caesarean section or having a baby with a low Apgar score (less than 7). These increases appear to be unrelated to the type of medication taken during pregnancy.
Researchers suggest that the small risks associated with the use ADHD medications in early pregnancies may be offset by the greater benefits to both mother and baby from continuing treatment for the woman’s disorder. Doctors should discuss with their patients about this and as much as possible, assist them develop coping strategies that can lessen the impact of her disorder in her daily functioning and her relationships.
Interactions with Medication
As more women than ever before are being diagnosed with ADHD and being treated with medication, the question of whether to continue or discontinue treatment during pregnancy is one that doctors are having to confront. Often, these decisions are made in the absence of solid and reliable evidence regardless, so doctors must weigh what they know, the experiences of other doctors, and what research suggests on the subject as well as their own best judgment for each patient.
In particular, the issue of potential risks for the infant can be difficult. The research on this issue is based on observations rather than controlled studies and the results are in conflict. Most studies limit their analysis to live-births, which could underestimate the teratogenic impact which can cause abortions or terminations of pregnancy. The study presented in the journal club addresses these issues, by examining both 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 risk of certain birth defects, others have found no connection, and most studies have a neutral or slightly negative impact. In the end an accurate risk-benefit analysis must be done in each instance.
For many women with ADHD, the decision to stop medication is difficult if not impossible. In fact, in an article recently published in the Archives of Women's Mental Health psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can cause depression, feelings of loneliness and family conflict for patients with ADHD. A loss of read more medication may also impact the ability to drive safely and perform work-related tasks, which are essential aspects of everyday life for those suffering from ADHD.
She recommends that women who are unsure about whether or not to discontinue medication due to their pregnancy, consider informing family members, friends and colleagues on the condition, its effects on daily functioning, and the benefits of keeping the current treatment regimen. Educating them can also aid in ensuring that the woman feels supported as she struggles with her decision. It is important to note that some drugs can be absorbed through the placenta so if a woman decides to stop taking her ADHD medication during pregnancy and breastfeeding, she should be aware that the effects of the drug could be passed on to the baby.
Birth Defects and Risk of
As the use and abuse of ADHD medication to treat symptoms of attention deficit hyperactivity disorder (ADHD) is increasing as does the concern about the potential effects of these drugs on the fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge regarding this topic. Researchers used two massive data sets to examine over 4.3 million pregnant women and determine whether stimulant medications increased birth defects. Although the risk overall is low, the researchers did find that first-trimester exposure to ADHD medicines was associated with an increased risk of specific heart defects, such as ventriculoseptal defect (VSD).
The researchers behind the study found no link between early use of medication and congenital abnormalities such as facial clefting or club foot. The results are consistent with previous studies that have shown an increase, but not significant, in the risk of cardiac malformations among women who began taking ADHD medications prior to the time of pregnancy. The risk grew during the latter part of pregnancy, when many women are forced to stop taking their ADHD medications.
Women who used ADHD medications in the first trimester of pregnancy were also more likely to undergo caesarean section, low Apgar score following delivery, and a baby that required breathing assistance at birth. However the authors of the study were not able to eliminate bias due to selection by restricting the study to women who didn't have any other medical conditions that could be a contributing factor to these findings.
The researchers hope that their research will aid in the clinical decisions of doctors who treat pregnant women. They advise that while the discussion of the risks and benefits is crucial, the decision to stop or maintain medication must be based on each woman's needs and the severity of her ADHD symptoms.
The authors warn that, while stopping the medication is a possibility to consider, it is not advised due to the high rate depression and other mental disorders among women who are pregnant or recently gave birth. Further, research shows that women who stop taking their medication will have a difficult time adjusting to a life without them once the baby is born.
Nursing
The responsibilities that come with being a new mom can be overwhelming. Women who suffer from ADHD who have to deal with their symptoms while attending physician appointments as well as preparing for the arrival of their child and adjusting to new household routines can experience severe challenges. Many women opt to continue taking their ADHD medication during pregnancy.
The majority of stimulant medications pass through breast milk in low amounts, therefore the risk for breastfeeding infant is minimal. However, the frequency of exposure to medication by the infant can differ based on dosage, frequency it is taken and at what time the medication is administered. In addition, different medications are introduced into the baby's system via the gastrointestinal tract or through breast milk. The effect 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 a woman's pregnancy. It's a difficult choice for the woman who must weigh the advantages of her medication against the risk to the fetus. As long as there is no more information, doctors should ask all pregnant patients about their history of ADHD and if they plan or are taking to take medication during the perinatal time.
A increasing number of studies have revealed that the majority of women are able to safely continue their ADHD medication during pregnancy and while breastfeeding. In the end, more and more patients choose to do so and, in consultation with their doctor they have discovered that the benefits of continuing their current medication outweigh any risks.
Women with ADHD who plan to breastfeed should seek the advice of an expert psychiatrist prior to becoming pregnant. They should discuss the medication they are taking with their physician as well as the pros and cons for continuing treatment. This includes non-pharmacological strategies. Psychoeducation is also needed to help pregnant women suffering from ADHD recognize the signs and underlying disorder. They should also learn about treatment options and strengthen the coping mechanisms. This should include a multidisciplinary approach, which includes the GP, obstetricians and psychiatry. The pregnancy counselling should consist of the discussion of a plan for management for both the mother and child, as well as monitoring for signs of deterioration, and when necessary, making adjustments to the medication regimen.