ADHD Medication During Pregnancy and Breastfeeding
The decision to stop or keep ADHD medications during pregnancy and nursing is a difficult decision for women suffering from the condition. There aren't enough data on how long-term exposure may affect the pregnant fetus.
A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological issues such as hearing loss or vision, febrile seizures, or IQ impairment. The authors acknowledge the need for more high-quality studies.
Risk/Benefit Analysis
Women who are pregnant and taking ADHD medications need to balance the benefits of taking them against the potential risks to the foetus. Physicians don't have the data needed to give clear guidelines however they can provide information about risks and benefits that help pregnant women make informed choices.
A study published in Molecular Psychiatry concluded that women who took ADHD medication during their early pregnancy were not at higher risk of fetal malformations, or structural birth defects. Researchers conducted a massive population-based study of case control to compare the incidence of structural defects that were major in infants born to mothers who took stimulants during pregnancy. Clinical geneticists and pediatric cardiologists examined the cases to ensure accurate case classification and to limit the possibility of bias.
The study of the researchers was not without limitations. Researchers were unable to, in the first place to differentiate the effects caused by the medication from the disorder. This makes it difficult for researchers to establish whether the few associations observed between the exposed groups were due to the use of medication or if they were confounded by comorbidities. Additionally the researchers did not study long-term offspring outcomes.
The study revealed that babies whose mothers had taken ADHD medication during pregnancy had a higher risk of admission to the neonatal care unit (NICU) in comparison to those whose mothers didn't take any medication during pregnancy or discontinued taking their medication prior to or during pregnancy. The reason for this was central nervous system disorders. The increased risk of admission was not influenced by the stimulant medication used during pregnancy.
Women who were taking stimulant ADHD medication during pregnancy also had an elevated chance of having a caesarean section or having a child with a low Apgar score (less than 7). These risks did not appear to be affected by the kind of medication used during pregnancy.
Researchers suggest that the small risk of using ADHD medications during early pregnancies could be offset by the greater benefits for baby and mother of continued treatment for the woman’s disorder. Physicians should discuss the issue with their patients and, when they are able, assist them in developing strategies to improve coping skills which can reduce the negative impact of her condition on her daily functioning and relationships.
Interactions with Medication
As more women than ever before are being diagnosed with ADHD and being treated with medication, the dilemma of whether or not to stop treatment during pregnancy is a question that more and more doctors confront. The majority of these decisions are made in the absence of any evidence that is clear and definitive either way, so physicians must weigh their knowledge, the experiences of other doctors, and what the research suggests about the subject as well as their own judgments for each individual patient.
In particular, the issue of potential risks for the infant can be difficult. Many studies on this subject are based on observational data rather than controlled research and their findings are often contradictory. Additionally, the majority of studies limit their analysis to live births, which could undervalue the serious teratogenic effects that can cause abortion or termination of the pregnancy. The study that is discussed in the journal club addresses these shortcomings by analyzing both the data from deceased and live births.
Conclusion Some studies have found an association between ADHD medications and certain birth defects However, other studies haven't established a link. Most studies have shown a neutral, or even somewhat negative, impact. As a result, a careful risk/benefit analysis is required in every situation.
For many women with ADHD and ADD, the decision to discontinue 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 cause depression and feelings of being isolated. A decrease in medication could affect the ability to safely drive and complete work-related tasks, which are vital aspects of normal life for those suffering from ADHD.
She suggests that women who are unsure about whether to continue or stop medication in light of their pregnancy, consider informing family members, friends, and coworkers on the condition, its impact on daily life, and the advantages of staying on the current treatment regimen. It can also help a woman feel confident about her decision. Some medications can pass through the placenta. If a patient decides to not take 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) increases as does the concern about the potential effects of these drugs on foetuses. A study that was published in the journal Molecular Psychiatry adds to the existing knowledge about this subject. With two massive data sets, researchers were able to look at more than 4.3 million pregnancies and determine whether stimulant medications increased the risk of birth defects. Although the risk overall is low, the researchers discovered that the first-trimester exposure to ADHD medications was linked to an increased risk of certain heart defects, like ventriculo-septal defects (VSD).
The authors of the study found no link between early use of medication and other congenital abnormalities, like facial clefting, or club foot. The results are in the same vein as previous studies that showed the existence of a slight, but significant increase in the number of cardiac malformations among women who began taking ADHD medication before the birth of their child. The risk increased in the latter stages of pregnancy when a large number of women decided to stop taking their medication.
Women who were taking ADHD medication in the first trimester were more likely require a caesarean delivery or have a low Apgar after birth and had a baby that required help breathing when they were born. However, the authors of the study were not able to eliminate selection bias by limiting the study to women who didn't have any other medical conditions that could be a contributing factor to these findings.
medication for add adults hope that their research will help inform the clinical decisions of physicians who see pregnant women. They recommend that, while the discussion of risks and benefits is important however, the decision to stop or keep treatment should be based on each woman's requirements and the severity of her ADHD symptoms.
The authors warn that, even though stopping the medication is a possibility to consider, it is not recommended due to the high prevalence of depression and other mental problems among women who are pregnant or have recently given birth. Additionally, the research suggests that women who decide to stop taking their medication are more likely to experience difficulties getting used to life without them following the birth of their baby.
Nursing
It can be a stressful experience becoming a mother. Women with ADHD who must work through their symptoms while attending doctor appointments and getting ready 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 risk to breastfeeding infant is minimal because the majority of stimulant medications is absorbed through breast milk at a low level. However, the rate of exposure to medications by the newborn may differ based on dosage, frequency it is taken and at what time it is administered. In addition, various medications enter the baby’s system through the gastrointestinal tract, or through breast milk. The impact on the health of a newborn isn't completely comprehended.
Some doctors may stop taking stimulant medications during a woman's pregnancy due to the lack of research. It is a difficult decision for the woman who must weigh the benefits of her medication against the potential risks to the embryo. In the meantime, until more information is available, GPs should ask all pregnant patients about their experience with ADHD and whether they are taking or planning to take medication during the perinatal period.
Many studies have shown that women can continue to take their ADHD medication without risk while breastfeeding and during pregnancy. In response, an increasing number of patients are opting to do this. They have concluded through consultation with their doctors that the benefits of keeping their current medication outweigh any risk.
It's important for women with ADHD who are considering breastfeeding to seek out a specialist psychiatrist's advice prior to 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 needed to help pregnant women suffering from ADHD recognize the signs and the underlying disorder. They should also be educated about treatment options and reinforce the coping mechanisms. This should be a multidisciplinary approach with the GP doctors, obstetricians and psychiatrists. The pregnancy counselling should consist of the discussion of a plan for management for both mother and child, monitoring for signs of deterioration, and when necessary, making adjustments to the medication regimen.