ADHD Medication During Pregnancy and Breastfeeding
The choice of whether to stop or continue ADHD medication during pregnancy and breastfeeding is a difficult decision for women suffering from the condition. There isn't much information on how long-term exposure to these medications may affect the foetus.
A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus don't develop neurological developmental conditions like hearing or vision impairment seizures, febrile seizures or IQ impairment. The authors acknowledge the need for more high-quality research.
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 do not have the necessary data to make unequivocal recommendations however they can provide information on risks and benefits that assist pregnant women in making informed choices.
A study published in Molecular Psychiatry found that women who used ADHD medications during their early pregnancy did not face an increased risk of fetal cardiac malformations or major structural birth defects. Researchers conducted a large sample-based case control study to examine the prevalence of structural defects that were major in infants who were born to mothers who used stimulants during pregnancy. Pediatric cardiologists, clinical geneticists and other experts reviewed the cases in order to make sure that the classification was accurate and to reduce any bias.
However, the study had its limitations. The researchers were not able, in the first place, to separate the effects of the medication from the disorder. This makes it difficult for researchers to determine whether the few associations observed between the groups that were exposed to medication use or affected by the presence of comorbidities. In addition the study did not study long-term offspring outcomes.
The study did find that babies whose mothers had taken ADHD medication during pregnancy were at a more risk of being admitted to the neonatal intensive care unit (NICU) than infants whose mothers had not taken any medication or stopped their medications before or during pregnancy. This increase was caused by central nervous system disorders. The higher risk of admission was not affected by the stimulant medications used during pregnancy.
Women who were taking stimulant ADHD medication during pregnancy were also at an elevated chance of having a caesarean delivery or having a baby born with an low Apgar score (less than 7). These increases appear to be unrelated to the type of medication used during pregnancy.
The researchers suggest that the risk of a small amount with the use of ADHD medications during early pregnancy could be offset by the greater benefits to both mother and child from continued treatment for the woman's condition. Physicians should discuss this with their patients and, when possible, help them develop strategies for improving their coping skills which can reduce the negative impact of her condition on her daily life and relationships.
Medication Interactions
Doctors are increasingly faced with the decision of whether to continue treatment or stop during pregnancy as more women are diagnosed with ADHD. These decisions are usually taken without clear and authoritative evidence. Instead, physicians must weigh their own knowledge, the experience of other physicians and the research on the topic.
Particularly, the subject of possible risks to the infant can be difficult. The research that has been conducted on this topic is based on observations rather than controlled studies, and a lot of the results are in conflict. Additionally, the majority of studies limit their analysis to live births, which could undervalue the serious teratogenic effects that can result in abortion or termination of the pregnancy. The study presented in this journal club addresses these shortcomings by looking at data from both live and deceased births.
The conclusion: While some studies have shown an association between ADHD medications and the risk of certain birth defects, other studies have found no such relationship and the majority of studies have a neutral or slight negative effect. As a result an accurate risk-benefit analysis must be conducted in every case.
For a lot of women with ADHD, the decision to discontinue medication is difficult, if not impossible. In fact, in an article published in the Archives of Women's Mental Health, psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can increase depression, feelings of isolation and family conflict for patients with ADHD. Furthermore, a loss of medication can interfere with the ability to perform job-related tasks and drive safely that are crucial aspects of daily life for a lot of people with ADHD.
She suggests that women who are not sure whether to take the medication or stop due to pregnancy should educate family members, coworkers, and acquaintances about the condition, the impact on daily functioning and the benefits of keeping the current treatment plan. It will also help a woman feel confident about her decision. medication for adhd in adults can pass through the placenta. If a woman decides not to take her ADHD medication while breastfeeding, it is crucial to be aware that the drug could be transferred to the infant.
Birth Defects and Risk of
As the use of ADHD medications to treat symptoms of attention deficit hyperactivity disorder (ADHD) grows, so do concerns about the effects that the medications could have on the fetuses. A study that was published in the journal Molecular Psychiatry adds to the existing knowledge on this subject. Researchers used two huge data sets to examine over 4.3 million pregnant women and determine if stimulant medication use increased the risk of birth defects. Researchers discovered that although the overall risk is low, first-trimester ADHD medication use was associated with slightly higher rates of specific heart defects such as ventriculoseptal defect.
The researchers of the study found no association between early medication use and congenital abnormalities such as facial clefting or club foot. The results are in the same vein as previous studies that have shown an insignificant, but small increase in the number of cardiac malformations among women who began taking ADHD medication prior to the time of the birth of their child. The risk increased in the latter half of pregnancy when many women began to stop taking their medication.
Women who took ADHD medication in the first trimester of their pregnancies were also more likely to undergo caesarean section, low Apgar score after delivery and a baby who needed breathing assistance during birth. However the researchers of the study were unable to eliminate bias due to selection 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 inform physicians when they meet pregnant women. They suggest that although the discussion of risks and benefits is important but the decision to stop or keep medication should be based on the woman's requirements and the severity of her ADHD symptoms.
The authors warn that, even though stopping the medication is an option to look into, it is not recommended due to the high rate depression and mental health issues for women who are pregnant or have recently given birth. Additionally, research suggests that women who stop taking their medication will have a harder time adjusting to a life without them after the baby is born.
Nursing
It can be a challenge becoming a mother. Women who suffer from ADHD who have to deal with their symptoms while attending doctor appointments as well as preparing for the arrival of a child and adjusting to new household routines are often faced with a number of difficulties. Therefore, many women elect to continue taking their ADHD medications throughout the course of pregnancy.
The majority of stimulant drugs are absorbed through breast milk in low quantities, so the risk for breastfeeding infant is minimal. The amount of exposure to medications will differ based on dosage and frequency of administration as well as the time of the day. In addition, various medications enter the baby’s system through the gastrointestinal tract or through breast milk. The impact of these medications on the health of a newborn isn't fully comprehended.
Due to the absence of research, some physicians might be tempted to stop taking stimulant drugs during the course of pregnancy. This is a difficult decision for the patient, who must weigh the benefits of continuing her medication against the potential dangers to the fetus. As long as there is no more information, GPs should ask all pregnant patients about their experience with ADHD and if they are taking or planning to take medication during the perinatal time.
A increasing number of studies have revealed that the majority of women are able to safely continue taking their ADHD medication during pregnancy and breastfeeding. As a result, more and more patients choose to do so, and in consultation with their physician, they have discovered that the benefits of keeping their current medication exceed any risk.
Women who suffer from ADHD who plan to breastfeed should seek advice from a specialist psychiatrist prior to becoming pregnant. They should review their medications with their doctor and discuss the advantages and disadvantages of continuing treatment, including non-pharmacological strategies. Psychoeducation is also required to help pregnant women suffering from ADHD recognize the signs and the underlying disorder. They should also be informed about treatment options and build the coping mechanisms. This should include a multidisciplinary approach with the GP as well as obstetricians, psychiatry and obstetricians. The pregnancy counselling should consist of discussion of a management plan for both mother and child, and monitoring for signs of deterioration and when necessary, making adjustments to the medication regimen.