ADHD Medication During Pregnancy and Breastfeeding
The choice of whether to stop or continue ADHD medication during breastfeeding and pregnancy is a challenge for women suffering from the condition. Little data exists about how long-term exposure to these drugs may affect the foetus.
A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication during the uterus do not develop neurological disorders like hearing or vision impairment seizures, febrile seizures or IQ impairment. The authors acknowledge that more high-quality studies are needed.
Risk/Benefit Analysis
Women who are expecting and taking ADHD medication should consider the benefits of taking it against the potential risks to the baby. Physicians do not have the information needed to provide clear recommendations however they can provide information about risks and benefits that help pregnant women make informed decisions.
A study published in Molecular Psychiatry found that women who used ADHD medications during their early pregnancy did not face a significantly higher risk of fetal cardiac malformations or major structural birth defects. Researchers used a large sample-based case control study to assess the frequency of structural defects that were major in infants who were born to mothers who took stimulants during pregnancy. Clinical geneticists, pediatric cardiologists and other experts examined the cases to ensure that the classification was accurate and to minimize any bias.
However, the researchers' study had its limitations. The researchers were unable in the beginning to distinguish the effects caused by the medication from the disorder. This limitation makes it difficult to know whether the limited associations observed in the groups that were exposed result from medication use or the confounding effect of comorbidities. In addition the researchers did not examine long-term offspring outcomes.
The study revealed that infants whose mothers took ADHD medication during pregnancy had a slightly higher chance of being admitted to the neonatal care unit (NICU) as compared to mothers who didn't take any medication during pregnancy or stopped taking their medication before or during pregnancy. The reason for this was central nervous system-related disorders, and the higher risk of admission was not found to be influenced by which stimulant medications were used during pregnancy.
Women who were taking stimulant ADHD medications during pregnancy also had a higher risk of having to have caesarean sections or the baby was not scoring well on the Apgar scale (less than 7). These risks did not appear to be influenced by the kind of medication used during pregnancy.
Researchers suggest that the minor risk of using ADHD medications during early pregnancies may be offset by the more beneficial outcomes for both mother and baby of continuing treatment for the woman's disorder. Physicians should discuss the issue with their patients and, when possible, assist them in developing strategies to improve their coping abilities that may minimize the effects of her disorder on her daily life and relationships.
Medication Interactions
As more women than ever are diagnosed with ADHD and being treated with medication, the question of whether to keep or stop treatment during pregnancy is one that more and more physicians have to face. These decisions are frequently made without clear and reliable evidence. Instead, doctors must consider their own expertise and experience, as well as the experiences of other doctors and the research that has been conducted on the subject.
The issue of risk for infants can be difficult to determine. A lot of studies on this topic are based on observational evidence rather than controlled research, and their findings are often contradictory. In addition, most studies limit their analysis to live births, which could underestimate severe teratogenic effects that result in abortion or termination of the pregnancy. The study discussed in this journal club addresses these issues by looking at data from both live and deceased births.
Conclusion: While some studies have shown an association between ADHD medications and certain birth defects However, other studies haven't found a correlation. Most studies have shown a neutral, or even slight negative impact. In every case, a careful evaluation of the risks and benefits must be performed.
It can be challenging, if not impossible, for women with ADHD to stop taking their medication. In medications for adhd uk in the 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. A loss of medication may also affect the ability to drive safely and perform work-related tasks, which are crucial aspects of everyday life for those suffering from ADHD.
She recommends women who are unsure about whether to keep or stop medication in light of their pregnancy consider educating family members, friends and colleagues on the condition, its effects on daily functioning, and the advantages of continuing the current treatment plan. Educating them can also aid in ensuring that the woman feels supported in her struggle with her decision. Some medications can pass through the placenta. If the patient decides not to take her ADHD medication while breastfeeding, it is crucial to be aware that the medication could be passed on to her baby.
Risk of Birth Defects
As the use of ADHD medications to treat symptoms of attention deficit hyperactivity disorder (ADHD) grows as do concerns about the effects that the drugs could have on the fetuses. Recent research published in the journal Molecular Psychiatry has added to the body knowledge on this topic. Using two massive data sets researchers were able to analyze more than 4.3 million pregnancies to determine whether stimulant medication use increased the risk of birth defects. Researchers discovered that, while the risk overall is low, the first trimester ADHD medication use was associated with slightly higher rates of certain heart defects, like ventriculoseptal defect.
The authors of the study could not discover any connection between the use of early medications and congenital anomalies such as facial deformities or club feet. The results are in line with previous studies which showed the existence of a slight, but significant increase in the number of cardiac malformations among women who began taking ADHD medication prior to the time of the time of pregnancy. The risk grew during the latter part of pregnancy, when a lot of women are forced to stop taking their ADHD medication.
Women who were taking ADHD medication during the first trimester were more likely need a caesarean, have an insufficient Apgar after delivery and have a baby who needed help breathing when they were born. The researchers of the study could not remove bias in selection since they limited the study to women who did not have any other medical conditions that could have contributed to the findings.
The researchers hope that their research will serve to inform the clinical decisions of physicians who encounter pregnant women. They advise that while the discussion of risks and benefits is important but the decision to stop or continue treatment must be based on each woman's needs and the severity of her ADHD symptoms.
The authors warn that, even though stopping the medication is an option 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. Furthermore, research suggests that women who decide to stop their medications are more likely to experience a difficult time getting used to life without them after the baby's arrival.
Nursing
It can be overwhelming to become a mom. Women with ADHD who have to manage their symptoms while attending physician appointments, making preparations for the arrival of a child and adjusting to new household routines are often faced with a number of difficulties. This is why many women elect to continue taking their ADHD medications throughout pregnancy.
The risk to a breastfeeding infant is minimal because the majority of stimulant medications passes through breast milk in low amounts. The rate of medication exposure will vary based on the dosage, frequency of administration and the time of the day. In addition, various medications enter the baby’s system through the gastrointestinal tract, or through breast milk. The effect on a newborn's health is not completely comprehended.
Some doctors may decide to stop stimulant medications during a woman's pregnancy due to the lack of research. It's a difficult choice for the mother, who must weigh the benefits of taking her medication as well as the risk to the foetus. Until more information becomes available, GPs may ask pregnant patients whether they have an background of ADHD or if they plan to take medication during the perinatal phase.
Many studies have shown that women can continue taking their ADHD medication safely during pregnancy and breast-feeding. In the end, more and more patients opt to do this and, in consultation with their doctor they have discovered that the benefits of maintaining their current medication exceed any risk.
It's important for women with ADHD who are contemplating breastfeeding to seek a specialist psychiatrist's guidance 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 should also be offered to help women with ADHD recognize their symptoms and underlying disorder and learn about treatments and to reinforce existing strategies for managing. This should be a multidisciplinary process with the GPs, obstetricians, and psychiatrists. Pregnancy counseling should include a discussion of a treatment plan for the mother and child, monitoring of signs of deterioration, and, if needed, adjustments to the medication regime.