ADHD Medication During Pregnancy and Breastfeeding
The decision to stop or continue ADHD medication during pregnancy and nursing is a difficult decision for women suffering from the condition. There is a lack of information about how long-term exposure to these drugs can affect the fetus.
A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication during the uterus do not develop neurological developmental disorders like hearing loss or impaired vision, febrile seizures, or IQ impairment. The authors acknowledge that further high-quality research is needed.
Risk/Benefit Analysis
Women who are pregnant and take ADHD medication should weigh the benefits of taking it against the possible risks for the baby. The doctors don't have the information to provide clear recommendations however they can provide information on the risks and benefits to assist pregnant women to make informed choices.
A study published in Molecular Psychiatry concluded that women who were taking ADHD medication during early pregnancy were not at greater risk of fetal malformations, or structural birth defects. Researchers conducted a large population-based case control study to compare the incidence of major structural defects in infants born to mothers who were taking stimulants during pregnancy. Pediatric cardiologists and clinical geneticists looked over the cases to ensure an accurate classification of the cases and to reduce the possibility of bias.
However, the study was not without its flaws. Most important, they were unable to separate the effects of the medication from those of the disorder that is underlying. This limitation makes it difficult for researchers to determine if the few associations observed between the groups that were exposed to the use of medications or if they were affected by comorbidities. The researchers also did not examine long-term outcomes for the offspring.
The study did reveal that babies whose mothers had taken ADHD medications during pregnancy were at slightly greater risk of being admitted to the neonatal intensive care unit (NICU) than infants who were born without any medication or cut back on their medications prior to or during pregnancy. This increase was caused by central nervous system disorders. The increased risk of admission was not affected by the stimulant medication used during pregnancy.
Women who used stimulant ADHD medication during pregnancy were also at an increased chance of having a caesarean birth or having a child with a low Apgar score (less than 7). These increases didn't appear to be affected by the type of medication that was used during pregnancy.
Researchers suggest that the small risks posed by the use of ADHD medications during early pregnancies can be offset by greater benefits for baby and mother of continued treatment for the woman's disorder. Physicians should discuss this with their patients and, where possible, assist them in developing strategies for improving their coping skills that may minimize the effects of her disorder on her daily life and relationships.
Medication Interactions
Doctors are increasingly faced with the decision of whether to keep treatment or stop as more women are diagnosed with ADHD. Most of the time, these decisions are made in the absence of clear and authoritative evidence regardless, so doctors have to weigh their experience from their own experiences, those of other doctors, and what research suggests on the subject, along with their own judgments for each individual patient.
Particularly, the subject of potential risks for the baby can be a challenge. The research on this issue is based on observation rather than controlled studies, and the results are conflicting. Furthermore, most studies restrict their analysis to live births, which may underestimate severe teratogenic effects that cause abortion or termination of the pregnancy. The study discussed in the journal club addresses these limitations, by examining both the data from deceased and live births.
Conclusion A few studies have found an association between ADHD medications and certain birth defects However, other studies haven't shown such a relationship. The majority of studies show a neutral, or even slightly negative, effect. As a result, a careful risk/benefit analysis must be done in each case.
It can be challenging, if not impossible, for women with ADHD to stop taking their medication. In a recent article in Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can lead to depression and feelings of isolation. A loss of medication may also impact the ability to safely drive and complete work-related tasks, which are essential aspects of daily life for people with ADHD.
She suggests that women who aren't sure whether to continue taking medication or stop it due to their pregnancy should educate family members, coworkers and their friends about the condition, the impact on daily functioning and the advantages of staying on the current treatment plan. It can also help a woman feel confident about her decision. It is important to remember that some drugs can pass through the placenta therefore, if a patient decides to stop her ADHD medication during pregnancy and breastfeeding, she should be aware of the possibility that traces of the drug could be passed on to the baby.
Risk of Birth Defects
As the use of ADHD medication to treat the symptoms of attention deficit hyperactivity disorder (ADHD) grows, so do concerns about the effects that the drugs might have on the fetuses. A study that was published in the journal Molecular Psychiatry adds to the existing knowledge about this subject. Using two massive data sets, researchers were able to examine more than 4.3 million pregnancies and determine whether stimulant medications increased the risk of birth defects. Although the risk overall remains low, the researchers did find that first-trimester exposure to ADHD medications was associated with an increased risk of specific heart defects, such as ventriculo-septal defect (VSD).
The authors of the study didn't find any association between early medication usage and congenital anomalies such as facial deformities or club feet. The findings are in line with previous studies that have shown the presence of a small, but significant increase in the risk of developing cardiac malformations among women who began taking ADHD medications prior to the time of pregnancy. The risk was higher in the later part of pregnancy, as many women decide to stop taking their ADHD medication.
Women who were taking ADHD medication during the first trimester were more likely to need a caesarean or have a low Apgar after birth and have a baby that needed breathing assistance at birth. However, the authors of the study were not able to eliminate selection bias by restricting the study to women who didn't have other medical issues that could be a contributing factor to these findings.
The researchers hope that their research will help inform the clinical decisions of doctors who treat pregnant women. They suggest that although the discussion of risks and benefits is important however, the decision to stop or maintain treatment should be based on the woman's requirements and the severity of her ADHD symptoms.
The authors caution that, while stopping the medication is an option to look into, it is not recommended due to the high prevalence of depression and mental health issues among women who are pregnant or have recently given birth. Research has also shown that women who stop taking their medications will have a difficult time adjusting to a life without them once the baby is born.
Nursing
It can be overwhelming becoming a mother. Women with ADHD who have to deal with their symptoms while attending doctor appointments, making preparations for the arrival of a baby and adjusting to new household routines are often faced with a number of difficulties. Many women decide to continue taking their ADHD medication during pregnancy.
The risk to breastfeeding infant is minimal because the majority of stimulant medication is absorbed through breast milk in low amounts. However, the rate of medication exposure to the newborn may differ based on dosage, frequency it is taken 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 click here the impact of this on a newborn is not fully known.
Due to the absence of research, some doctors might be tempted to stop taking stimulant drugs during the pregnancy of a woman. This is a difficult decision for the patient, who must weigh the benefits of keeping her medication against the possible dangers to the foetus. In the meantime, until more information is available, doctors can inquire about pregnant patients whether they have any background of ADHD or if they intend to take medication during the perinatal phase.
Numerous studies have proven that women can continue taking their ADHD medication safely during pregnancy and while breast-feeding. In the end, an increasing number of patients choose to do so and in consultation with their doctor they have discovered that the benefits of keeping their current medication far exceed any risk.
Women with ADHD who are planning to nurse should seek advice from an expert psychiatrist prior to becoming pregnant. They should discuss their medication with their prescriber as well as the pros and cons of continuing treatment. This includes non-pharmacological methods. Psychoeducation is also necessary to help pregnant women suffering from ADHD recognize the signs and underlying disorder. They should also be informed about treatment options and build the coping mechanisms. This should involve 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 mother and child, as well as monitoring for signs of deterioration and the need for adjustments to the medication regimen.