ADHD Medication During Pregnancy and Breastfeeding
Women suffering from ADHD have to make a difficult choice on whether to keep or stop taking ADHD medication during pregnancy and breastfeeding. Little data exists about how long-term exposure to these medications can affect the fetus.
A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological issues like hearing loss or vision, febrile seizures or IQ impairment. The authors acknowledge that more high quality research is needed.
Risk/Benefit Analysis
Women who are expecting and taking ADHD medication should evaluate the benefits of using it versus the risks to the fetus. Physicians don't have the data to make unambiguous recommendations, but can provide information on risks and benefits to aid pregnant women in making informed decisions.
A study published in Molecular Psychiatry concluded that women who took ADHD medication in early pregnancy were not at a greater risk of fetal malformations or structural birth defects. Researchers conducted a large population-based case-control study to assess the risk of major structural birth defects in infants born to mothers who took stimulants during early pregnancy, and those who did not. Pediatric cardiologists and clinical geneticists examined the cases to ensure an accurate classification of the cases and to reduce the chance of bias.
The research conducted by the researchers was not without its limitations. The most important issue was that they were unable to distinguish the effects of the medication from the disorder that is underlying. This limitation makes it difficult for researchers to establish whether the small associations observed among the groups that were exposed to medication use or if they were confounded by the presence of comorbidities. The researchers also did not look at the long-term effects for the offspring.
The study did reveal that infants whose mothers took ADHD medication during pregnancy were at a slightly greater risk of being admitted to the neonatal intensive care unit (NICU) than those who whose mothers did not take any medication or cut back on their medications prior to or during pregnancy. This increase was caused by central nervous system disorders. The higher risk of admission was not influenced by the stimulant medication that was used during pregnancy.
Women who used stimulant ADHD medication during pregnancy also had an increased risk of having a caesarean section or having a child with low Apgar score (less than 7). These increases didn't seem to be influenced by the kind of medication used during pregnancy.
The research suggests that the small risk associated with the use of ADHD medications during the early stages of pregnancy may be offset by the higher benefit for both mother and child from continued treatment for the woman's condition. Doctors should discuss with their patients about this and as much as possible, assist them develop coping strategies that may reduce the effects of her disorder on her daily life and relationships.
Medication Interactions
Doctors are increasingly confronted with the dilemma of whether to continue treatment or stop as more women are diagnosed with ADHD. adhd medication for adults are often made without clear and authoritative evidence. Instead, doctors have to consider their own expertise and experience, as well as the experiences of other physicians and the research that has been conducted on the subject.
The issue of risk for infants can be extremely difficult. A lot of studies on this subject are based on observations rather than controlled research, and their findings are often contradictory. The majority of studies limit their analysis to live-births, which could underestimate the severity of teratogenic effects that can lead to terminations or abortions of pregnancy. The study that is discussed in the journal club addresses these issues, by examining both information on deceased and live births.
Conclusion A few studies have revealed a positive correlation between ADHD medications and certain birth defects, other studies have not found a correlation. Most studies show an unintended, or slight negative effect. Therefore an accurate risk-benefit analysis must be conducted in every instance.
It can be challenging, if not impossible for women suffering from 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 increase depression and feelings of loneliness. Additionally, the loss of medication may affect the ability to do job-related tasks and drive safely that are crucial aspects of daily life for many people with ADHD.
She suggests women who are uncertain about whether to continue or stop medication in light of their pregnancy should consider informing family members, friends and colleagues about the condition, its impact on daily functioning, and the benefits of keeping the current treatment regimen. It can also make the woman feel more comfortable in her struggle with her decision. It is important to note that some medications are able to pass through the placenta so if a woman decides to stop taking her ADHD medication during pregnancy and breastfeeding, she should be aware of the possibility that traces of the medication could be transferred to the infant.
Birth Defects and Risk of
As the use and misuse of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases, so does concern about the potential effects of these drugs on the fetuses. A study that was published in the journal Molecular Psychiatry adds to the existing knowledge about this subject. Researchers used two massive data sets to examine over 4.3 million pregnancy and determine if stimulant medication use increased birth defects. Although the risk overall remains low, the researchers found that exposure in the first trimester to ADHD medications was associated with a slightly higher rate of certain heart defects, like ventriculo-septal defects (VSD).
The authors of the study didn't discover any connection between early medication usage and other congenital anomalies like facial deformities, or club feet. The results are in the same vein as 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 pregnancy. The risk increased in the latter part of pregnancy when many women stopped taking their medication.
Women who took ADHD medication in the first trimester were more likely require a caesarean birth and also have an insufficient Apgar after birth and have a baby that needed help breathing after birth. However, the authors of the study were unable to eliminate bias due to selection by limiting the study to women who didn't have any other medical issues that could have contributed to these findings.
The researchers hope that their research will serve to inform the clinical decisions of physicians who see pregnant women. The researchers advise that while discussing the risks and benefits are important, the choice on whether to continue or stop medication should be in light of the severity of each woman's ADHD symptoms and her requirements.
The authors caution that, even though stopping the medication is a possibility to consider, it is not recommended due to the high rate depression and mental health issues among women who are pregnant or who have recently given birth. Research has also shown that women who stop taking their medication will have a difficult adjustment to life without them after the baby is born.
Nursing
It can be overwhelming to become a mom. Women suffering from ADHD can face severe challenges when they have to manage their symptoms, go to doctor appointments and prepare for the birth of their child and adjust to new routines. Many women decide to continue taking their ADHD medication during pregnancy.
The risk for nursing infant is low because the majority of stimulant medications is absorbed through breast milk in low amounts. The rate of exposure to medication will differ based on dosage, frequency of administration and the time of the day. Additionally, individual medications enter the baby's system differently through the gastrointestinal tract as well as breast milk. The impact of this on a newborn isn't well understood.
Because of the lack of research, some physicians may be inclined to discontinue stimulant medications during a woman's pregnancy. It's a difficult choice for the woman, who must weigh the benefits of continuing her medication against the potential risks to the fetus. In the meantime, until more information is available, doctors can inquire about pregnant patients if they have any background of ADHD or if they plan to take medication in the perinatal stage.
A increasing number of studies have shown that the majority of women are able to safely continue their ADHD medication while they are pregnant and nursing. In the end, an increasing number of patients choose to do so and, after consulting with their doctor, they have found that the benefits of maintaining their current medication far exceed any risk.
Women with ADHD who are planning to nurse should seek the advice of a specialist psychiatrist prior to becoming pregnant. adhd medication for adults should discuss their medication with their doctor and discuss the pros and cons of continued treatment, including non-pharmacological management strategies. Psychoeducation is also required to help pregnant women suffering from ADHD recognize their symptoms and the root cause Learn about the available treatment options and strengthen existing coping strategies. This should be a multidisciplinary approach, which includes the GP as well as obstetricians, psychiatry and obstetricians. Counselling for pregnancy should include the discussion of a plan for management for both mother and child, and monitoring for signs of deterioration and, if necessary, adjustments to the medication regimen.