ADHD Medication During Pregnancy and Breastfeeding
Women suffering from ADHD face a difficult decision regarding whether or not to stop taking ADHD medication during pregnancy and breast-feeding. There are few data on how long-term exposure may affect a foetus.
A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological problems like hearing loss or vision, febrile seizures or IQ impairment. The authors acknowledge the need for higher-quality research.
Risk/Benefit Analysis
Women who are pregnant and taking ADHD medication should evaluate the benefits of using it against the possible risks to the baby. Doctors don't have the necessary data to provide clear recommendations however they can provide information regarding 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 have an increased risk of fetal cardiac malformations or major birth defects that are structural. Researchers used a vast population-based case-control study to evaluate the incidence of major structural birth defects in infants born to mothers who had taken stimulants during early pregnancy and those who had not. Clinical geneticists, pediatric cardiologists and other experts reviewed the cases in order to ensure that the classification was accurate and to eliminate any bias.
The research conducted by the researchers had some limitations. Most important, they were not able to differentiate the effects of the medication from the underlying disorder. This limitation makes it difficult for researchers to determine if the small differences observed between the exposed groups were due to medication use or if they were confounded by co-morbidities. The researchers did not study long-term outcomes for offspring.
The study showed that infants whose mothers took ADHD medication during pregnancy had a slightly greater risk of being admitted to the neonatal care unit (NICU) as compared to those whose mothers didn't take any medication during pregnancy or had discontinued taking their medication prior to or during pregnancy. This was due to central nervous system-related disorders, and the increased risk of admission was not found to be affected by the type of stimulant medications were taken during pregnancy.
Women who were taking stimulant ADHD medications during pregnancy also had a higher chance of having caesarean sections or a baby that scored low on the Apgar scale (less than 7). These increases did not seem to be influenced by the type of medication that was used during pregnancy.
Researchers suggest that the small risk of using ADHD medications during early pregnancies may be offset by the more beneficial outcomes for both baby and mother of continued treatment for the woman’s disorder. Physicians should talk to their patients about this issue and try to help them develop coping strategies that could reduce the effects of her disorder on her daily functioning and her relationships.
Medication Interactions
As more women than ever before are being diagnosed with ADHD and being treated with medication, the issue of whether to keep or discontinue treatment during pregnancy is one that more and more physicians confront. Often, these decisions are made in the absence of clear and authoritative evidence in either case, which means that doctors must weigh what they know about their experiences, the experiences of other doctors, and what research says on the topic, along with their own best judgment for each individual patient.
The issue of possible risks to infants is particularly tricky. The research that has been conducted on this topic is based on observations rather than controlled studies, and many of the findings are conflicting. The majority of studies limit their analysis to live births, which can underestimate the teratogenic impact which can cause terminations or abortions of pregnancy. The study presented in the journal club addresses these issues by analyzing information on deceased and live births.
Conclusion A few studies have found an association between ADHD medications and certain birth defects however, other studies haven't found a correlation. Most studies show that there is a neutral, or somewhat negative, impact. Therefore, a careful risk/benefit assessment must be done in each instance.
It can be challenging, if not impossible for women suffering from ADHD to stop taking their medication. In fact, in a recent article 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 those suffering from the disorder. A decrease in medication could affect the ability to drive safely and complete work-related tasks, which are vital aspects of everyday life for people with ADHD.
She suggests women who are unsure about whether to keep or stop taking medication because of their pregnancy, consider the possibility of educating friends, family members, and coworkers on the condition, its effects on daily functioning, and the advantages of continuing the current treatment plan. It can also help the woman feel supported in her struggle with her decision. Certain medications can be passed through the placenta. If the patient decides to not take her ADHD medication while breastfeeding, it is important to be aware that the medication could be passed on to her infant.
Birth Defects Risk
As the use and use of ADHD medications to treat the symptoms of attention deficit disorder hyperactivity disorder (ADHD) increases as does the concern about the possible effects of the drugs on fetuses. A recent study published in the journal Molecular Psychiatry adds to the existing information on this topic. Utilizing two huge data sets researchers were able to examine more than 4.3 million pregnancies and determine whether stimulant medication use increased the risk of birth defects. Researchers found that while the overall risk is low, the first trimester ADHD exposure to medication was associated with slightly higher rates of certain heart defects, such as ventriculoseptal defect.
The researchers of the study found no connection between the use of early medications and congenital abnormalities such as facial clefting or club foot. The results are in line with previous studies that have shown the existence of a slight, but significant increase in cardiac malformations for women who began taking ADHD medication prior to the time of pregnancy. The risk grew in the latter half of pregnancy, when a lot of women begin to discontinue their medication.
Women who used ADHD medications in the first trimester of their pregnancies were also more likely to undergo a caesarean section, a low Apgar score after delivery and a baby who needed breathing assistance during birth. However, the authors of the study were not able to eliminate bias due to selection by restricting the study to women who didn't have any other medical conditions that could have contributed to these findings.
Researchers hope that their research will provide doctors with information when they see pregnant women. They suggest that although the discussion of the benefits and risks is important, the decision to stop or continue treatment must be based on each woman's requirements and the severity of her ADHD symptoms.
The authors warn that, although stopping the medication is a possibility to think about, it isn't recommended due to the high rate depression and other mental disorders for women who are pregnant or recently gave birth. Further, the research suggests that women who choose to stop taking their medication are more likely to experience difficulties adapting to life without them after the baby's arrival.
Nursing
It can be overwhelming to become a mom. Women suffering from ADHD are often faced with a number of difficulties when they must deal with their symptoms, go to doctor appointments, prepare for the birth of a baby and adjust to a new routine. Therefore, many women decide to continue taking their ADHD medications throughout the course of pregnancy.
The majority of stimulant medicines are absorbed by breast milk in low amounts, therefore the risk to the breastfeeding infant is minimal. However, the rate of exposure to medications by the newborn may differ based on the dosage, frequency it is administered and the time of day it is administered. Additionally, different medications enter the body of the baby differently through the gastrointestinal tract as well as breast milk, and the effect of this on a newborn isn't yet fully known.
Because of the lack of evidence, some doctors may be inclined to discontinue stimulant medications during the pregnancy of a woman. This is a difficult choice for the patient, who must balance the benefits of continuing her medication with the potential dangers to the foetus. Until more information becomes available, doctors can inquire about pregnant patients whether they have an background of ADHD or if they plan to take medication during the perinatal stage.
A growing number of studies have shown that most women can safely continue their ADHD medication during pregnancy and while breastfeeding. In response, a growing number of patients are opting to do so. They have discovered after consulting with their doctor, that the benefits of continuing their current medication outweigh possible risks.
Women with ADHD who are planning to nurse should seek advice from an expert psychiatrist prior to becoming pregnant. They should review their medications with their doctor and discuss the advantages and disadvantages of continued treatment, including non-pharmacological management strategies. Psychoeducation should also be provided to help women with ADHD recognize their symptoms and the root cause Learn about the available treatment options and reinforce existing coping strategies. This should be an approach that is multidisciplinary, including the GP doctors, obstetricians and psychiatrists. Pregnancy counseling should include discussion of a treatment plan for the mother and the child, as well as monitoring for indicators of deterioration, and, if needed modifications to the medication regime.