ADHD Medication During Pregnancy and Breastfeeding
Women with ADHD have to make a difficult choice on whether to keep or stop taking ADHD medication during pregnancy and breastfeeding. There aren't enough data regarding how exposure over time may affect the foetus.
A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological problems such as impaired hearing or vision, febrile seizures or IQ impairment. The authors acknowledge that further high-quality research is needed.
Risk/Benefit Analysis
Pregnant women who take ADHD medications must weigh the advantages of taking them against the potential risks to the fetus. Doctors don't have enough data to provide clear recommendations, but can provide information on the risks and benefits to aid pregnant women in making informed decisions.
A study published in Molecular Psychiatry found that women who used ADHD medications in early pregnancy did not have a significantly higher risk of fetal cardiac malformations or major birth defects that are structural. The researchers used a large population-based study of case-control to determine the prevalence of major structural birth defects in babies born to mothers who had taken stimulants in early pregnancy, and those who did not. Pediatric cardiologists, clinical geneticists and other experts looked over the cases to make sure that the classification was correct and to minimize any bias.
However, the researchers' study had its limitations. The researchers were unable, in the first place to distinguish the effects caused by the medication from the disorder. That limitation makes it difficult to know whether the limited associations observed in the exposed groups result from medication use or the confounding effect of comorbidities. Additionally the study did not study the long-term effects of offspring on their parents.
The study revealed that infants whose mothers had taken ADHD medication during pregnancy were at a slightly higher risk of admission to the neonatal care unit (NICU), compared to those whose mothers didn't take any medication during pregnancy, or had quit taking the medication prior to or during pregnancy. The reason for this was central nervous system disorders. The increased risk of admission was not influenced by the stimulant medication used during pregnancy.
Women who took stimulant ADHD medications during pregnancy also had a higher risk of having to have an emergency caesarean section or having one whose baby scored low on the Apgar scale (less than 7). These increases didn't seem to be influenced by the kind of medication used during pregnancy.
The researchers suggest that the small risk associated with the use of ADHD medications during early pregnancy could be offset by the greater benefits for both mother and child of continuing treatment for the woman's condition. Physicians should discuss this with their patients and, if they are able, assist them in developing strategies for improving their coping skills that can lessen the negative impact of her condition 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 or not to end treatment during pregnancy is one that doctors are having to have to face. These decisions are usually made without clear and authoritative evidence. Instead, physicians must consider their own expertise, the experience of other doctors and the research that has been conducted on the subject.
Particularly, the issue of potential risks for the baby can be a challenge. The research on this issue is based on observations rather than controlled studies and many of the findings are conflicting. Additionally, the majority of studies limit their analysis to live births, which can underestimate the severity of teratogenic effects that could lead to abortion or termination of the pregnancy. The study discussed in the journal club addresses these limitations by analyzing both information on deceased and live births.
The conclusion is that while some studies have found an association between ADHD medications and the risk of certain birth defects, other studies have not found any evidence of a link and the majority of studies demonstrate a neutral or slightly negative impact. In every case it is imperative to conduct a thorough study of the potential risks and benefits must be performed.
For women suffering from ADHD, the decision to discontinue medication can be difficult, if not impossible. 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 cause depression, feelings of loneliness, and family conflict for patients with ADHD. In addition, a decrease in medication may affect the ability to complete work-related tasks and safely drive, which are important aspects of daily life for a lot of people with ADHD.
She suggests that women who aren't sure whether to continue taking medication or discontinue it due to pregnancy should educate family members, coworkers, and acquaintances about the condition, the effects on daily functioning, and the benefits of keeping the current treatment regimen. It can also help the woman feel supported when she is struggling with her decision. It is important to note that certain drugs can pass through the placenta, so if a woman decides to stop her ADHD medication during pregnancy and breastfeeding, she should be aware that click here traces of the drug could be transferred to the child.
Birth Defects and Risk of
As the use and misuse of ADHD medication to treat symptoms of attention deficit hyperactivity disorder (ADHD), increases the concern over the possible effects of the drugs on foetuses. A recent study published in the journal Molecular Psychiatry adds to the body of knowledge about this subject. Researchers utilized two massive data sets to study more than 4.3 million pregnancies and determine if the use of stimulant medications increased the risk of birth defects. Researchers discovered that although the risk overall is low, first-trimester ADHD exposure to medication was associated with slightly higher risk of certain heart defects, such as ventriculoseptal defect.
The authors of the study found no connection between early use of medication and congenital abnormalities like facial clefting, or club foot. The results are in agreement with previous studies that have shown a small, but significant increase in cardiac malformations for women who began taking ADHD medication before the birth of their child. This risk increased during the latter part of pregnancy when many women began to stop taking their medication.
Women who used ADHD medication in the first trimester of pregnancy were also more likely to experience caesarean sections, a low Apgar score after delivery and a baby who needed help breathing at birth. The researchers of the study were unable to eliminate selection bias because they limited the study to women without other medical conditions that could have contributed to the findings.
The researchers hope their study will aid in the clinical decisions of physicians who treat pregnant women. They advise that while the discussion of the benefits and risks is important, the decision to stop or keep treatment should be based on each woman's needs and the severity of her ADHD symptoms.
The authors caution that, although stopping the medication is an option to consider, it is not advised because of the high incidence of depression and other mental disorders among women who are pregnant or who have recently given birth. Additionally, the research suggests that women who choose to stop taking their medications are more likely to experience a difficult time getting used to life without them following the birth of their baby.
Nursing
The responsibilities that come with being a new mother can be overwhelming. Women suffering from ADHD may face a lot of challenges when they have to manage their symptoms, attend doctor appointments and prepare for the birth of their child and adjust to a new routine. As such, many women decide to continue taking their ADHD medication throughout the pregnancy.
The majority of stimulant medicines pass through breast milk in low quantities, so the risk to infant who is breastfeeding is low. The amount of exposure to medications will differ based on dosage, frequency of administration and the time of day. Additionally, different medications are introduced into the baby's system via the gastrointestinal tract or breast milk. The impact of these medications on a newborn's health is not completely known.
Some physicians may discontinue stimulant medication during a woman’s pregnancy due to the absence of research. It's a difficult choice for the mother, who must weigh the benefits of her medication against the risks to the embryo. As long as there is no more information, GPs should ask all pregnant patients about their experience with ADHD and if they are planning or taking to take medication during the perinatal time.
Numerous studies have demonstrated that women can continue to take their ADHD medication without risk during pregnancy and while breast-feeding. As a result, an increasing number of patients choose to do so and in consultation with their doctor they have found that the benefits of keeping their current medication outweigh any risks.
It is crucial for women suffering from ADHD who are considering breastfeeding to seek out a specialist psychiatrist's guidance prior to becoming pregnant. They should discuss their medication with their doctor and discuss the pros and cons of continued treatment, including non-pharmacological management strategies. Psychoeducation is also necessary to help pregnant women with ADHD understand the symptoms and the underlying disorder. They should also be informed about treatment options and strengthen coping mechanisms. This should be a multidisciplinary effort including obstetricians, GPs and psychiatry. Pregnancy counselling should include discussion of a management plan for both mother and child, monitoring for signs of deterioration, and, if necessary, adjustments to the medication regimen.