ADHD Medication During Pregnancy and Breastfeeding
The decision to stop or continue ADHD medication during pregnancy and nursing is a challenge for women suffering from the condition. There aren't many studies on how exposure to ADHD for a long time could affect the pregnant fetus.
click for source 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 the need for more high-quality studies.
Risk/Benefit Analysis
Women who are pregnant and take ADHD medication should consider the benefits of taking it against the potential risks to the baby. Doctors don't have enough data to make unambiguous recommendations, but can provide information on the risks and benefits to aid pregnant women in making informed choices.
A study published in Molecular Psychiatry found that women who were taking ADHD medications during early pregnancy did not have a significantly increased risk of fetal heart malformations or major structural birth defects. Researchers used a vast population-based case-control study to evaluate the incidence of major structural birth defects in babies born to mothers who had taken stimulants in early pregnancy and those who had not. Pediatric cardiologists, clinical geneticists and other experts reviewed the cases in order to confirm that the classification was correct and to reduce any bias.
The research conducted by the researchers had some limitations. The researchers were unable, in the first place, to separate the effects of the medication from the disorder. This makes it difficult for researchers to determine whether the few associations observed between the groups that were exposed to the use of medications or confounded by comorbidities. Researchers also did not examine long-term outcomes for the offspring.
The study did reveal that infants whose mothers took ADHD medication during pregnancy were at a higher risk of being admitted to the neonatal intensive care unit (NICU) than infants who were born without any medication or taken off their medication prior to or during pregnancy. This increase was due to central nervous system-related disorders, and the increased risk of admission did not appear to be influenced by the stimulant medications were taken during pregnancy.
Women who took stimulant ADHD medication during pregnancy were also at an increased chance of having a caesarean delivery or having a child with an low Apgar score (less than 7). These risks did not seem to be influenced by the type of medication that was used during pregnancy.
The research suggests that the small risk associated with the use of ADHD medications during early pregnancy may be offset by the greater benefit to both the mother and child of continuing treatment for the woman's condition. Physicians should speak with their patients about this issue and, if possible, help them develop coping strategies that can lessen the effects of her disorder on her daily life and relationships.
Interactions with Medication
Many doctors are faced with the decision of whether to maintain treatment or stop as more women are diagnosed with ADHD. The majority of these decisions are taken in the absence of clear and authoritative evidence in either case, which means that doctors have to weigh their experience from their own experiences, those of other doctors, and what research suggests about the subject as well as their own best judgment for each patient.
In particular, the issue of potential risks to the baby can be tricky. Many studies on this topic are based on observational evidence rather than controlled research, and their conclusions are often contradictory. Furthermore, most studies restrict their analysis to live births, which may underestimate severe teratogenic effects that lead to abortion or termination of the pregnancy. The study presented in the journal club addresses these limitations by analyzing data on live and deceased births.
Conclusion Some studies have revealed an association between ADHD medications and certain birth defects, other studies have not established a link. The majority of studies show an unintended, or somewhat negative, effect. Therefore an accurate risk-benefit analysis must be done in each situation.
For many women with ADHD who suffer from ADHD, the decision to discontinue medication can be difficult, if not impossible. In a recent piece published in Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can cause depression and feelings of being isolated. The loss of medication can also impact the ability to safely drive and perform work-related tasks, which are essential aspects of everyday life for people with ADHD.
She recommends women who are unsure about whether to continue or discontinue medication due to their pregnancy consider educating family members, friends and colleagues about the condition, its effects on daily functioning, and on the benefits of keeping the current treatment plan. It can also help women feel more confident in her decision. It is important to remember that some drugs can pass through the placenta so if a woman decides to discontinue her ADHD medication during pregnancy and breastfeeding, she must be aware that the effects of the medication could be passed on to the 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 medications could have on the fetuses. A recent study published in the journal Molecular Psychiatry adds to the body of knowledge on this subject. Researchers used two massive datasets to analyze more than 4.3 million pregnant women and determine whether stimulant medications increased the risk of birth defects. While the overall risk is low, the researchers did find that first-trimester exposure to ADHD medications was associated with an increased risk of certain heart defects, such as ventriculoseptal defect (VSD).
The authors of the study didn't discover any link between the use of early medications and other congenital anomalies such as facial deformities or club feet. The results are consistent with previous studies that have shown a small but significant increase in the risk of heart malformations among women who started taking ADHD medications prior to pregnancy. This risk increased during the latter part of pregnancy when many women decided to stop taking their medication.
Women who took ADHD medications during the first trimester of their pregnancy were also more likely to experience caesarean section, low Apgar score following delivery, and a baby that required breathing assistance during birth. However the researchers of the study were unable to eliminate selection bias by restricting the study to women who didn't have any other medical issues that could have contributed to these findings.
The researchers hope their study will help inform the clinical decisions of physicians who see pregnant women. The researchers advise that, while discussing risks and benefits are crucial, the decision on whether to continue or stop medication should be based on the severity of each woman's ADHD symptoms and her needs.
The authors also caution that, while stopping the medication is an alternative, it is not a recommended practice because of the high incidence of depression and other mental health issues among women who are pregnant or who are recently postpartum. Research has also shown that women who stop taking their medication will have a tough adjustment to life without them once the baby is born.
Nursing
It can be a stressful experience to become a mother. Women suffering from ADHD may face a lot of challenges when they must deal with their symptoms, go to doctor appointments and prepare for the birth of a child and adjust to new routines. As such, many women choose to continue taking their ADHD medications throughout the course of pregnancy.
The majority of stimulant medicines are absorbed by breast milk in very small amounts, therefore the risk for nursing infant is very low. The amount of exposure to medications can vary depending upon the dosage the medication is administered, its frequency and the time of the day. In addition, different medications are introduced into the baby's system through the gastrointestinal tract or through breast milk. The effect on the health of a newborn is not completely understood.
Some doctors may stop taking stimulant medications during a woman's pregnancy due to the absence of research. This is a difficult decision for the woman, who must weigh the benefits of taking her medication as well as the potential risks to the embryo. In the meantime, until more information is available, doctors should ask all pregnant patients about their history of ADHD and whether they are taking or planning to take medication during the perinatal time.
A growing number of studies have proven that the majority of women are able to safely continue taking their ADHD medication during pregnancy and while breastfeeding. In the end, an increasing number of patients opt to do this and, after consulting with their doctor, they have discovered that the benefits of keeping their current medication outweigh any potential risks.
It is essential for women with ADHD who are considering breastfeeding to seek out a specialist psychiatrist's guidance prior to becoming pregnant. They should discuss their medication with their physician and discuss the advantages and disadvantages of continued treatment, including non-pharmacological management strategies. Psychoeducation is also required to help pregnant women suffering from ADHD be aware of the symptoms and underlying disorder. They should also be educated about treatment options and reinforce the coping mechanisms. This should be a multidisciplinary effort with the GPs, obstetricians, and psychiatry. Pregnancy counseling should include a discussion of a treatment plan for the mother and the child, monitoring of indicators of deterioration, and, if needed modifications to the medication regime.