ADHD Medication During Pregnancy and Breastfeeding
Women with ADHD must make a difficult decision regarding whether or not to stop taking ADHD medication during pregnancy and breast-feeding. There isn't much information on how long-term exposure to these drugs could affect the fetus.
A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication during the uterus don't develop neurological conditions like hearing or vision impairment, febrile seizures, or IQ impairment. The authors acknowledge that more high-quality research is needed.
Risk/Benefit Analysis
Women who are pregnant and take ADHD medication must evaluate the benefits of using it against the possible risks for the fetus. Physicians don't have the data to provide clear recommendations however they can provide information on the risks and benefits to help pregnant women make an informed decision.
A study published in Molecular Psychiatry found that women who used ADHD medications during their early pregnancy did not face a significantly higher risk of fetal cardiac malformations or major structural birth defects. Researchers used a large population-based case control study to compare the incidence of major structural defects in infants born to mothers who used stimulants during pregnancy. Clinical geneticists and pediatric cardiologists examined the cases to ensure an accurate case classification and to limit the chance of bias.
However, the researchers' study had its limitations. Most important, they were not able to differentiate the effects of the medication from those of the underlying disorder. This limitation makes it difficult to determine whether the limited associations observed in the exposed groups result from medication use or confounding by comorbidities. In addition the study did not study the long-term outcomes of offspring.
The study did find that babies whose mothers had taken ADHD medication during pregnancy were at slightly greater risk of being admitted to the neonatal intensive care unit (NICU) than infants whose mothers had not taken any medication or had taken off their medication prior to or during pregnancy. This increase was caused by central nervous system disorders. The higher risk of admission was not affected by the stimulant medications used during pregnancy.
Women who were taking stimulant ADHD medication during pregnancy were also at an elevated risk of having a caesarean birth or having a baby with low Apgar score (less than 7). These risks did not appear 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 the early stages of pregnancy could be offset by the greater benefit for both mother and child of continued treatment for the woman's condition. Physicians should discuss the issue with their patients and, if possible, help them develop strategies to improve coping skills that can lessen the impact of her disorder on her daily life and relationships.
Medication Interactions
Doctors are increasingly confronted with the dilemma of whether to keep treatment or stop it during pregnancy as more women are diagnosed with ADHD. These decisions are frequently made without clear and reliable evidence. Instead, doctors have to consider their own expertise, the experience of other physicians and the research on the topic.
Particularly, the issue of possible risks to the infant can be difficult. The research on this subject is based on observation rather than controlled studies, and the results are conflicting. The majority of studies focus on live births, which can underestimate the severity of teratogenic effects which can cause terminations or abortions of pregnancy. The study presented in this journal club addresses these limitations by analyzing data on live and deceased births.
The conclusion The conclusion: While certain studies have demonstrated that there is a positive correlation between ADHD medications and the risk of certain birth defects, other studies have found no such relationship and the majority of studies have a neutral or slightly negative effect. In every case an in-depth evaluation of the benefits and risks must be performed.
For a lot of women with ADHD who suffer from ADHD, the decision to stop medication can be difficult, if not impossible. In a recent article 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. Furthermore, a loss of medication can affect the ability to do jobs and drive safely, which are important aspects of daily life for many people with ADHD.
She suggests that women who aren't sure whether to take the medication or stop it due to their pregnancy educate family members, colleagues, and acquaintances about the condition, the impact on daily functioning and the benefits of keeping the current treatment plan. It will also help a woman feel confident about her decision. It is also worth noting that some drugs can be absorbed through the placenta so if the patient decides to stop taking her ADHD medication during pregnancy and breastfeeding, she should be aware that traces of the medication could be passed on to the baby.
Birth Defects Risk
As the use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases as do concerns about what impact the drugs might have on foetuses. A study that was published in the journal Molecular Psychiatry adds to the body of knowledge about this subject. Researchers utilized two massive data sets to examine more than 4.3 million pregnancy and determine whether stimulant medications increased the risk of birth defects. While the overall risk remains low, the scientists did find that first-trimester exposure to ADHD medications was associated with an increase in the risk of specific heart defects, such as ventriculo-septal defect (VSD).
The researchers of the study found no association between early medication use and other congenital abnormalities, such as facial clefting or club foot. The findings are in line with previous studies that have shown a small but significant increase in the risk of cardiac malformations among women who started taking ADHD medications prior to the time of the birth of their child. This risk increased during the latter part of pregnancy, as many women begin to discontinue their medication.
Women who were taking ADHD medication in the first trimester were more likely to need a caesarean and also have a low Apgar after delivery and have a baby that needed help breathing when they were born. However the authors of the study were not able to eliminate bias due to selection by limiting the study to women who didn't have other medical issues that could have contributed to these findings.
Researchers hope that their research will provide doctors with information when they encounter pregnant women. They recommend that, while a discussion of risks and benefits is important, the decision to stop or keep medication should be based on each woman's requirements and the severity of her ADHD symptoms.
The authors caution that, even though stopping the medication is an option to consider, it is not recommended because of the high incidence of depression and other mental problems for women who are pregnant or have recently given birth. Further, the research suggests that women who choose to stop taking their medication are more likely to experience difficulties getting used to life without them following the birth of their baby.
Nursing
It can be a stressful experience to become a mom. Women with ADHD who have to manage their symptoms while attending physician appointments, getting ready for the arrival of a baby and getting used to new routines at home can experience severe challenges. Many women decide to continue taking their ADHD medication during pregnancy.
The majority of stimulant drugs pass through breast milk in small amounts, therefore the risk to infant who is breastfeeding is low. The rate of exposure to medication can vary depending upon the dosage, frequency of administration and the time of day. Additionally, individual medications enter the baby's system differently through the gastrointestinal tract as well as breast milk and the impact of this on a newborn is not well understood.
Due to the absence of research, some doctors may be inclined to discontinue stimulant drugs during the pregnancy of a woman. This is a complicated decision for the patient, who must balance the benefits of continuing her medication against the potential dangers to the fetus. In the meantime, until more information is available, doctors should inquire with all pregnant patients about their history of ADHD and whether they plan or are taking to take medication during the perinatal time.
A growing number of studies have shown that most women can safely continue taking their ADHD medication during pregnancy and breastfeeding. As a result, many patients choose to do so and in consultation with their physician, they have discovered that the benefits of maintaining their current medication outweigh any risks.
Women who suffer from ADHD who are planning to breastfeed should seek advice from an expert psychiatrist prior to becoming pregnant. They should review their medications with their prescriber and discuss the pros and cons of continued treatment, including non-pharmacological strategies. Psychoeducation is also required to help pregnant women suffering from ADHD be aware of their symptoms and the root cause and learn about treatments and to reinforce existing strategies for coping. adhd in adults medication I Am Psychiatry should involve a multidisciplinary approach, which includes the GP doctors, obstetricians and psychiatrists. Pregnancy counseling should consist of a discussion of a treatment plan for the mother and the child, as well as monitoring for signs of deterioration and, if necessary modifications to the medication regimen.