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 isn't much information on how long-term exposure to these medications can affect the fetus.
A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication during the uterus don't develop neurological developmental disorders like hearing or vision impairment seizures, febrile seizures, or IQ impairment. The authors acknowledge that further high-quality studies are required.
Risk/Benefit Analysis
Pregnant women who use ADHD medications need to balance the advantages of taking them against potential risks to the foetus. Physicians don't have the necessary data to provide clear recommendations however they can provide information regarding the risks and benefits to help pregnant women make informed choices.
A study published in Molecular Psychiatry found that women who were taking ADHD medications in early pregnancy did not face an increased risk of fetal heart malformations or major birth defects that are structural. Researchers conducted a large population-based study of case control to compare the incidence of major structural defects in infants who were born to mothers who used stimulants during pregnancy. Clinical geneticists and pediatric cardiologists looked over the cases to ensure accurate case classification and to minimize the chance of bias.
However, the study had its limitations. The researchers were unable, in the first place, to separate the effects triggered by the medication from the disorder. This limitation makes it difficult to know whether the small associations observed in the groups that were exposed are due to medication use or the confounding effect of comorbidities. The researchers also did not look at the long-term effects for the offspring.
The study revealed that babies whose mothers had taken ADHD medication during pregnancy had a slightly greater risk of being admitted to the neonatal care unit (NICU) as compared to those whose mothers did not take any medication during pregnancy or had quit taking the medication prior to or during pregnancy. This increase was due to central nervous system disorders, and the increased risk of admission did not appear 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 likelihood of having an emergency caesarean section or having a baby that scored low on the Apgar scale (less than 7). These increases appear to be independent of the type of medication taken during pregnancy.
Researchers suggest that the minor risks associated with the use ADHD medications during early pregnancies may be offset by the greater benefits for mother and baby from continuing treatment for the woman's disorder. Physicians should discuss this with their patients and, if they are able, assist them in developing strategies for improving their coping skills that may minimize the effects of her disorder on her daily functioning and relationships.
Medication Interactions
As more women than ever before are being diagnosed with ADHD and being treated with medication, the question of whether to continue or stop treatment during pregnancy is one that more and more doctors have to face. Often, these decisions are made in the absence of any evidence that is clear and definitive either way, so physicians must weigh what they know about their experiences, the experiences of other doctors, and what research suggests on the subject, along with their own judgments for each individual patient.
The issue of possible risks to the infant can be particularly tricky. The research on this subject is based on observation instead of controlled studies and the results are contradictory. The majority of studies limit their analysis to live births, which may 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 the data from deceased and live births.
Conclusion A few studies have revealed an association between ADHD medications and certain birth defects However, other studies haven't established a link. The majority of studies show a neutral, or even slight negative impact. In the end an accurate risk-benefit analysis must be conducted in every situation.
For many women with ADHD and ADD, the decision to stop medication is difficult if not impossible. In fact, in an article published in the Archives of Women's Mental Health, psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can lead to increased depression, feelings of isolation and family conflict for these patients. Furthermore, a loss of medication can affect the ability to do work-related tasks and safely drive that are crucial aspects of daily life for a lot of people with ADHD.
She recommends that women who are unsure about whether to keep or discontinue medication due to their pregnancy should consider informing family members, friends, and coworkers on the condition, its effects on daily functioning, and the advantages of continuing the current treatment regimen. It can also help women feel confident about her decision. Some medications can pass through the placenta. If a woman decides to stop taking her ADHD medication while breastfeeding, it's important to be aware that the drug may be transferred to her infant.
Birth Defects and Risk of
As the use of ADHD medication to treat the symptoms of attention deficit hyperactivity disorder (ADHD) increases as do concerns over the impact that these medications could have on foetuses. Recent research published in the journal Molecular Psychiatry has added to the body knowledge on this topic. adhd and medication used two massive data sets to examine more than 4.3 million pregnant women and determine if the use of stimulant medications increased the risk of birth defects. Although the risk overall remains low, the researchers discovered that the first-trimester exposure to ADHD medications was linked to an increased risk of certain heart defects such as ventriculo-septal defect (VSD).
The researchers of the study did not discover any connection between early medication usage and other congenital anomalies like facial deformities, or club feet. The results are in line with previous studies that have shown 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. This risk increased during the latter part of pregnancy, when a lot of women began to stop 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 delivery and have a baby who needed breathing assistance after birth. The researchers of the study were unable to remove bias in selection since they restricted the study to women who did not have any other medical conditions that might have contributed to the findings.
Researchers hope that their study will inform physicians when they see pregnant women. They recommend that, while the discussion of the benefits and risks is important however, the decision to stop or keep medication must be based on each woman's needs and the severity of her ADHD symptoms.
The authors caution that, while stopping the medication is an option to look into, it is not advised because of the high incidence of depression and mental health issues for women who are pregnant or recently gave birth. Further, research shows that women who stop taking their medications will have a tough transitioning to life without them after the baby is born.
Nursing
The responsibilities of a new mother can be overwhelming. Women with ADHD who have to deal with their symptoms while attending physician appointments as well as getting ready for the arrival of a baby and getting used to new routines at home are often faced with a number of difficulties. This is why many women choose to continue taking their ADHD medication throughout the pregnancy.
The majority of stimulant medications are absorbed through breast milk in low amounts, so the risk to the breastfeeding infant is minimal. The rate of medication exposure can vary depending upon the dosage and frequency of administration as well as the time of the day. Additionally, different medications enter the body of the baby differently through the gastrointestinal tract as well as breast milk. The impact of this on a newborn isn't fully understood.
Because of the lack of research, some physicians may recommend stopping stimulant drugs during the pregnancy of a woman. This is a difficult decision for the patient, who must weigh the benefits of continuing her medication with the potential risks to the foetus. In the meantime, until more information is available, GPs may ask pregnant patients whether they have any history of ADHD or if they intend to take medication during the perinatal period.
A growing number of studies have revealed that most women can safely continue to take their ADHD medication while they are pregnant and nursing. As a result, many patients opt to do this and, after consulting with their doctor, they have discovered that the benefits of keeping their current medication outweigh any risks.
It's important for women with ADHD who are contemplating breastfeeding to seek out a specialist psychiatrist's advice prior 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 needed to help pregnant women suffering from ADHD understand the symptoms and underlying disorder. They should also be educated about treatment options and strengthen strategies for coping. This should include an approach that is multidisciplinary, including the GP as well as obstetricians, psychiatry and obstetricians. The pregnancy counselling should consist of discussion of a management plan for both the mother and child, and monitoring for signs of deterioration, and, if necessary, adjustments to the medication regimen.