ADHD Medication During Pregnancy and Breastfeeding
The decision to stop or continue ADHD medication during pregnancy and breastfeeding is a difficult decision for women suffering from the condition. There aren't enough data on how exposure to ADHD for a long time could affect a fetus.
A recent study published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological problems such as hearing loss or vision, febrile seizures or IQ impairment. The authors acknowledge that more high-quality research is needed.
Risk/Benefit Analysis
Women who are pregnant and taking ADHD medications must weigh the advantages of taking them against the potential risks to the fetus. Doctors don't have the data needed to give clear guidelines, but they can provide information regarding the risks and benefits to aid pregnant women in making informed decisions.
A study published in Molecular Psychiatry concluded that women who were taking ADHD medication during early pregnancy did not have a higher risk of fetal malformations or structural birth defects. The researchers used a large population-based case-control study to evaluate the incidence of major structural birth defects in babies born to mothers who had taken stimulants during early pregnancy, as well as those who had not. Clinical geneticists, pediatric cardiologists and other experts reviewed the cases in order to confirm that the classification was correct and to eliminate any bias.
The study of the researchers was not without limitations. Most important, they were unable to distinguish the effects of the medication from the effects of the disorder at hand. This limitation makes it difficult for researchers to determine whether the small differences observed between the groups that were exposed to the use of medication or caused by comorbidities. In addition the researchers did not study the long-term outcomes of offspring.
The study did find that infants whose mothers took ADHD medications during pregnancy were at a more 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 caused by central nervous system disorders. The increased risk of admission was not influenced by the stimulant medication that was used during pregnancy.
Women who took stimulant ADHD medications during pregnancy also had a higher likelihood of having to have caesarean sections or one whose baby scored low on the Apgar scale (less than 7). These risks did not seem to be influenced by the kind of medication used during pregnancy.
Researchers suggest that the minor risks posed by the use of ADHD medication during pregnancies in the early stages may be offset by the more beneficial outcomes for both baby and mother of continued treatment for the woman's condition. Doctors should discuss with their patients about this issue and try to help them develop coping skills that may reduce the impact of her disorder in her daily functioning and her relationships.
Medication Interactions
As more women than ever are being diagnosed with ADHD and treated with medication, the dilemma of whether or not to end treatment during pregnancy is one that doctors are having to face. Often, these decisions are made without any evidence that is clear and definitive regardless, so doctors must weigh their knowledge from their own experiences, those of other doctors, and what research suggests on the subject as well as their best judgment for each individual patient.
The issue of potential risks for infants can be extremely difficult. The research on this subject is based on observation rather than controlled studies, and many of the findings are conflicting. Most studies limit their analysis to live births, which may underestimate the severity of teratogenic effects which can cause abortions or terminations of pregnancy. The study that is discussed in the journal club addresses these limitations by analyzing both the data from deceased and live births.
The conclusion The conclusion: While some studies have shown an association between ADHD medications and the possibility of certain birth defects, other studies have not found any evidence of a link and the majority of studies show a neutral or even slightly negative effect. In all cases, a careful evaluation of the risks and benefits must be performed.
For women suffering from ADHD who suffer from ADHD, the decision to discontinue medication is difficult, if not impossible. In an article published in 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 these patients. A loss of medication may also impact the ability to safely drive and complete work-related tasks, which are crucial aspects of everyday life for those with ADHD.
She suggests women who are uncertain about whether to continue or stop taking medication because of their pregnancy consider educating family members, friends and colleagues about the condition, its effects on daily life, and the benefits of keeping the current treatment plan. It can also help a woman feel confident about her decision. It is important to note that certain drugs can pass through the placenta, therefore, if a patient decides to stop her ADHD medication during pregnancy and breastfeeding, she should be aware that the effects of the medication could be transferred to the infant.
Birth Defects and Risk of
As the use of ADHD medications to treat symptoms of attention deficit hyperactivity disorder (ADHD) grows there are concerns about the effects that the medications could have on fetuses. A study that was published in the journal Molecular Psychiatry adds to the body of information on this topic. Utilizing two huge data sets, researchers were able to analyze more than 4.3 million pregnancies to determine whether stimulant medications increased the risk of birth defects. Although most effective adhd medication for adults is low, the researchers found that exposure in the first trimester to ADHD medications was linked to a slightly higher rate of certain heart defects, such as ventriculoseptal defect (VSD).
The researchers behind the study found no connection between early medication use and other congenital abnormalities, such as facial clefting or club foot. The results are in line 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 the time of the time of pregnancy. The risk was higher in the later part of pregnancy, when many women decide to stop taking their ADHD medications.
Women who used ADHD medication in the first trimester of their pregnancy were also more likely to have caesarean sections, a low Apgar score following delivery, and a baby who required breathing assistance at birth. However the authors of the study were not able to eliminate selection bias by limiting the study to women who did not have other medical issues that could have contributed to the findings.
Researchers hope their research will inform physicians when they see pregnant women. The researchers suggest that, while discussing risks and benefits are important, the choice regarding whether or not to stop medication should be according to the severity of each woman's ADHD symptoms and the needs of the woman.
The authors also warn that while discontinuing the medications is an alternative, it is not an option to consider due to the high incidence of depression and other mental health issues among women who are pregnant or recently postpartum. Research has also shown that women who stop taking their medications will have a harder adjustment to life without them after the baby is born.
Nursing
The responsibilities of being a new mother can be overwhelming. Women with ADHD can face severe challenges when they must manage their symptoms, attend doctor appointments, prepare for the birth of a child and adjust to a new routine. Many women opt to continue taking their ADHD medication during pregnancy.
The majority of stimulant medications pass through breast milk in very small quantities, so the risk for nursing infant is very low. The rate of exposure to medication will differ based on dosage and frequency of administration as well as the time of day. Additionally, different medications enter the infant's system differently through the gastrointestinal tract and breast milk. The impact of this on a newborn is not fully understood.
Because of the lack of research, some physicians might be tempted to stop taking stimulant medications during the course of pregnancy. This is a difficult decision for the woman who must weigh the advantages of continuing her medication against the risks to the fetus. As long as more information is available, GPs may inquire about pregnant patients whether they have an background of ADHD or if they are planning to take medication in the perinatal stage.
Numerous studies have demonstrated that women can continue to take their ADHD medication safely during pregnancy and breast-feeding. In the end, an increasing number of patients are choosing to do so and, after consulting with their doctor, they have found that the benefits of continuing their current medication far outweigh any risks.
It is essential for women with ADHD who are contemplating breastfeeding to seek out a specialist psychiatrist's advice prior to becoming pregnant. They should review their medications with their prescriber and discuss the pros and cons of continued treatment, including non-pharmacological management strategies. Psychoeducation is also required to help pregnant women suffering from ADHD understand the symptoms and underlying disorder. They should also learn about treatment options and reinforce the coping mechanisms. 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.