ADHD Medication During Pregnancy and Breastfeeding
The choice of whether to stop or continue ADHD medication during breastfeeding and pregnancy is a challenge for women suffering from the condition. There are few data on how exposure to ADHD for a long time could affect the fetus.
A recent study published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological issues such as hearing loss or vision, febrile seizures or IQ impairment. The authors acknowledge that more high quality studies are required.
Risk/Benefit Analysis
Pregnant women who take ADHD medications need to balance the advantages of taking them against the potential risks to the foetus. Physicians don't have the data to provide clear recommendations, but can provide information about risks and benefits to aid pregnant women in making informed decisions.
A study published in Molecular Psychiatry concluded that women who took ADHD medication during early pregnancy were not at a greater risk of fetal malformations, or structural birth defects. Researchers conducted a large sample-based case control study to assess the frequency of structural defects that were major in infants born to mothers who were taking stimulants during pregnancy. Pediatric cardiologists and clinical geneticists looked over the cases to ensure an accurate case classification and to limit the chance of bias.
However, the study was not without its flaws. The researchers were not able in the beginning to distinguish the effects caused by the medication from the disorder. This makes it difficult to know whether the small associations observed in the groups that were exposed are due to medication use or comorbidities that cause confusion. The researchers did not examine the long-term effects for the offspring.
The study did find that infants whose mothers had taken ADHD medications during pregnancy were at a slightly greater risk of being admitted to the neonatal intensive care unit (NICU) than those who whose mothers did not take 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 used during pregnancy.
Women who took stimulant ADHD medications during pregnancy also had a higher likelihood 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 appear to be affected by the type of medication that was used during pregnancy.
Researchers suggest that the minor risk of using ADHD medication during pregnancies in the early stages may be offset by the greater benefits for mother and baby from continuing treatment for the woman’s disorder. Physicians should speak with their patients about this and as much as possible, assist them develop coping skills that may reduce the effects of her disorder on her daily life and relationships.
Medication Interactions
More and more doctors are faced with the decision of whether to keep treatment or stop it during pregnancy as more women are diagnosed with ADHD. The majority of these decisions are taken in the absence of any evidence that is clear and definitive regardless, so doctors must weigh their knowledge, the experiences of other doctors, and what research suggests on the subject, along with their best judgment for each patient.
In particular, the issue of possible risks to the infant can be difficult. A lot of studies on this topic are based on observational data rather than controlled research and their conclusions are often contradictory. In addition, most studies limit their analysis to live births, which can underestimate severe teratogenic effects that cause abortion or termination of the pregnancy. adhd medication uk discussed in this journal club addresses these shortcomings by analyzing data on live and deceased births.
The conclusion The conclusion: While some studies have shown an association between ADHD medications and the risk of certain birth defects, others have found no such relationship and the majority of studies show a neutral or even slightly negative impact. Therefore an accurate risk-benefit analysis must be conducted in every instance.
It can be difficult, if not impossible for women with ADHD to stop taking their medication. In fact, in an article recently published in the 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 patients with ADHD. A decrease in medication could affect the ability to safely drive and complete work-related tasks, which are vital aspects of normal life for those suffering from ADHD.
She suggests that women who are not sure whether to continue taking the medication or stop it due to their pregnancy educate family members, coworkers, and their friends about the condition, the impact on daily functioning and the advantages of staying on the current treatment regimen. It can also help women feel more confident in her decision. It is also worth noting that some medications can pass through the placenta, therefore, if a patient decides to stop her ADHD medication during pregnancy and breastfeeding, she should be aware that traces of the drug could be transferred to the infant.
Risk of Birth Defects
As the use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) grows as do concerns about the effects that the drugs might have on foetuses. A recent study published in the journal Molecular Psychiatry adds to the existing information on this topic. Researchers utilized two massive data sets to examine more than 4.3 million pregnant women and determine if the use of stimulant medications caused birth defects. Although the risk overall remains low, the scientists found that exposure in the first trimester to ADHD medications was associated with an increased risk of specific heart defects, like ventriculo-septal defects (VSD).
The authors of the study didn't find any association between early medication usage and other congenital anomalies, such as facial deformities or club feet. The results 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 in the later part of pregnancy, as many women are forced to stop taking their ADHD medication.
Women who took ADHD medication during the first trimester were more likely to require a caesarean delivery, have an insufficient Apgar after delivery and had a baby that required breathing assistance at birth. However, the authors of the study were unable to eliminate selection bias by restricting the study to women who didn't have other medical issues that could be a contributing factor to these findings.
Researchers hope their research will provide doctors with information when they meet pregnant women. They advise that while the discussion of the risks and benefits is crucial but the decision to stop or continue medication should be based on each woman's needs and the severity of her ADHD symptoms.
The authors also caution that even though stopping the medication is an option, it isn't a recommended practice because of the high incidence of depression and other mental health problems in women who are pregnant or post-partum. Further, research shows that women who stop taking their medication will have a difficult transitioning to life without them once the baby is born.
Nursing
medication for adhd can be a challenge to become a mom. Women with ADHD who must work through their symptoms while attending doctor appointments, getting ready for the arrival of a child and adjusting to new household routines are often faced with a number of difficulties. Many women choose to continue taking their ADHD medication during pregnancy.
The majority of stimulant medicines are absorbed through breast milk in small amounts, therefore the risk to the nursing infant is very low. However, the amount of exposure to medications by the infant can differ based on dosage, how often it is administered and the time of the day the medication is administered. Additionally, individual medications enter the body of the baby differently through the gastrointestinal tract as well as breast milk and the impact of this on a newborn infant is not fully understood.
Due to the absence of research, some doctors may be inclined to discontinue stimulant medication during the course of pregnancy. This is a complicated decision for the patient, who must weigh the benefit of continuing her medication with the potential dangers to the fetus. In the meantime, until more information is available, doctors should ask 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 women can continue taking their ADHD medication during pregnancy and while breastfeeding. As a result, many patients opt to do this and, in consultation with their doctor they have discovered that the benefits of maintaining their current medication exceed any risk.
Women who suffer from ADHD who plan to breastfeed should seek advice from a specialist psychiatrist prior to becoming pregnant. They should review their medications 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 recognize the signs and the underlying disorder. They should also be informed about treatment options and build strategies for coping. This should include a multidisciplinary approach, which includes the GP as well as obstetricians, psychiatry and obstetricians. Counselling for pregnancy should include the discussion of a treatment plan for both the mother and child, and monitoring for signs of deterioration, and the need for adjustments to the medication regimen.