ADHD Medication During Pregnancy and Breastfeeding
Women suffering from ADHD must make a difficult decision on whether to keep or stop taking ADHD medication during pregnancy and breast-feeding. Little data exists about how long-term exposure to these medications can affect the foetus.
A recent study published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological problems like 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 expecting and taking ADHD medication must weigh the benefits of taking it against the potential risks for the fetus. Physicians don't have the data to provide clear recommendations but they can provide information about risks and benefits to help pregnant women make informed decisions.
A study published in Molecular Psychiatry found that women who took ADHD medications in early pregnancy did not face a significantly increased risk of fetal heart malformations or major structural birth defects. The researchers used a large population-based case-control study to determine the prevalence 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 ensure that the classification was accurate and to eliminate any bias.
However, the study was not without its flaws. The researchers were unable in the beginning to differentiate the effects triggered by the medication from the disorder. This limitation makes it difficult to determine whether the small associations observed in the groups that were exposed are due to medication use or confounding by comorbidities. Additionally the researchers did not look at long-term offspring outcomes.
The study found that babies whose mothers took ADHD medication during pregnancy were at a slightly higher chance of being admitted to the neonatal care unit (NICU) in comparison to mothers who didn't take any medication during pregnancy or had discontinued taking their medication prior to or during pregnancy. The reason for this was central nervous system disorders. The increased risk of admission was not affected by the stimulant medication used during pregnancy.
Women who used stimulant ADHD medication during pregnancy also had an elevated chance of having a caesarean birth or having a baby born with an low Apgar score (less than 7). These increases appear to be independent of the type of medication taken during pregnancy.
The researchers suggest that the risk of a small amount with the use of ADHD medications during early pregnancy may be offset by the greater benefit to both mother and child of continued treatment for the woman's condition. Doctors should discuss with their patients about this and as much as possible, assist them improve coping skills which could reduce the effects of her disorder on her daily life and relationships.
Medication Interactions
As more women than ever are diagnosed with ADHD and being treated with medication, the question of whether or not to end treatment during pregnancy is a question that doctors are having to face. The majority of these decisions are made without any evidence that is clear and definitive regardless, so doctors must weigh their knowledge about their experiences, the experiences of other doctors, and what research suggests about the subject and their own judgments for each individual patient.
The issue of risk for infants can be difficult to determine. The research on this issue is based on observations instead of controlled studies and a lot of the results are contradictory. Most studies limit their analysis to live births, which may underestimate the severity of teratogenic effects which can cause terminations or abortions of pregnancy. The study discussed in this journal club addresses these shortcomings by analyzing data on live and deceased births.
The conclusion is that while certain studies have demonstrated a positive association between ADHD medications and the risk of certain birth defects, others have found no connection, and most studies demonstrate a neutral or slightly negative effect. As a result, a careful risk/benefit assessment is required in every instance.
It isn't easy, but not impossible, for women suffering from ADHD to stop taking their medication. In a recent article 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 those suffering from the disorder. The loss of medication can also impact the ability to safely drive and to perform work-related tasks which are crucial aspects of daily life for people with ADHD.
She recommends women who are unsure about whether to keep or stop taking medication because of their pregnancy consider educating family members, friends and colleagues on the condition, its impact on daily functioning, and on the advantages of continuing the current treatment plan. Educating them can also aid in ensuring that the woman feels supported when she is struggling with her decision. It is important to remember that some medications can be absorbed through the placenta therefore, if a patient decides to discontinue her ADHD medication during pregnancy and breastfeeding, she should be aware of the possibility that traces of the medication could be transferred to the infant.
Risk of Birth Defects
As the use and use of ADHD medications to treat the symptoms of attention deficit hyperactivity disorder (ADHD), increases as does the concern about the potential effects of these drugs on fetuses. A study that was published in the journal Molecular Psychiatry adds to the body of knowledge about this subject. Utilizing two huge data sets researchers were able examine more than 4.3 million pregnancies to determine whether stimulant medications increased the risk of birth defects. While the overall risk remains low, the researchers discovered that the first-trimester exposure to ADHD medicines was associated with a slightly higher rate of specific heart defects, such as ventriculoseptal defect (VSD).
The researchers behind the study found no association between early medication use and other congenital anomalies, like facial clefting, or club foot. The findings are in line with previous studies showing a small but significant increase in the risk of cardiac malformations among women who began taking ADHD medications prior to the time of the time of pregnancy. The risk grew in the latter half of pregnancy, when a lot of women begin to discontinue their medication.
Women who used ADHD medications in the first trimester of their pregnancy were also more likely to undergo caesarean sections, a low Apgar score after delivery and a baby who needed breathing assistance during birth. The authors of the study were not able to remove bias in selection since they restricted the study to women with no other medical conditions that could have contributed to the findings.
Researchers hope that their study will provide doctors with information when they see pregnant women. They suggest that although the discussion of the benefits and risks is important however, the decision to stop or maintain treatment should be based on each woman's needs and the severity of her ADHD symptoms.
The authors warn that, while stopping the medication is an option to think about, it isn't advised due to the high prevalence of depression and other mental disorders for women who are pregnant or who have recently given birth. Further, the research suggests that women who choose to stop their medications are more likely to experience difficulties getting used to life without them following the baby's arrival.
Nursing
It can be overwhelming becoming a mother. Women with ADHD who must work through their symptoms while attending doctor appointments, making preparations for the arrival of a child and adapting to new routines in the home are often faced with a number of difficulties. This is why many women elect to continue taking their ADHD medication throughout the pregnancy.
The risk to a breastfeeding infant is not too high since the majority of stimulant medication is absorbed through breast milk in low amounts. The rate of exposure to medication will vary based on the dosage, frequency of administration and the time of day. Additionally, different medications enter the infant's system differently through the gastrointestinal tract as well as breast milk and the impact of this on a newborn isn't yet fully understood.
Due to the absence of research, some doctors might be tempted to stop taking stimulant medications during a woman's pregnancy. It is a difficult decision for the woman, who must weigh the advantages of her medication against the potential risks to the embryo. In the meantime, until more information is available, GPs can inquire about pregnant patients if they have an history of ADHD or if they are planning to take medication in the perinatal phase.
add medication uk increasing number of studies have proven that the majority of women are able to safely continue to take their ADHD medication during pregnancy and while breastfeeding. In response, an increasing number of patients are opting to do so. They have discovered through consultation with their doctors, that the benefits of keeping their current medication outweigh risk.
It is essential for women with ADHD who are contemplating breastfeeding to seek a specialist psychiatrist's advice prior to becoming pregnant. They should review their medications with their prescriber and discuss the advantages and disadvantages of continued treatment, including non-pharmacological management strategies. Psychoeducation is also necessary to help pregnant women suffering from ADHD be aware of the symptoms and underlying disorder. They should also be informed about treatment options and build coping mechanisms. This should be a multidisciplinary approach including obstetricians, GPs, and psychiatry. The pregnancy counselling should consist of the discussion of a plan for management for both the mother and child, and monitoring for signs of deterioration, and when necessary, making adjustments to the medication regimen.