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 aren't many studies 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 issues such as impaired hearing or vision, febrile seizures, or IQ impairment. The authors acknowledge the need for higher-quality research.
Risk/Benefit Analysis
Women who are expecting and taking ADHD medication need to evaluate the benefits of using it against the possible dangers for the fetus. Physicians don't have the data to give clear advice but they can provide information about risks and benefits to assist pregnant women to make an informed decision.
A study published in Molecular Psychiatry concluded that women who were taking ADHD medication during their early pregnancy were not at a greater risk of fetal malformations or structural birth defects. Researchers used a large sample-based case control study to assess the frequency of structural defects that were major in infants born to mothers who took stimulants during pregnancy. Clinical geneticists and pediatric cardiologists examined the cases to ensure correct case classification and to minimize the chance of bias.
However, the study had its limitations. Researchers were unable to, in the first place to differentiate the effects triggered by the medication from the disorder. This limitation makes it difficult to know whether the small associations observed in the exposed groups are due to the use of medication or comorbidities that cause confusion. Researchers also did not look at the long-term effects for the offspring.
The study found that infants whose mother had taken ADHD medication during pregnancy were at a slightly higher chance of being admitted to the neonatal care unit (NICU) as compared to those whose mothers didn't take any medication during pregnancy or had discontinued taking their medication prior to or during pregnancy. This was due to central nervous system-related disorders, and the higher risk of admission was not found to be affected by the type of stimulant medications were used during pregnancy.
Women who were taking stimulant ADHD medications during pregnancy also had a higher likelihood of having a caesarean section or one whose baby scored low on the Apgar scale (less than 7). These increases appeared to be unrelated to the type of medication taken during pregnancy.
The researchers suggest that the low risk associated with the use of ADHD medications during early pregnancy could be offset by the greater benefits to both the mother and child of continued treatment for the woman's disorder. Physicians should discuss the issue with their patients and, where they are able, assist them in developing strategies for improving their coping skills that may minimize the negative impact of her condition on her daily life and relationships.
Medication Interactions
More and more doctors are faced with the decision of whether to maintain treatment or stop it during pregnancy as more women are diagnosed with ADHD. Most of the time, these decisions are made in the absence of clear and authoritative evidence regardless, so doctors have to weigh their experience about their experiences, the experiences of other doctors, and what research says on the topic and their own judgments for each individual patient.
The issue of risk to the infant can be particularly tricky. Many studies on this topic are based on observational data rather than controlled research, and their conclusions are often contradictory. Most studies restrict their analysis to live births, which may underestimate the teratogenic impact that can lead to abortions or terminations of pregnancy. The study presented in the journal club addresses these issues by analyzing both data on live and deceased births.
Conclusion Some studies have shown a positive correlation between ADHD medications and certain birth defects However, other studies haven't established a link. Most studies show an unintended, or slightly negative, impact. As a result, a careful risk/benefit assessment must be done in each situation.
For a lot of women with ADHD, the decision to stop taking medication is difficult if not impossible. In a recent article 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. A loss of medication may affect the ability to drive safely and complete work-related tasks, which are essential aspects of normal life for people with ADHD.
She recommends women who are uncertain about whether to continue or stop taking medication because of their pregnancy consider the possibility of educating friends, family members and colleagues on the condition, its effects on daily life, and the benefits of keeping the current treatment plan. It can also help women feel more confident in her decision. Certain medications can pass through the placenta. If the patient decides to stop taking her ADHD medication while breastfeeding, it is important to be aware that the drug could be transferred to the baby.
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 about the effects that the drugs could have on fetuses. A study that was published in the journal Molecular Psychiatry adds to the body of information on this topic. Researchers used two massive datasets to analyze over 4.3 million pregnant women and determine if stimulant medication use increased birth defects. Although the risk overall is low, the researchers did find that first-trimester exposure to ADHD medicines was associated with a slightly higher rate of certain heart defects such as ventriculo-septal defect (VSD).
The researchers of the study found no link between early use of medication and congenital abnormalities like facial clefting, or club foot. The results are in agreement with previous studies which showed a small, but significant increase in cardiac malformations for women who started taking ADHD medication prior to the time of pregnancy. This risk increased during the latter part of pregnancy, when a lot of women are forced to stop taking their medication.
Women who took ADHD medication in the first trimester of their pregnancy were also more likely to experience caesarean sections, a low Apgar score following delivery, and a baby that required breathing assistance during birth. The authors of the study were unable to eliminate bias due to selection because they limited the study to women with no other medical conditions that might have contributed to the findings.
The researchers hope their research will aid in the clinical decisions of doctors who treat pregnant women. The researchers suggest that while discussing the risks and benefits are important, the choice regarding whether or not to stop taking medication should be according to the severity of each woman's ADHD symptoms and her requirements.
The authors also caution that even though stopping the medication is an option, it isn't an option to consider due to the high prevalence of depression and other mental health problems in women who are pregnant or postpartum. Further, research shows that women who stop taking their medications will have a harder adjustment to life without them once the baby is born.
Nursing
The responsibilities of a new mother can be overwhelming. Women who suffer from ADHD who have to deal with their symptoms while attending doctor appointments, getting ready for the arrival of a child and adjusting to new household routines may face a lot of challenges. Many women opt to continue taking their ADHD medication during pregnancy.
The risk for breastfeeding infant is minimal because the majority of stimulant medication is absorbed through breast milk in low amounts. The rate of exposure to medication will differ based on dosage the medication is administered, its frequency and the time of the day. In addition, individual medications enter the infant's system differently through the gastrointestinal tract as well as breast milk. The impact of this on a newborn infant is not fully understood.
Due to the absence of evidence, some doctors might be tempted to stop taking stimulant medication during the course of pregnancy. This is a difficult choice for the patient, who must balance the benefits 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 period.
A growing number of studies have proven that most women can safely continue to take their ADHD medication while they are pregnant and nursing. In response, an increasing number of patients are opting to do so. They have concluded, in consultation with their doctors, that the benefits of retaining their current medication outweigh any risk.
It is crucial for women suffering from ADHD who are thinking of breastfeeding to seek a specialist psychiatrist's advice prior to becoming pregnant. They should discuss the medication they are taking with their physician as well as the pros and cons of continuing treatment. This includes non-pharmacological strategies. Psychoeducation is also necessary to help pregnant women suffering from ADHD understand the symptoms and underlying disorder. They should also be educated about treatment options and strengthen coping mechanisms. This should be an approach that is multidisciplinary, including the GP doctors, obstetricians and psychiatrists. medication for add adults should include discussion of a treatment plan for the mother and the child, as well as monitoring for signs of deterioration and, if needed, adjustments to the medication regimen.