ADHD Medication During Pregnancy and Breastfeeding
The decision to stop or keep ADHD medications during pregnancy and nursing is challenging for women with the condition. There are few data on how long-term exposure may affect the fetus.
A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication in utero do not develop neurological developmental conditions like impaired vision or hearing seizures, febrile seizures or IQ impairment. The authors acknowledge that more high quality studies are needed.
Risk/Benefit Analysis
Women who are expecting and taking ADHD medication need to weigh the benefits of taking it against the potential risks for the baby. Physicians don't have the data to make unambiguous recommendations, but can provide information on the risks and benefits to help pregnant women make informed decisions.
A study published in Molecular Psychiatry found that women who were taking ADHD medications during early pregnancy did not face an increased risk of fetal cardiac malformations or major structural birth defects. Researchers conducted a large population-based study of case-control to evaluate the incidence of major structural birth defects in infants born to mothers who had taken stimulants in the early stages of pregnancy and those who had not. Pediatric cardiologists and clinical geneticists reviewed the cases to ensure correct case classification and to limit the chance of bias.
The study of the researchers was not without limitations. Researchers were unable to, in the first place to differentiate the effects of the medication from the disorder. This makes it difficult for researchers to determine whether the few associations observed between the groups exposed were due to the use of medications, or if they were caused by the presence of comorbidities. Additionally the researchers did not examine the long-term outcomes of offspring.
The study did show that babies whose mothers had taken ADHD medication during pregnancy were at a slightly higher risk of being admitted to the neonatal intensive care unit (NICU) than those whose mothers had not taken any medication or stopped their medications before or during pregnancy. This was due to central nervous system-related 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 medication during pregnancy were also at an elevated chance of having a caesarean birth or having a child with a low Apgar score (less than 7). These increases appear to be unrelated to 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 benefits to both the mother and child of continued treatment for the woman's disorder. Physicians should talk to their patients about this and try to help them develop coping strategies that could reduce the impact of her disorder in her daily life and relationships.
Interactions with Medication
Doctors are increasingly faced with the decision of whether to keep treatment or stop it during pregnancy as more women are diagnosed with ADHD. These decisions are often made without clear and authoritative evidence. Instead, doctors must consider their own expertise in conjunction with the experiences of other doctors, and the research on the topic.
Particularly, the subject of potential risks to the infant can be difficult. Many studies on this issue are based on observations rather than controlled research and their conclusions are often contradictory. The majority of studies limit their analysis to live-births, which could underestimate the teratogenic impact which can cause abortions or terminations of pregnancy. The study discussed in the journal club addresses these limitations, by examining both the data from deceased and live births.
The conclusion The conclusion: While some studies have found a positive 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 an in-depth analysis of the potential risks and benefits is required.
It can be challenging, if not impossible, for women suffering from ADHD to stop taking their medication. 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 those suffering from the disorder. The loss of medication can affect the ability to drive safely and perform work-related tasks, which are essential aspects of daily life for those with ADHD.
She recommends that women who are unsure about whether to continue or stop medication in light of their pregnancy, consider educating family members, friends, and coworkers on the condition, its impact on daily functioning, and on the benefits of keeping the current treatment regimen. It will also help a woman feel more confident in her decision. It is important to note that some drugs can pass through the placenta therefore, if a patient decides to stop taking 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 of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases there are concerns about what impact the drugs might have on the fetuses. Recent research published in the journal Molecular Psychiatry has added to the body knowledge on this issue. Researchers utilized two massive data sets to study more than 4.3 million pregnant women and determine whether stimulant medications caused birth defects. While the overall risk remains low, the scientists found that exposure in the first trimester to ADHD medications was associated with a slightly higher rate of certain heart defects, such as ventriculo-septal defect (VSD).
The researchers of the study did not find any association between early use of medication and other congenital anomalies like facial deformities or club feet. The results are consistent with previous studies showing a small but significant increase in the risk of developing cardiac malformations among women who began taking ADHD medications prior to the time of the birth of their child. This risk increased in the later part of pregnancy, when a lot of women begin to discontinue their ADHD medications.
Women who took ADHD medication in the first trimester were more likely require a caesarean birth and also have an insufficient Apgar after birth and have a baby who needed help breathing after birth. However, the authors of the study were not able to eliminate bias due to selection by limiting the study to women who didn't have any other medical issues that could have contributed to these findings.
The researchers hope their research will help inform the clinical decisions of doctors who see pregnant women. They advise that while discussing the benefits and risks is important 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 caution that, although stopping the medication is a possibility to look into, it is not advised because of the high incidence of depression and mental health issues for women who are pregnant or who have recently given birth. Further, the research suggests that women who decide to stop their medications are more likely to experience difficulties adjusting to life without them after the baby's arrival.
Nursing
It can be a challenge becoming a mother. click for source with ADHD who must work through their symptoms while attending physician appointments and making preparations for the arrival of a baby and adjusting to new household routines may face a lot of challenges. This is why many women choose to continue taking their ADHD medications throughout pregnancy.
The majority of stimulant medicines are absorbed through breast milk in low quantities, so the risk for infant who is breastfeeding is low. The rate of exposure to medication will differ based on dosage, frequency of administration and the time of day. Additionally, different medications are introduced into the baby's system through the gastrointestinal tract, or through breast milk. The impact of these medications on the health of a newborn isn't completely known.
Some doctors may decide to stop stimulant medication during a woman’s pregnancy due to the absence of research. This is a difficult choice for the patient, who must balance the benefit of continuing her medication against the potential risks to the fetus. As long as more information is available, GPs may ask pregnant patients if they have any background of ADHD or if they are planning to take medication in the perinatal period.
Numerous studies have proven that women can continue to take their ADHD medication in a safe manner during pregnancy and breast-feeding. As a result, an increasing number of patients are choosing to do so and after consulting with their doctor, they have discovered that the benefits of maintaining their current medication outweigh any risks.
Women who suffer from ADHD who plan to breastfeed should seek the advice of an expert psychiatrist prior to becoming pregnant. They should discuss their medication with their physician and discuss the pros and cons of continued treatment, including non-pharmacological management strategies. Psychoeducation is also needed to help pregnant women with ADHD understand the symptoms and the underlying disorder. They should also be educated about treatment options and reinforce coping mechanisms. This should include an approach that is multidisciplinary, including the GP, obstetricians and psychiatry. Pregnancy counselling should include the discussion of a treatment plan for both the mother as well as the child, monitoring for signs of deterioration, and when necessary, making adjustments to the medication regimen.