ADHD Medication During Pregnancy and Breastfeeding
The decision to stop or keep ADHD medications during pregnancy and breastfeeding is challenging for women with the condition. There are few data regarding how exposure over time may affect the pregnant fetus.
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 the need for higher-quality studies.
Risk/Benefit Analysis
Women who are pregnant and taking ADHD medication must weigh the benefits of taking it against the potential risks to the fetus. Physicians don't have the data to make unambiguous recommendations however they can provide information on the risks and benefits to help pregnant women make informed decisions.
A study published in Molecular Psychiatry concluded that women who took ADHD medication in early pregnancy were not at a greater risk of fetal malformations, or structural birth defects. The researchers used a large population-based study of case-control to determine the prevalence of major structural birth defects in infants born to mothers who had taken stimulants during the early stages of pregnancy, as well as those who had not. Clinical geneticists, pediatric cardiologists and other experts reviewed the cases in order to make sure that the classification was correct and to eliminate any bias.
However, the researchers' study had its limitations. Researchers were unable to, in the first place, to separate the effects caused by the medication from the disorder. This limitation makes it difficult to determine whether the small differences observed in the groups that were exposed are due to the use of medication or the confounding effect of comorbidities. The researchers also did not look at the long-term effects for the offspring.
The study revealed that babies whose mothers took ADHD medication during pregnancy had a slightly greater risk of being admitted to the neonatal care unit (NICU), compared to mothers who did not take any medication during pregnancy or discontinued taking their medication prior to or during pregnancy. The reason for this was central nervous system disorders. The higher risk of admission was not influenced by the stimulant medication that was used during pregnancy.
Women who used stimulant ADHD medication during pregnancy were also at an increased chance of having a caesarean birth or having a baby born with a low Apgar score (less than 7). These increases did not appear to be affected by the kind of medication used during pregnancy.
The research suggests that the low risk associated with the use of ADHD medications during the early stages of pregnancy may be offset by the greater benefits for both mother and child from continued treatment for the woman's disorder. Physicians should speak with their patients about this issue and, if possible, help them develop coping strategies that may reduce the effects of her disorder on her daily life and relationships.
Interactions with Medication
As more women than ever are being diagnosed with ADHD and treated with medication, the question of whether to continue or end treatment during pregnancy is a question that more and more doctors face. These decisions are usually made without clear and authoritative evidence. Instead, doctors must consider their own expertise in conjunction with the experiences of other doctors and the research that has been conducted on the subject.
Particularly, the subject of potential risks to the baby can be tricky. A lot of studies on this topic are based on observational data rather than controlled research, and their findings are often contradictory. Furthermore, most studies restrict their analysis to live births, which can undervalue the serious teratogenic effects that can lead to abortion or termination of the pregnancy. The study that is discussed in this journal club addresses these issues by looking at data from both live and deceased births.
add in adults medication : While certain studies have demonstrated a positive association between ADHD medications and the risk of certain birth defects, others have found no such relationship, and most studies have a neutral or slight negative effect. As a result an accurate risk-benefit analysis must be done in each instance.
For many women with ADHD and ADD, the decision to stop taking medication is difficult, if not impossible. In a recent article published in Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can lead to depression and feelings of being isolated. In addition, a decrease in medication can affect the ability to perform jobs and drive safely which are essential aspects of daily life for many people suffering from ADHD.
She suggests that women who aren't sure whether to continue taking the medication or stop due to pregnancy should educate family members, coworkers, and their friends about the condition, its effects on daily functioning, and the advantages of staying on the current treatment. In addition, educating them can make the woman feel more comfortable when she is struggling with her decision. Certain medications can pass through the placenta. If the patient decides to stop taking her ADHD medication while pregnant and 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 medications to treat symptoms of attention deficit hyperactivity disorder (ADHD) grows, so do concerns about what impact the drugs might have on fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge on this subject. Utilizing two huge data sets, researchers were able to examine more than 4.3 million pregnancies to determine whether the use of stimulant medications increased the risk of birth defects. Researchers discovered that, while the overall risk is low, first-trimester ADHD medication use was associated with slightly higher rates of certain heart defects, such as ventriculoseptal defect.
The researchers of the study found no link between early medication use and other congenital anomalies, like facial clefting, or club foot. The results are in agreement with previous studies which showed an insignificant, but small increase in the number of cardiac malformations among women who started taking ADHD medication before the birth of their child. The risk increased in the latter part of pregnancy when a large number of women stopped taking their medication.
Women who took ADHD medication in the first trimester of their pregnancy were also more likely to have caesarean sections, a low Apgar score after delivery and a baby who needed help breathing at birth. However, the authors of the study were unable to eliminate bias due to selection by restricting the study to women who did not have any other medical issues that could be a contributing factor to these findings.
Researchers hope their research will help doctors when they encounter pregnant women. They advise that while a discussion of the risks and benefits is crucial, the decision to stop or continue treatment must be based on each woman's needs and the severity of her ADHD symptoms.
The authors also warn that even though stopping the medication is an alternative, it is not an option that is recommended due to the high prevalence of depression and other mental health problems in women who are pregnant or postpartum. Additionally, research suggests that women who stop taking their medications will have a harder time adjusting to a life without them once the baby is born.
Nursing
The responsibilities that come with being a new mother can be overwhelming. Women who suffer from ADHD who have to manage their symptoms while attending physician appointments and getting ready for the arrival of a child and adjusting to new household routines may face a lot of challenges. Many women decide to continue taking their ADHD medication during pregnancy.
The majority of stimulant drugs are absorbed through breast milk in very small amounts, therefore the risk for infant who is breastfeeding is low. The rate of medication exposure will vary based on the dosage and frequency of administration as well as the time of day. Additionally, individual medications enter the infant's system differently through the gastrointestinal tract and breast milk, and the effect of this on a newborn isn't fully understood.
Some doctors may stop taking stimulant medications during a woman's pregnancy due to the absence of research. It is a difficult decision for the mother, who must weigh the advantages of taking her medication as well as the potential risks to the embryo. Until more information becomes available, GPs can inquire about pregnant patients whether they have any background of ADHD or if they are planning to take medication in the perinatal period.
A increasing number of studies have proven that most women can safely continue their ADHD medication during pregnancy and while breastfeeding. In response, a rising number of patients are opting to do this. They have concluded after consulting with their doctor, that the benefits of retaining their current medication far outweigh any risk.
Women who suffer from ADHD who are planning to nurse should seek advice from a specialist psychiatrist before becoming pregnant. They should review their medications with their physician and discuss the pros and cons of continued treatment, including non-pharmacological strategies. Psychoeducation should also be provided to help pregnant women suffering from ADHD recognize their symptoms and the underlying disorder and learn about treatments and to reinforce existing strategies for managing. This should be a multidisciplinary approach, which includes the GP as well as obstetricians, psychiatry and obstetricians. Pregnancy counselling should include the discussion of a plan for management for both mother and child, as well as monitoring for signs of deterioration and when necessary, making adjustments to the medication regimen.