ADHD Medication During Pregnancy and Breastfeeding
Women with ADHD must make a difficult decision about whether to continue or stop taking ADHD medication during pregnancy and breast-feeding. There aren't enough data on how long-term exposure may affect a foetus.
A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication during the uterus don't develop neurological developmental conditions like impaired vision or hearing seizures, febrile seizures or IQ impairment. The authors acknowledge that more high-quality studies are required.
Risk/Benefit Analysis
Women who are pregnant and taking ADHD medications must weigh the advantages of using them against the risks to the fetus. Doctors don't have the information needed to provide clear recommendations however they can provide information regarding benefits and risks that can assist pregnant women in making informed decisions.
A study published in Molecular Psychiatry concluded that women who took ADHD medication during their early pregnancy did not have a higher risk of fetal malformations or structural birth defects. The researchers used a large population-based case-control study to evaluate the incidence of major structural birth defects in babies born to mothers who had taken stimulants in early pregnancy and those who had not. adhd treatment without medication and clinical geneticists examined the cases to ensure accurate case classification and to limit the chance of bias.
However, the study was not without its flaws. Researchers were unable to, in the first place to distinguish the effects of the medication from the disorder. This limitation makes it difficult to know whether the small associations observed in the exposed groups result from medication use or the confounding effect of comorbidities. Additionally, the researchers did not look at long-term offspring outcomes.
The study showed that infants whose mothers had taken ADHD medication during pregnancy had a slightly greater risk of being admitted to the neonatal care unit (NICU) as compared to mothers who did not take any medication during pregnancy or quit taking the medication prior to or during pregnancy. This increase 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 used during pregnancy.
Women who took stimulant ADHD medications during pregnancy also had a higher risk of having an emergency caesarean section or having a baby that scored low on the Apgar scale (less than 7). These risks did not appear to be affected by the kind of medication used during pregnancy.
Researchers suggest that the small risk of using ADHD medications during early pregnancies can be offset by greater benefits to both baby and mother of continued treatment for the woman's disorder. Physicians should discuss the issue with their patients and, when possible, help them develop strategies to improve their coping abilities that can lessen the effects of her disorder on her daily life and relationships.
Interactions with Medication
Doctors are increasingly confronted with the dilemma of whether to keep treatment or stop it during pregnancy as more women are diagnosed with ADHD. The majority of these decisions are made in the absence of clear and authoritative evidence in either case, which means that doctors have to weigh their experience about their experiences, the experiences of other doctors, and what the research says on the topic as well as their own best judgment for each patient.
Particularly, the subject of potential risks to the baby can be a challenge. The research that has been conducted on this topic is based on observation rather than controlled studies, and the results are in conflict. Most studies restrict 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 issues by examining data on both 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 have a neutral or slightly negative effect. In the end, a careful risk/benefit assessment is required in every situation.
For women suffering from ADHD and ADD, the decision to stop medication is difficult, if not impossible. In a recent piece published in the 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 isolation. The loss of medication can also affect the ability to safely drive and perform work-related tasks, which are essential aspects of everyday life for those with ADHD.
She suggests that women who are not sure whether to continue taking medication or stop due to pregnancy should educate family members, coworkers, and acquaintances about the condition, the impact on daily functioning and the benefits of continuing the current treatment. It can also help a woman feel supported in her decision. It is also worth noting that certain medications are able to pass through the placenta, therefore, if a patient decides to stop taking her ADHD medication during pregnancy and breastfeeding, she must be aware that the effects of the drug could be passed on to the baby.
Risk of Birth Defects
As the use and abuse of ADHD medication to treat symptoms of attention deficit disorder hyperactivity disorder (ADHD) is increasing as does the concern about the possible effects of the drugs on foetuses. Recent research published in the journal Molecular Psychiatry has added to the body knowledge on this topic. Utilizing two huge data sets researchers were able analyze more than 4.3 million pregnancies and see whether the use of stimulant medications increased the risk of birth defects. Researchers discovered that although the overall risk is low, first-trimester ADHD medication exposure was associated with slightly higher risk of specific heart defects like ventriculoseptal defects.
The researchers behind the study found no connection between early use of medication and congenital abnormalities such as facial clefting or club foot. The results are in agreement with previous studies which showed a small, but significant increase in the number of cardiac malformations among women who started taking ADHD medication prior to the birth of their child. The risk increased in the latter part of pregnancy when many women stopped taking their medication.
Women who took ADHD medication in the first trimester of their pregnancy were also more likely to have caesarean section, low Apgar score after delivery and a baby who needed breathing assistance at birth. The authors of the study could not eliminate bias due to selection because they restricted the study to women without other medical conditions that might have contributed to the findings.
Researchers hope that their research will inform physicians when they encounter pregnant women. The researchers suggest that while discussing the risks and benefits are important, the choice about whether to continue or stop medication should be made based on the severity of each woman's ADHD symptoms and her needs.
The authors caution that, although stopping the medication is a possibility to consider, it is not advised because of the high incidence of depression and mental health issues among women who are pregnant or recently gave birth. Additionally, the research suggests that women who choose to stop their medications are more likely to have difficulties adjusting to life without them following the birth of their baby.
Nursing
The responsibilities of a new mother can be overwhelming. Women with ADHD who must work through their symptoms while attending doctor appointments and preparing for the arrival of a child and getting used to new routines at home are often faced with a number of difficulties. Therefore, many women choose to continue taking their ADHD medications throughout the course of pregnancy.
The majority of stimulant medicines pass through breast milk in very small quantities, so the risk to the infant who is breastfeeding is low. However, the frequency of exposure to medications by the newborn may differ based on dosage, frequency it is taken and the time of the day it is administered. Additionally, individual medications enter the baby's system differently through the gastrointestinal tract as well as breast milk, and the effect of this on a newborn isn't well understood.
Due to the absence of research, some doctors may be inclined to discontinue stimulant medications during the course of pregnancy. This is a difficult decision for the mother, who must weigh the benefits of her medication against the risks to the fetus. As long as there is no more information, GPs should ask all pregnant patients about their experience with ADHD and whether they are planning or taking to take medication during the perinatal period.
Numerous studies have demonstrated that women can continue taking their ADHD medication without risk during pregnancy and breast-feeding. In response, a rising number of patients are opting to do so. They have concluded after consulting with their doctors, that the benefits of keeping their current medication outweigh possible risks.
It's important for women with ADHD who are thinking of breastfeeding to seek out a specialist psychiatrist's advice prior to becoming pregnant. They should discuss their medication with their prescriber and discuss the pros and cons for continuing treatment. This includes non-pharmacological methods. Psychoeducation is also required to help pregnant women suffering from ADHD recognize their symptoms and the root cause Learn about the available treatment options and reinforce existing strategies for managing. This should be a multidisciplinary process with the GPs, obstetricians, and psychiatry. The pregnancy counselling should consist of the discussion of a plan for management for both the mother as well as the child, monitoring for signs of deterioration and, if necessary, adjustments to the medication regimen.