ADHD Medication During Pregnancy and Breastfeeding
The choice of whether to stop or continue ADHD medication during breastfeeding and pregnancy is challenging for women with the condition. There are few data on how exposure to ADHD for a long time could affect the pregnant fetus.
A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological issues such as 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 pregnant and taking ADHD medications need to balance the benefits of taking them against the potential risks to the foetus. Doctors don't have the necessary data to give clear guidelines, but 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 in early pregnancy did not have a higher risk of fetal malformations or structural birth defects. Researchers conducted a large population-based case-control study to evaluate the incidence of major structural birth defects in infants born to mothers who took stimulants during early pregnancy and those who had not. Pediatric cardiologists and clinical geneticists examined the cases to ensure accurate case classification and to limit the possibility of bias.
The study conducted by the researchers was not without limitations. The researchers were unable to, in the first place to distinguish the effects caused by the medication from the disorder. This makes it difficult to determine whether the limited associations observed in the groups that were exposed are due to the use of medication or comorbidities that cause confusion. Additionally the study did not look at long-term offspring outcomes.
The study revealed that babies whose mothers had taken ADHD medication during pregnancy were at a slightly greater risk of being admitted to the neonatal care unit (NICU) in comparison to those whose mothers didn't take any medication during pregnancy or discontinued taking their medication prior to or during pregnancy. The reason for this was central nervous system disorders, and the increased risk of admission did not appear to be influenced by the stimulant medications were used during pregnancy.
Women who used stimulant ADHD medication during pregnancy were also at an increased risk of having a caesarean birth or having a baby with low Apgar score (less than 7). These increases appear to be independent of the type of medication taken during pregnancy.
Researchers suggest that the minor risks associated with the use ADHD medications in early pregnancies could be offset by the greater benefits for baby and mother of continued treatment for the woman's disorder. Physicians should discuss this with their patients and, where they are able, assist them in developing strategies for improving their coping skills that may minimize the impact of her disorder on her daily life and relationships.
Medication Interactions
As more women than ever before are being diagnosed with ADHD and treated with medication, the issue of whether to keep or stop treatment during pregnancy is one that more and more physicians confront. These decisions are usually taken without clear and authoritative evidence. Instead, doctors have to consider their own expertise, the experience of other physicians and the research that has been conducted on the subject.
The issue of potential risks to the infant can be extremely difficult. The research on this subject is based on observations instead of controlled studies and many of the findings are conflicting. In addition, most studies limit their analysis to live births, which can underestimate the severity of teratogenic effects that could cause abortion or termination of the pregnancy. adhd medication list discussed in this journal club addresses these limitations by looking at data from both live and deceased births.
The conclusion is that while some studies have found a positive association between ADHD medications and the risk of certain birth defects, other studies have found no such relationship, and most studies show a neutral or even slightly negative impact. In each case an in-depth analysis of the risks and benefits must be performed.
For many women with ADHD, the decision to stop taking medication can be difficult, if not impossible. In a recent article published in the Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can increase depression and feelings of isolation. In addition, a decrease in medication may affect the ability to complete jobs and drive safely, which are important aspects of a normal life for a lot of people with ADHD.
She suggests that women who are not sure whether to continue taking the medication or discontinue it due to pregnancy educate family members, colleagues, and their friends about the condition, the impact on daily functioning and the advantages of staying on the current treatment. It can also help a woman feel confident about her decision. It is important to note that some medications are able to pass through the placenta therefore, if a patient decides to stop her ADHD medication during pregnancy and breastfeeding, she must be aware that traces of the drug can be passed on to the baby.
Risk of Birth Defects
As the use and abuse of ADHD medications to treat the symptoms of attention deficit disorder hyperactivity disorder (ADHD), increases as does the concern about the potential adverse effects of the drugs on foetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge on this issue. Researchers used two massive data sets to study more than 4.3 million pregnant women and determine if the use of stimulant medications caused birth defects. Researchers found that while the risk overall is low, the first trimester ADHD exposure to medication was associated with slightly higher risk of specific heart defects like ventriculoseptal defects.
The researchers of the study found no connection between early use of medication and other congenital abnormalities, such as facial clefting or club foot. The results are consistent with previous studies that have shown a small but significant increase in the risk of developing cardiac malformations in women who started taking ADHD medications prior to the time of pregnancy. This risk increased during the latter half of pregnancy when a large number of women began to stop taking their medication.
Women who used ADHD medication in the first trimester of their pregnancy were also more likely to have caesarean section, low Apgar score following delivery, and a baby that required breathing assistance at birth. However the researchers of the study were unable to eliminate bias due to selection by limiting the study to women who didn't have any other medical issues that could be a contributing factor to these findings.
The researchers hope their study will help inform the clinical decisions of physicians who treat pregnant women. The researchers recommend that while discussing benefits and risks are important, the choice on whether to continue or stop taking medication should be in light of the severity of each woman's ADHD symptoms and her needs.
The authors warn that, although stopping the medication is a possibility to consider, it is not advised because of the high incidence of depression and other mental disorders in women who are expecting or have recently given birth. Further, research shows that women who stop taking their medication will have a harder transitioning to life without them after the baby is born.
Nursing
The responsibilities that come with being a new mother can be overwhelming. Women with ADHD may face a lot of challenges when they must deal with their symptoms, go to doctor appointments and prepare for the birth of a baby and adjust to new routines. As such, many women choose to continue taking their ADHD medications throughout pregnancy.
The majority of stimulant medicines are absorbed by breast milk in very small amounts, so the risk to infant who is breastfeeding is low. The rate of exposure to medication can vary depending upon the dosage and frequency of administration as well as the time of the day. Additionally, individual medications enter the baby's system differently through the gastrointestinal tract as well as breast milk. how to treat adhd without medication in adults of this on a newborn infant is not well known.
Due to the absence of research, some physicians may be inclined to discontinue stimulant medications during the pregnancy of a woman. It is a difficult decision for the woman, who must weigh the benefits of taking her medication as well as the risks to the foetus. Until more information is available, doctors should inquire with all pregnant patients about their history of ADHD and whether they plan or are taking to take medication during the perinatal time.
A increasing number of studies have revealed that the majority of women are able to safely continue to take their ADHD medication while they are pregnant and nursing. In response, an increasing number of patients are choosing to do this. They have discovered, in consultation with their physicians that the benefits of continuing their current medication outweigh any risk.
Women with ADHD who are planning to breastfeed should seek the advice of an expert psychiatrist prior to becoming pregnant. They should review their medications with their physician and discuss the advantages and disadvantages of continuing treatment, including non-pharmacological strategies. Psychoeducation should also be provided to help women with ADHD understand their symptoms and underlying disorder and learn about treatment options and reinforce existing strategies for coping. This should be a multidisciplinary approach, which includes the GP, obstetricians and psychiatry. Pregnancy counselling should include the discussion of a treatment plan for both mother and child, monitoring for signs of deterioration, and the need for adjustments to the medication regimen.