ADHD Medication During Pregnancy and Breastfeeding
Women suffering from ADHD have to make a difficult choice about whether to continue or stop taking ADHD medication during pregnancy and breastfeeding. There isn't much information on how long-term exposure to these drugs could affect the fetus.
A recent study published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological disorders like hearing loss or vision, febrile seizures, or IQ impairment. The authors acknowledge that further high-quality research is needed.
Risk/Benefit Analysis
Women who are pregnant and take ADHD medication should weigh the benefits of taking it against the potential dangers for the baby. Physicians do not have the information needed to make unequivocal recommendations however they can provide information on risks and benefits that aid pregnant women in making informed choices.
A study published in Molecular Psychiatry found that women who were taking ADHD medications during early pregnancy did not have an increased risk of fetal cardiac malformations or major structural birth defects. The researchers used a large population-based case-control study to determine the prevalence of major structural birth defects in babies born to mothers who had taken stimulants in early pregnancy, and those who did not. Pediatric cardiologists, clinical geneticists and other experts examined the cases to confirm that the classification was correct and to minimize any bias.
The research conducted by the researchers was not without limitations. The most important issue was that they were unable to distinguish the effects of the medication from those of the disorder at hand. This makes it difficult to know whether the small associations observed in the groups that were exposed are due to the use of medication or comorbidities that cause confusion. In addition the researchers did not study long-term offspring outcomes.
The study did find that infants whose mothers had taken ADHD medications during pregnancy were at a slightly greater risk of being admitted to the neonatal intensive care unit (NICU) than infants who were born without any medication or had stopped their medications before or during pregnancy. This was due to central nervous system-related disorders, and the increased risk for admission did not appear to be affected by the type of stimulant medications were used during pregnancy.
Women who took stimulant ADHD medication during pregnancy were also at an increased risk of having a caesarean delivery or having a child with low Apgar score (less than 7). These increases didn't appear to be affected by the kind of medication used during pregnancy.
The researchers suggest that the risk of a small amount with the use of ADHD medications during the early stages of pregnancy may be offset by the greater benefits to both mother and child of continued treatment for the woman's condition. Physicians should speak with their patients about this and as much as possible, assist them develop coping strategies that can lessen the impact of her disorder in her daily life and relationships.
Medication Interactions
As more women than ever are diagnosed with ADHD and treated with medication, the question of whether to keep or stop treatment during pregnancy is a question that more and more doctors confront. The majority of these decisions are made in the absence of clear and authoritative evidence regardless, so doctors must weigh their knowledge from their own experiences, those of other doctors, and what the research suggests on the subject, along with their own best judgment for each individual patient.
In particular, the issue of potential risks to the baby can be a challenge. The research that has been conducted on this topic is based on observations rather than controlled studies and the results are in conflict. Furthermore, most studies restrict their analysis to live births, which may undervalue the serious teratogenic effects that can cause abortion or termination of the pregnancy. The study that is discussed in this journal club addresses these limitations by looking at data from both live and deceased births.
The conclusion: While some studies have shown an association between ADHD medications and the risk of certain birth defects, other studies have found no connection and the majority of studies show a neutral or even slight negative effect. In every case, a careful analysis of the risks and benefits should be conducted.
It can be challenging, if not impossible for women suffering from ADHD to stop taking their medication. In fact, in a recent article in the Archives of Women's Mental Health, psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can lead to increased depression, feelings of loneliness, and family conflict for these patients. Furthermore, a loss of medication can affect the ability to complete work-related tasks and safely drive, which are important aspects of daily life for many people suffering from ADHD.
She recommends women who are uncertain about whether or not to stop taking medication because of their pregnancy should consider the possibility of educating friends, family members, and coworkers on the condition, its impact on daily functioning, and on the advantages of staying on the current treatment regimen. In addition, educating them can make the woman feel more comfortable as she struggles with her decision. It is important to remember that some medications can be absorbed through the placenta so if the patient decides to discontinue her ADHD medication during pregnancy and breastfeeding, she must be aware that traces of the drug could be passed on to the baby.
Risk of Birth Defects
As the use of ADHD medications to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases as do concerns about the effects that the drugs could have on the fetuses. A recent study published in the journal Molecular Psychiatry adds to the existing knowledge on this subject. Researchers utilized two massive datasets to analyze over 4.3 million pregnant women and determine if stimulant medication use caused birth defects. Researchers discovered that, while the overall risk is low, first-trimester ADHD medication exposure was associated with slightly higher rates of certain heart defects, like ventriculoseptal defects.
The researchers of the study didn't discover any link between early medication usage and congenital anomalies such as facial deformities or club feet. The results are in line with previous studies revealing an increase, but not significant, in the risk of heart malformations in women who started taking ADHD medications before pregnancy. The risk increased in the latter half of pregnancy, when a lot of women decided to stop taking their medication.
adhd without medication who were taking ADHD medication in the first trimester were more likely to need a caesarean, have a low Apgar after delivery and have a baby that needed help breathing when they were born. However, the authors of the study were not able to eliminate bias due to selection by restricting the study to women who did not have any other medical conditions that could have contributed to the findings.
The researchers hope their research will aid in the clinical decisions of physicians who treat pregnant women. The researchers suggest that, while discussing risks and benefits are important, the decision about whether to continue or stop medication should be made in light of the severity of each woman's ADHD symptoms and her needs.
The authors also advise that while discontinuing the medications is an option, it isn't an option that is recommended due to the high rate of depression and other mental health issues for women who are expecting or recently post-partum. Research has also shown that women who stop taking their medication will have a harder transitioning to life without them once the baby is born.
Nursing
It can be overwhelming becoming a mother. Women with ADHD who must work through their symptoms while attending doctor appointments as well as getting ready for the arrival of a child and getting used to new routines at home may face a lot of challenges. Many women opt to continue taking their ADHD medication during pregnancy.
The majority of stimulant medicines pass through breast milk in small amounts, therefore the risk for nursing infant is very low. However, the amount of medication exposure to the newborn may differ based on the dosage, frequency it is administered, and at what time it is administered. Additionally, different medications enter the baby’s system through the gastrointestinal tract or breast milk. The effect on the health of a newborn is not completely comprehended.
Due to the absence of research, some doctors may recommend stopping stimulant medications during a woman's pregnancy. This is a difficult decision for the woman, who must weigh the benefits of taking her medication as well as the risk to the fetus. As long as there is no more information, doctors should ask all pregnant patients about their experience with ADHD and if they are planning or taking to take medication during the perinatal period.
A increasing number of studies have proven that the majority of women are able to safely continue taking their ADHD medication during pregnancy and while breastfeeding. In response, a growing number of patients are choosing to continue their medication. They have concluded after consulting with their physicians, that the benefits of retaining their current medication outweigh potential risks.
Women who suffer from ADHD who are planning to nurse should seek advice from an expert psychiatrist 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 methods. Psychoeducation is also required to help pregnant people with ADHD understand their symptoms and underlying disorder Learn about the available treatments and to reinforce existing strategies for managing. This should include a multidisciplinary approach with the GP doctors, obstetricians and psychiatrists. The pregnancy counselling should consist of discussion of a management plan for both the mother and child, and monitoring for signs of deterioration and the need for adjustments to the medication regimen.