ADHD Medication During Pregnancy and Breastfeeding
Women suffering from ADHD must make a difficult decision regarding whether or not to stop taking ADHD medication during pregnancy and breast-feeding. 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 problems 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 taking ADHD medications need to balance the benefits of taking them against the potential risks to the fetus. Physicians do not have the necessary data to provide clear recommendations, but they can provide information regarding risks and benefits that aid pregnant women in making informed decisions.
A study published in Molecular Psychiatry found that women who took ADHD medications during early pregnancy did not have an higher risk of fetal cardiac malformations or major birth defects that are structural. Researchers conducted a massive population-based case control study to compare the incidence of structural defects that were major in infants born to mothers who took stimulants during pregnancy. Clinical geneticists and pediatric cardiologists looked over the cases to ensure an accurate case classification and to limit the possibility of bias.
However, the study had its limitations. Most important, they were not able to differentiate the effects of the medication from the disorder at hand. This makes it difficult for researchers to determine whether the small differences observed between the exposed groups were due to the use of medication, or if they were affected by the presence of comorbidities. In addition the researchers did not look at the long-term outcomes of offspring.
The study did show that infants 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 who were born without any medication or taken off their medication prior to or during pregnancy. This increase was due to central nervous system disorders, and the increased risk for admission was not found to be influenced by the stimulant medications were used during pregnancy.
Women who took stimulant ADHD medication during pregnancy also had an increased chance of having a caesarean section or having a child with low Apgar score (less than 7). These increases did appear to be unrelated to the type of medication taken during pregnancy.
The researchers suggest that the small risk associated with the use of ADHD medications during early pregnancy could be offset by the higher benefit to both mother and child of continued treatment for the woman's condition. Physicians should discuss this with their patients and, if they are able, assist them in developing strategies to improve their coping abilities that can lessen the impact of her disorder on her daily functioning and relationships.
Medication Interactions
As more women than ever are being diagnosed with ADHD and being treated with medication, the dilemma of whether to keep or stop treatment during pregnancy is one that more and more doctors confront. These decisions are frequently taken without clear and authoritative evidence. Instead, physicians must weigh their own knowledge and experience, as well as the experiences of other physicians and the research on the subject.
Particularly, the subject of possible risks to the infant can be difficult. The research that has been conducted on this topic is based on observation instead of controlled studies and a lot of the results are conflicting. Additionally, the majority of studies limit their analysis to live births, which may underestimate the severity of teratogenic effects that could lead to abortion or termination of the pregnancy. visit this website discussed in the journal club addresses these shortcomings by analyzing both the data from deceased and live births.
The conclusion: While certain studies have demonstrated that there is a positive correlation between ADHD medications and the risk of certain birth defects, other studies have found no such relationship, and most studies demonstrate a neutral or slight negative effect. In every case it is imperative to conduct a thorough study of the risks and benefits must be performed.
For a lot of women with ADHD who suffer from ADHD, the decision to stop medication is difficult if not impossible. 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 cause depression, feelings of loneliness, and family conflict for these patients. A loss of medication may affect the ability to safely drive and complete work-related tasks, which are essential aspects of normal life for those suffering from ADHD.
She suggests that women who are unsure about whether to continue or stop medication in light 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 continuing the current treatment regimen. It can also help women feel more confident in her decision. It is important to note that certain medications can pass through the placenta therefore, if a patient decides to discontinue her ADHD medication during pregnancy and breastfeeding, she should be aware of the possibility that traces of the drug could be transferred to the infant.
Risk of Birth Defects
As the use and misuse of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) is increasing as does the concern about the possible effects of the drugs on the fetuses. A recent study published in the journal Molecular Psychiatry adds to the body of knowledge about this subject. Researchers used two massive data sets to study more than 4.3 million pregnancy and determine if stimulant medication use caused birth defects. Although the risk overall remains low, the researchers discovered that the first-trimester exposure to ADHD medications was linked to an increased risk of specific heart defects, like ventriculo-septal defects (VSD).
The authors of the study found no link between the use of early medications and other congenital anomalies, such as facial clefting or club foot. The results are in agreement with previous studies that have shown an insignificant, but small increase in cardiac malformations for women who began taking ADHD medication prior to the birth of their child. This risk increased during the latter half of pregnancy when many women stopped taking their medication.
Women who took ADHD medication in the first trimester of their pregnancies were also more likely to experience caesarean sections, a low Apgar score following delivery, and a baby who needed breathing assistance during birth. However the researchers of the study were unable to eliminate selection bias by limiting the study to women who did not have other medical issues that could be a contributing factor to these findings.
The researchers hope that their research will serve to inform the clinical decisions of physicians who treat pregnant women. The researchers recommend that, while discussing the risks and benefits are important, the choice about whether to continue or stop taking medication should be based on the severity of each woman's ADHD symptoms and the needs of the woman.
The authors also warn that, while stopping the medication is an option, it is not an option to consider due to the high prevalence of depression and other mental health problems for women who are expecting or who are recently post-partum. Additionally, the research suggests that women who choose to stop taking their medications are more likely to experience a difficult time adjusting to life without them following the baby's arrival.
Nursing
The responsibilities that come with being a new mother can be overwhelming. Women with ADHD can face severe 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. Many women decide to continue taking their ADHD medication during pregnancy.
The risk to breastfeeding infant is not too high since the majority of stimulant medication is absorbed through breast milk at low levels. The rate of exposure to medication will differ based on dosage the medication is administered, its frequency and the time of the day. In addition, different drugs enter the infant's system via the gastrointestinal tract, or through breast milk. The impact of these medications on a newborn's health is not fully comprehended.
Some doctors may decide to stop stimulant medication during a woman's pregnancy due to the absence of research. It's a difficult choice for the mother, who must weigh the benefits of taking her medication as well as the potential risks to the fetus. Until more information is available, doctors should inquire with all pregnant patients about their history of ADHD and whether they are planning or taking to take medication during the perinatal time.
A growing number of studies have shown that the majority of women are able to safely continue their ADHD medication during pregnancy and while breastfeeding. As a result, an increasing number of patients opt to do this and, after consulting with their doctor, they have found that the benefits of keeping their current medication far outweigh any potential risks.
Women who suffer from ADHD who plan to breastfeed should seek the advice of a specialist psychiatrist 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 strategies. Psychoeducation is also needed to help pregnant women suffering from ADHD be aware of the symptoms and underlying disorder. They should also be informed about treatment options and reinforce the coping mechanisms. This should be a multidisciplinary approach including obstetricians, GPs and psychiatry. Pregnancy counseling should include discussion of a treatment plan for the mother as well as the child, and monitoring for indicators of deterioration, and, if needed, adjustments to the medication regime.