ADHD Medication During Pregnancy and Breastfeeding
The choice of whether to stop or continue ADHD medication during pregnancy and breastfeeding is a difficult decision for women suffering from the condition. There is a lack of information about how long-term exposure to these drugs could affect the fetus.
A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication during the uterus do not develop neurological disorders like hearing or vision impairment, febrile seizures, or IQ impairment. The authors acknowledge that more high quality studies are required.
Risk/Benefit Analysis
Women who are pregnant and take ADHD medication must evaluate the benefits of using it versus the risks to the fetus. Physicians don't have the data to give clear advice however they can provide information about risks and benefits to help pregnant women make informed choices.
A study published in Molecular Psychiatry found that women who were taking ADHD medications during early pregnancy did not face an higher risk of fetal cardiac malformations or major birth defects that are structural. Researchers conducted a massive sample-based case control study to assess the frequency of structural defects that were major in infants who were born to mothers who used stimulants during pregnancy. Pediatric cardiologists and clinical geneticists reviewed the cases to ensure an accurate classification of the cases and to reduce the chance of bias.
The study of the researchers was not without limitations. medication for adult adhd , they were unable to distinguish the effects of the medication from those of the disorder that is underlying. This makes it difficult for researchers to determine whether the few associations observed between the exposed groups were due to medication use, or if they were affected by co-morbidities. Additionally, the researchers did not study long-term offspring outcomes.
The study showed that infants whose mother took ADHD medication during pregnancy had a higher risk of admission to the neonatal care unit (NICU) as compared to mothers who did not take any medication during pregnancy or had quit taking the medication prior to or during pregnancy. This increase was due to central nervous system-related disorders, and the increased risk for admission was not found to be influenced by the stimulant medications were taken during pregnancy.
Women who took stimulant ADHD medications during pregnancy also had a higher likelihood of having to have a caesarean section or the baby was not scoring well on the Apgar scale (less than 7). These increases did appear to be independent of the type of medication taken during pregnancy.
The researchers suggest that the small risk associated with the use of ADHD medications during the early stages of pregnancy may be offset by the greater benefit for both mother and child of continued treatment for the woman's disorder. Physicians should discuss the issue with their patients and, where possible, help them develop strategies for improving their coping skills that may minimize the impact of her disorder on her daily life and relationships.
Interactions with Medication
Doctors are increasingly confronted with the dilemma of whether to continue treatment or stop during pregnancy as more women are diagnosed with ADHD. The majority of these decisions are made without clear and authoritative evidence regardless, so doctors must weigh what they know, the experiences of other doctors, and what the research suggests about the subject, along with their own judgments for each individual patient.
In particular, the issue of possible risks to the baby can be a challenge. The research on this subject is based on observation rather than controlled studies and many of the findings are contradictory. Additionally, the majority of studies limit their analysis to live births, which can undervalue the serious teratogenic effects that can result in abortion or termination of the pregnancy. The study presented in this journal club addresses these limitations by analyzing data on live and deceased births.
Conclusion A few studies have revealed a positive correlation between ADHD medications and certain birth defects However, other studies haven't found a correlation. The majority of studies show a neutral, or even somewhat negative, effect. In all cases an in-depth analysis of the potential risks and benefits must be performed.
For women suffering from ADHD, the decision to stop taking medication can be difficult, if not impossible. In a recent article in Archives of Women's Mental Health, psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can lead to increased depression, feelings of isolation and family conflict for these patients. The loss of medication can also impact the ability to drive safely and to perform work-related tasks which are crucial aspects of everyday life for those suffering from ADHD.
She recommends that women who are unsure about whether to keep or stop medication in light of their pregnancy, consider the possibility of educating friends, family members, and coworkers on the condition, its effects on daily functioning, and on the benefits of keeping 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 note that some medications can be absorbed through the placenta therefore, if a patient decides to stop taking her ADHD medication during pregnancy and breastfeeding, she should be aware of the possibility that traces of the drug can be passed on to the baby.
Risk of Birth Defects
As the use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases as do concerns about what impact the drugs might have on fetuses. A study that was published in the journal Molecular Psychiatry adds to the body of information on this topic. Utilizing two huge data sets, researchers were able to examine more than 4.3 million pregnancies and determine whether the use of stimulant medications increased the risk of birth defects. Researchers discovered that although the overall risk is low, the first trimester ADHD medication use was associated with slightly higher rates of certain heart defects, like ventriculoseptal defect.
The researchers behind the study found no connection 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 the number of cardiac malformations among women who started taking ADHD medication before the time of pregnancy. This risk increased during the latter half of pregnancy, when a lot of women decided to stop taking their medication.
Women who took ADHD medications in the first trimester of their pregnancy were also more likely to experience caesarean sections, a 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 restricting the study to women who didn't have other medical issues that could have contributed to the findings.
The researchers hope that their research will aid in the clinical decisions of doctors who treat pregnant women. The researchers suggest that, while discussing the risks and benefits 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 also caution that, while stopping the medication is an option, it is not an option that is recommended due to the high incidence of depression and other mental health issues among women who are pregnant or post-partum. Additionally, research suggests that women who stop taking their medication will have a harder time adjusting to a life without them once the baby is born.
Nursing
The responsibilities of a new mom can be overwhelming. Women who suffer from ADHD who have to manage their symptoms while attending doctor appointments, preparing for the arrival of their child and adjusting to new household routines can experience severe challenges. Many women decide to continue taking their ADHD medication during pregnancy.
The risk for breastfeeding infant is minimal because the majority of stimulant medications passes through breast milk at low levels. However, the amount of exposure to medication by the infant can differ based on dosage, how often it is taken and the time of the day it is administered. Additionally, different medications are introduced into the baby's system via the gastrointestinal tract, or through breast milk. The effect on a newborn's health is not completely understood.
Some doctors may decide to stop stimulant medication during a woman’s pregnancy due to the lack of research. This is a difficult decision for the patient, who must weigh the benefit of continuing her medication with the potential dangers to the fetus. Until more information becomes available, GPs can ask pregnant patients if they have any background of ADHD or if they intend to take medication during the perinatal phase.
Many studies have shown that women can continue to take their ADHD medication without risk while breastfeeding and during pregnancy. In the end, more and more patients choose to do so, and in consultation with their doctor they have discovered that the benefits of keeping their current medication exceed any risk.
It is essential for women with ADHD who are considering breastfeeding to seek a specialist psychiatrist's advice prior to becoming pregnant. They should discuss their medication with their doctor and discuss the pros and cons for continuing treatment. This includes non-pharmacological methods. Psychoeducation is also required to help pregnant women with ADHD understand the symptoms and underlying disorder. They should also be informed about treatment options and strengthen strategies for coping. This should be a multidisciplinary approach including obstetricians, GPs and psychiatrists. Pregnancy counseling should include discussion of a treatment plan for the mother and child, monitoring of signs of deterioration and, if necessary modifications to the medication regime.