ADHD Medication During Pregnancy and Breastfeeding
Women suffering from ADHD face a difficult decision about whether to continue or stop taking ADHD medication during pregnancy and breastfeeding. There is a lack of information about how long-term exposure to these drugs can affect the foetus.
A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus don't develop neurological developmental conditions like hearing or vision impairment seizures, febrile seizures or IQ impairment. The authors acknowledge the need for higher-quality studies.
Risk/Benefit Analysis
Women who are pregnant and taking ADHD medications must weigh the benefits of taking them against the potential risks to the foetus. Physicians don't have the data to make unambiguous recommendations but they can provide information on risks and benefits to aid pregnant women in making informed choices.
A study published in Molecular Psychiatry found that women who were taking ADHD medications during their early pregnancy did not face a significantly increased risk of fetal cardiac malformations or major birth defects that are structural. Researchers conducted a large, population-based case-control study to assess the risk of major structural birth defects in babies born to mothers who had taken stimulants during early pregnancy and those who had not. adhd medication list , clinical geneticists and other experts examined the cases to make sure that the classification was correct and to eliminate any bias.
However, the study was not without its flaws. Most important, they were unable to distinguish the effects of the medication from the effects of the underlying disorder. That limitation makes it difficult to know whether the small associations observed in the groups that were exposed are due to the use of medication or confounding by comorbidities. Additionally the researchers did not study the long-term outcomes of offspring.
The study found that babies whose mothers took ADHD medication during pregnancy were at a slightly higher risk of admission to the neonatal care unit (NICU) in comparison to mothers who didn't take any medication during pregnancy, or had stopped taking their medication before or during pregnancy. This increase was due to central nervous system 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 medications during pregnancy also had a higher chance of having to have caesarean sections or a baby that scored low on the Apgar scale (less than 7). These increases appeared to be independent of the type of medication used during pregnancy.
Researchers suggest that the minor risks posed by the use of ADHD medication during pregnancies in the early stages can be offset by greater benefits to both baby and mother of continued treatment for the woman’s disorder. Doctors should discuss with their patients about this issue and as much as possible, assist them develop coping strategies that may reduce the impact of her disorder in her daily life and relationships.
Medication Interactions
Many doctors are confronted with the dilemma of whether to maintain treatment or stop during pregnancy as more women are diagnosed with ADHD. Often, these decisions are made in the absence of clear and authoritative evidence regardless, so doctors have to weigh their experience about their experiences, the experiences of other doctors, and what the research suggests on the subject, along with their own best judgment for each patient.
The issue of possible risks for infants can be difficult to determine. Many studies on this topic are based on observational evidence instead of controlled research and their findings are often contradictory. In addition, most studies limit their analysis to live births, which can underestimate the severity of teratogenic effects that could result in abortion or termination of the pregnancy. The study presented in this journal club addresses these shortcomings by examining data on both live and deceased births.
The conclusion is that while some studies have shown a positive association between ADHD medications and the risk of certain birth defects, others have found no connection, and most studies have a neutral or slightly negative effect. Therefore, a careful risk/benefit analysis is required in every instance.
It can be challenging, if not impossible for women with ADHD to stop taking their medication. 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 cause depression and feelings of loneliness. A decrease in medication could also impact the ability to drive safely and perform work-related tasks, which are crucial aspects of everyday life for people with ADHD.
She suggests women who are uncertain about whether or not to stop taking medication because of their pregnancy consider the possibility of educating friends, family members and colleagues on the condition, its effects on daily functioning, and the advantages of staying on the current treatment plan. Educating them can also make the woman feel more comfortable in her struggle with her decision. Certain medications can be passed through the placenta. If the patient decides not to take her ADHD medication while pregnant and breastfeeding, it is important to be aware that the drug may be transferred to her baby.
Risk of Birth Defects
As the use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases there are concerns about the effects that the drugs could have on fetuses. A study that was published in the journal Molecular Psychiatry adds to the existing knowledge about this subject. Using two massive data sets, researchers were able to analyze more than 4.3 million pregnancies to determine whether the use of stimulant medications increased the risk of birth defects. While the overall risk remains low, the scientists discovered that the first-trimester exposure to ADHD medicines was associated with an increase in the risk of certain heart defects, such as ventriculoseptal defect (VSD).
The authors of the study found no link between early use of medication and congenital abnormalities 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 time of the birth of their child. The risk was higher in the latter half of pregnancy, when many women are forced to stop taking their ADHD medication.
Women who took ADHD medication in the first trimester were more likely require a caesarean birth or have an insufficient Apgar after delivery, and have a baby that needed help breathing after birth. The authors of the study were not able to eliminate selection bias because they limited the study to women who did not have any other medical conditions that might have contributed to the findings.
The researchers hope that their research will serve to inform the clinical decisions of physicians who encounter pregnant women. They recommend that, while discussing risks and benefits is important however, the decision to stop or maintain treatment should be based on each woman's needs and the severity of her ADHD symptoms.
The authors warn that, although stopping the medication is an option to look into, it is not recommended because of the high incidence of depression and mental health issues among women who are pregnant or have recently given birth. Additionally, research suggests that women who stop taking their medications will have a harder transitioning to life without them after the baby is born.
Nursing
It can be a challenge to become a mom. Women suffering from ADHD are often faced with a number of difficulties when they must deal with their symptoms, attend doctor appointments and prepare for the birth of their child and adjust to a new routine. Many women decide to continue taking their ADHD medication during pregnancy.
The risk for breastfeeding infant is minimal because the majority of stimulant medications is absorbed through breast milk in low amounts. The rate of exposure to medication will differ based on dosage, frequency of administration and the time of the day. In addition, individual medications enter the infant's system differently through the gastrointestinal tract as well as breast milk and the impact of this on a newborn isn't yet fully understood.
Because of the lack of research, some doctors may be inclined to discontinue stimulant medications during the course of pregnancy. It is a difficult decision for the mother, who must weigh the advantages of taking her medication as well as the potential risks to the foetus. As long as more information is available, GPs may ask pregnant patients if they have an history of ADHD or if they intend to take medication in the perinatal period.
Numerous studies have proven that women can continue taking their ADHD medication safely while breastfeeding and during pregnancy. In response, a growing number of patients are opting to do so. They have concluded, in consultation with their doctor, that the benefits of retaining their current medication far outweigh any possible risks.
It is crucial for women suffering from ADHD who are thinking of breastfeeding to seek out a specialist psychiatrist's advice prior 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 with ADHD be aware of the symptoms and underlying disorder. They should also be educated about treatment options and strengthen strategies for coping. This should be a multidisciplinary process with the GPs, obstetricians, and psychiatrists. Pregnancy counseling should include a discussion of a treatment plan for the mother and child, and monitoring for signs of deterioration, and, if necessary, adjustments to the medication regimen.