ADHD Medication During Pregnancy and Breastfeeding
Women with ADHD face a difficult decision about whether to continue or stop taking ADHD medication during pregnancy and breast-feeding. Little data exists about how long-term exposure to these drugs may affect the foetus.
A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication during the uterus don't develop neurological disorders like hearing loss or impaired vision 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 need to balance the benefits of using them against the risks to the fetus. Physicians don't have the data needed to give clear guidelines, but 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 their early pregnancy did not have an increased risk of fetal cardiac malformations or major birth defects that are structural. Researchers conducted a large population-based study of case control to compare the incidence of structural defects that were major in infants born to mothers who used stimulants during pregnancy. Pediatric cardiologists, clinical geneticists and other experts examined the cases to ensure that the classification was correct and to eliminate any bias.
The research conducted by the researchers had some limitations. Most important, they were not able to differentiate the effects of the medication from the effects of the underlying disorder. This limitation makes it difficult to determine whether the limited associations observed in the exposed groups are due to the use of medication or the confounding effect of comorbidities. The researchers did not examine the long-term effects for the offspring.
The study found that babies whose mothers had taken ADHD medication during pregnancy had a slightly higher risk of admission to the neonatal care unit (NICU) as compared to those whose mothers did not use any medication during pregnancy, or had stopped taking their medication before or during pregnancy. This was due to central nervous system-related disorders and the higher risk of admission did not appear to be influenced by the stimulant medication was used during pregnancy.
Women who were taking stimulant ADHD medication during pregnancy also had an increased chance of having a caesarean birth or having a child with low Apgar score (less than 7). These increases did appear to be independent of the type of medication used during pregnancy.
The researchers suggest that the small risk associated with the use of ADHD medications during the early stages of pregnancy could be offset by the greater benefits to both the mother and child of continued treatment for the woman's disorder. Physicians should speak with their patients about this and as much as possible, assist them develop coping skills that may reduce the impact of her disorder in her daily life and relationships.
Medication Interactions
Many doctors are faced with the decision of whether to continue treatment or stop during pregnancy as more women are diagnosed with ADHD. These decisions are usually taken without clear and authoritative evidence. Instead, doctors have to weigh their own knowledge and experience, as well as the experiences of other physicians and the research that has been conducted on the subject.
The issue of risk to the infant can be difficult to determine. Many studies on this topic are based on observations instead of controlled research and their conclusions are often contradictory. Furthermore, most studies restrict their analysis to live births, which could undervalue the serious teratogenic effects that can lead to abortion or termination of the pregnancy. The study presented in this journal club addresses these issues by examining data on both live and deceased births.
The conclusion: While some studies have found 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 slight negative effect. Therefore, a careful risk/benefit assessment must be conducted in every instance.
It isn't easy, but not impossible for women suffering from ADHD to stop taking their medication. In a recent article 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 being isolated. A loss of medication may also impact the ability to safely drive and perform work-related tasks, which are crucial aspects of everyday life for those with ADHD.
She suggests that women who aren't sure whether to take the medication or stop it due to their pregnancy, educate their family members, coworkers, and acquaintances about the condition, the effects on daily functioning, and the benefits of continuing the current treatment plan. It can also help women feel more confident in her decision. Some medications can pass through the placenta. If a woman decides to not take her ADHD medication while pregnant and breastfeeding, it's important to be aware that the drug could be passed on to her baby.
Birth Defects and Risk of
As the use and abuse of ADHD medication to treat symptoms of attention deficit hyperactivity disorder (ADHD), increases, so does concern about the potential effects of these drugs on fetuses. A recent study published in the journal Molecular Psychiatry adds to the body of information on this topic. Using two massive data sets researchers were able look at more than 4.3 million pregnancies to determine whether stimulant medications increased the risk of birth defects. Researchers found that while the overall risk is low, the first trimester ADHD exposure to medication was associated with slightly higher risk of certain heart defects, like ventriculoseptal defect.
The authors of the study found no connection between the use of early medications and other congenital anomalies, like facial clefting, or club foot. The results are in the same vein as previous studies that have shown a small, but significant increase in the number of cardiac malformations among women who started taking ADHD medication before the birth of their child. The risk increased in the latter part of pregnancy when a large number of women stopped taking their medication.
Women who used ADHD medications during the first trimester of pregnancy were also more likely to have a caesarean section, a low Apgar score after delivery and a baby who required breathing assistance during birth. However the researchers of the study were not able to eliminate selection bias by restricting the study to women who did not have any other medical issues that could have contributed to these findings.
Researchers hope that their study will provide doctors with information when they meet pregnant women. The researchers suggest that, while discussing risks and benefits are crucial, the decision on whether to continue or stop medication should be according to the severity of each woman's ADHD symptoms and the needs of the woman.
The authors also advise that even though stopping the medication is an option, it isn't an option to consider due to the high incidence of depression and other mental health issues among women who are pregnant or post-partum. Research has also shown that women who stop taking their medication will have a tough time adjusting to a life without them once the baby is born.
Nursing
It can be a challenge to become a mom. Women who suffer from ADHD who must work through their symptoms while attending physician appointments and getting ready for the arrival of a child and adapting to new routines in the home are often faced with a number of difficulties. This is why many women elect to continue taking their ADHD medications throughout pregnancy.
The majority of stimulant drugs are absorbed by breast milk in small quantities, so the risk for breastfeeding infant is minimal. However, the rate of exposure to medications by the newborn may differ based on dosage, frequency it is administered, and at what time the medication is administered. In addition, various drugs enter the infant's system through the gastrointestinal tract, or through breast milk. how to treat adhd without medication in adults of these medications on a newborn's health is not completely comprehended.
Some doctors may stop taking stimulant medication during a woman's pregnancy due to the absence of research. It is a difficult decision for the mother, who must weigh the advantages of taking her medication as well as the risks to the fetus. 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 period.
A increasing number of studies have revealed that women can continue their ADHD medication during pregnancy and breastfeeding. In response, an increasing number of patients are choosing to do so. They have found, in consultation with their doctor, that the benefits of continuing their current medication far outweigh any risk.
It is essential for women with ADHD who are thinking of breastfeeding to seek out a specialist psychiatrist's guidance prior to becoming pregnant. They should discuss their medication with their prescriber as well as the pros and cons of continuing treatment. This includes non-pharmacological methods. Psychoeducation is also necessary to help pregnant women with ADHD recognize the signs and the underlying disorder. They should also be educated about treatment options and build the coping mechanisms. This should be a multidisciplinary process with the GPs, obstetricians, and psychiatry. Pregnancy counseling should consist of a discussion of a treatment plan for the mother and the child, monitoring of signs of deterioration and, if necessary modifications to the medication regime.