ADHD Medication During Pregnancy and Breastfeeding
Women with ADHD face a difficult decision on whether to keep or stop taking ADHD medication during pregnancy and breastfeeding. There isn't much information on how long-term exposure to these drugs may affect the foetus.
A study recently 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 more high-quality studies are required.
Risk/Benefit Analysis
Pregnant women who use ADHD medications need to balance the advantages of taking them against the potential risks to the fetus. Doctors don't have enough data to make unambiguous recommendations, but can provide information on risks and benefits to help pregnant women make informed choices.
A study published in Molecular Psychiatry concluded that women who were taking ADHD medication in early pregnancy did not have a greater risk of fetal malformations or structural birth defects. Researchers conducted a large population-based study of case-control to determine the prevalence of major structural birth defects in infants born to mothers who had taken stimulants during the early stages of pregnancy and those who had not. Pediatric cardiologists, clinical geneticists and other experts examined the cases to ensure that the classification was correct and to reduce any bias.
However, the study was not without its flaws. In particular, they were unable to distinguish the effects of the medication from those of the underlying disorder. This makes it difficult to know whether the small differences observed in the exposed groups result from medication use or the confounding effect of comorbidities. Additionally the study did not examine the long-term outcomes of offspring.
The study showed that infants whose mother had taken ADHD medication during pregnancy had a slightly higher risk of admission to the neonatal care unit (NICU), compared to those whose mothers did not take any medication during pregnancy, or had discontinued taking their medication prior to or during pregnancy. The reason for this was central nervous system disorders. The increased risk of admission was not influenced by the stimulant medications used during pregnancy.
Women who used stimulant ADHD medication during pregnancy were also at an elevated risk of having a caesarean delivery or having a baby born with a low Apgar score (less than 7). These risks did not appear to be affected by the type of medication that was used during pregnancy.
The researchers suggest that the small risk associated with the use of ADHD medications during early pregnancy could be offset by the greater benefits to both the mother and child from continued treatment for the woman's disorder. Doctors should discuss with their patients about this issue and try to help them improve coping skills which can lessen the impact of her disorder in her daily life and relationships.
Medication Interactions
Many doctors are faced with the decision of whether to maintain treatment or stop during pregnancy as more women are diagnosed with ADHD. These decisions are often made without clear and authoritative evidence. Instead, doctors must take into account their own experience, the experience of other doctors and the research on the subject.
Particularly, the subject of possible risks to the infant can be difficult. A lot of studies on this issue are based on observational evidence instead of controlled research and their findings are often contradictory. The majority of studies restrict their analysis to live births, which can underestimate the teratogenic impact which can cause terminations or abortions of 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 is that while some studies have found an association between ADHD medications and the risk of certain birth defects, other studies have found no connection, and most studies show a neutral or even slightly negative effect. In every case an in-depth study of the benefits and risks is required.
It can be challenging, if not impossible for women with ADHD to stop taking their medication. In an article published in 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 patients with ADHD. A loss of medication may also affect the ability to safely drive and complete work-related tasks, which are crucial aspects of everyday life for people with ADHD.
She suggests that women who aren't sure whether to continue taking medication or discontinue it due to pregnancy should educate family members, colleagues, and their friends about the condition, the effects on daily functioning, and the benefits of continuing the current treatment. In addition, educating them can make the woman feel more comfortable as she struggles with her decision. Certain medications can be passed through the placenta. If a woman decides not to take her ADHD medication while pregnant and breastfeeding, it is crucial to be aware that the medication could be transferred to the baby.
Birth Defects and Risk of
As the use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases, so do concerns about what impact the medications could have on fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge on this topic. Using two massive data sets, researchers were able to examine more than 4.3 million pregnancies and determine whether stimulant medications increased the risk of birth defects. Although the risk overall remains low, the researchers did find that first-trimester exposure to ADHD medications was linked to a slightly higher rate of certain heart defects, such as ventriculoseptal defect (VSD).
The researchers of the study did not find any association between the use of early medications and other congenital anomalies such as facial deformities or club feet. The results are in line with previous studies that have shown an increase, but not significant, in the risk of heart malformations among women who began taking ADHD medications before pregnancy. This risk increased during the latter stages of pregnancy when a large number of women decided to stop taking their medication.
Women who were taking ADHD medication during the first trimester were more likely to need a caesarean and also have an insufficient Apgar after birth and have a baby who needed help breathing at birth. However the authors of the study were not able to eliminate bias due to selection by limiting the study to women who didn't have any other medical issues that could have contributed to these findings.
Researchers hope that their research will provide doctors with information when they encounter pregnant women. They advise that while discussing the risks and benefits is crucial however, the decision to stop or maintain treatment must be based on each woman's requirements and the severity of her ADHD symptoms.
The authors also warn that while discontinuing the medications is an alternative, it is not a recommended practice because of the high rate of depression and other mental health issues for women who are expecting or post-partum. Furthermore, research suggests that women who choose to stop taking their medication are more likely to have difficulties getting used to life without them after the baby's arrival.
Nursing
It can be overwhelming becoming a mother. Women with ADHD are often faced with a number of difficulties when they must manage their symptoms, attend 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 majority of stimulant medicines are absorbed through breast milk in low amounts, therefore the risk for infant who is breastfeeding is low. However, the frequency of exposure to medication by the newborn can vary depending on dosage, how often it is administered and the time of day the medication is administered. Additionally, different medications enter the body of the baby differently through the gastrointestinal tract and breast milk, and the effect of this on a newborn infant is not yet fully understood.
Some doctors may stop taking stimulant medication during a woman's pregnancy due to the lack of research. This is a difficult decision for the woman, who must weigh the advantages of continuing her medication against the potential risks to the fetus. In the meantime, until more information is available, doctors should inquire with all pregnant patients about their experience with ADHD and whether they are taking or planning to take medication during the perinatal period.
Many studies have shown that women can continue taking their ADHD medication without risk during pregnancy and while breast-feeding. In response, an increasing number of patients are choosing to do this. They have concluded through consultation with their physicians, that the benefits of keeping their current medication outweigh potential risks.
Women with ADHD who plan to breastfeed should seek the advice of a specialist psychiatrist before becoming pregnant. They should review their medications with their doctor and discuss the pros and cons of continued treatment, including non-pharmacological strategies. Psychoeducation should also be offered to help pregnant people with ADHD recognize their symptoms and underlying disorder and learn about treatments and to reinforce existing strategies for coping. This should be a multidisciplinary effort including obstetricians, GPs and psychiatrists. adhd treatment without medication should include discussion of a treatment plan for the mother and the child, and monitoring for signs of deterioration, and, if necessary, adjustments to the medication regime.