ADHD Medication During Pregnancy and Breastfeeding
Women suffering from ADHD must make a difficult decision on whether to keep or stop taking ADHD medication during pregnancy and breastfeeding. There aren't enough data regarding how exposure over time may affect the foetus.
A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication in utero do not develop neurological disorders such as hearing loss or impaired vision, 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 weigh the benefits of taking it against the possible risks to the fetus. Physicians don't have the data to provide clear recommendations, but can provide information about risks and benefits to aid pregnant women in making an informed decision.
A study published in Molecular Psychiatry concluded that women who were taking ADHD medication during early pregnancy were not at a higher risk of fetal malformations or structural birth defects. Researchers conducted a massive population-based case control study to examine the prevalence of major structural defects in infants born to mothers who took stimulants during pregnancy. Pediatric cardiologists and clinical geneticists reviewed the cases to ensure an accurate classification of the cases and to reduce the possibility of bias.
adhd without medication conducted by the researchers was not without its limitations. In particular, they were unable to separate the effects of the medication from the effects of the disorder that is underlying. This limitation makes it difficult to determine whether the limited associations observed in the groups that were exposed result from medication use or confounding by comorbidities. In addition the researchers did not examine long-term offspring outcomes.
The study did find that infants whose mothers took ADHD medication during pregnancy were at slightly more risk of being admitted to the neonatal intensive care unit (NICU) than those whose mothers had not taken any medication or taken off their medication prior to or during pregnancy. This was due to central nervous system disorders. The higher risk of admission was not affected by the stimulant medication that was used during pregnancy.
Women who were taking stimulant ADHD medication during pregnancy were also at an elevated chance of having a caesarean delivery or having a baby with low Apgar score (less than 7). These risks did not seem to be influenced by the kind of medication used during pregnancy.
Researchers suggest that the minor risk of using ADHD medication during pregnancies in the early stages could be offset by the greater benefits for baby and mother of continued treatment for the woman's disorder. Physicians should discuss the issue with their patients and, where possible, help them develop strategies to improve coping skills that can lessen the negative impact of her condition on her daily life and relationships.
Medication Interactions
More and more doctors are confronted with the dilemma of whether to continue treatment or stop it during pregnancy as more women are diagnosed with ADHD. These decisions are frequently made without clear and reliable evidence. Instead, doctors have to consider their own expertise in conjunction with the experiences of other doctors, and the research on the subject.
In particular, the issue of possible risks to the infant can be difficult. The research on this issue is based on observation rather than controlled studies and many of the findings are contradictory. Most studies restrict their analysis to live births, which can underestimate the severity of teratogenic effects that can lead to abortions or terminations of pregnancy. The study that is discussed in the journal club addresses these issues, by examining both information on deceased and live births.
The conclusion is that while some studies have shown that there is a positive correlation between ADHD medications and the possibility of certain birth defects, other studies have not found any evidence of a link and the majority of studies show a neutral or even slightly negative impact. In each case, a careful evaluation of the potential risks and benefits should be conducted.
For a lot of women with ADHD and ADD, the decision to stop taking medication is difficult, if not impossible. In a recent article published in Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can cause depression and feelings of isolation. Furthermore, a loss of medication can interfere with the ability to do work-related tasks and safely drive which are essential aspects of a normal life for many people with ADHD.
She suggests that women who aren't sure whether to continue taking medication or stop due to pregnancy educate family members, colleagues, and acquaintances about the condition, its effects on daily functioning, and the benefits of keeping the current treatment plan. It will also help a woman feel more confident in her decision. It is important to note that some medications can pass through the placenta, so if a woman decides to stop her ADHD medication during pregnancy and breastfeeding, she should be aware that traces of the drug can be transferred to the infant.
Risk of Birth Defects
As the use and misuse of ADHD medication to treat symptoms of attention deficit disorder 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 existing knowledge about this subject. Utilizing two huge data sets, researchers were able to analyze more than 4.3 million pregnancies and see whether stimulant medications increased the risk of birth defects. Researchers found that while the risk overall is low, the first trimester ADHD medication use was associated with slightly higher rates of specific heart defects like ventriculoseptal defects.
The researchers of the study found no link between early medication use and congenital abnormalities such as facial clefting or club foot. The findings are in line with previous studies showing a small but significant increase in the risk of developing cardiac malformations among women who began taking ADHD medications prior to the birth of their child. This risk increased during the latter part of pregnancy when many women decided to stop taking their medication.
Women who used ADHD medications during the first trimester of pregnancy were also more likely to undergo caesarean sections, a low Apgar score after delivery and a baby who required help breathing at birth. However the authors of the study were unable to eliminate bias due to selection 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 their study will serve to inform the clinical decisions of physicians who see pregnant women. They advise that while a discussion of the risks and benefits is crucial, the decision to stop or keep medication should be based on each woman's needs and the severity of her ADHD symptoms.
The authors warn that, even though stopping the medication is an option to look into, it is not recommended due to the high prevalence of depression and other mental disorders among women who are pregnant or recently gave birth. Further, research shows that women who stop taking their medications will have a tough transitioning to life without them after the baby is born.
Nursing
It can be a stressful experience to become a mom. Women with ADHD may face a lot of challenges when they must manage their symptoms, attend doctor appointments, prepare for the birth of a baby and adjust to a new routine. As such, many women decide to continue taking their ADHD medications throughout the course of pregnancy.
The majority of stimulant medicines pass through breast milk in very small amounts, so the risk to infant who is breastfeeding is low. However, the frequency of exposure to medications by the newborn may differ based on the dosage, frequency it is administered, and the time of 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 the health of a newborn isn't fully understood.
adhd depression medication may decide to stop stimulant medications during a woman's pregnancy due to the lack of research. It's a difficult choice for the woman who must weigh the advantages of taking her medication as well as the risks to the fetus. As long as there is no more information, doctors should ask all pregnant patients about their history of ADHD and whether they are planning or taking to take medication during the perinatal period.
Numerous studies have proven that women can continue taking their ADHD medication in a safe manner while breastfeeding and during pregnancy. This has led to many patients are choosing to do so and, in consultation with their physician, they have discovered that the benefits of continuing their current medication far exceed any risk.
It is crucial for women suffering from ADHD who are thinking of breastfeeding to seek a specialist psychiatrist's advice prior becoming pregnant. They should discuss their medication with their prescriber as well as the pros and cons for continuing treatment. This includes non-pharmacological strategies. Psychoeducation should also be offered to help pregnant people with ADHD be aware of their symptoms and the underlying disorder Learn about the available treatment options and reinforce existing strategies for managing. This should involve an approach that is multidisciplinary, including the GP, obstetricians and psychiatry. The pregnancy counselling should consist of discussion of a management plan for both mother and child, monitoring for signs of deterioration, and the need for adjustments to the medication regimen.