ADHD Medication During Pregnancy and Breastfeeding
Women suffering from ADHD must make a difficult decision regarding whether or not to stop taking ADHD medication during pregnancy and breast-feeding. There are few data on how long-term exposure may affect a pregnant fetus.
A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication during the uterus do not develop neurological developmental disorders such as hearing loss or impaired vision seizures, febrile seizures or IQ impairment. The authors acknowledge the need for more high-quality research.
Risk/Benefit Analysis
Pregnant women who use ADHD medications need to balance the advantages of taking them against potential risks to the fetus. Physicians don't have the data to make unambiguous recommendations, but can provide information on the risks and benefits to assist pregnant women to make an informed decision.
A study published in Molecular Psychiatry concluded that women who were taking ADHD medication in early pregnancy were not at a greater risk of fetal malformations or structural birth defects. Researchers conducted a large population-based case control study to assess the frequency of major structural defects in infants who were born to mothers who took stimulants during pregnancy. Clinical geneticists and pediatric cardiologists examined the cases to ensure accurate case classification and to limit the possibility of bias.
However, the researchers' study was not without its flaws. Most important, they were unable to separate the effects of the medication from the underlying disorder. This limitation makes it difficult to know whether the small associations observed in the exposed groups result from medication use or the confounding effect of comorbidities. The researchers did not study the long-term effects for the offspring.
The study revealed that babies whose mothers had taken ADHD medication during pregnancy were at a slightly higher risk of admission to the neonatal care unit (NICU) in comparison to mothers who did not take any medication during pregnancy or stopped taking their medication before or during pregnancy. This was due to central nervous system disorders, and the increased risk of admission did not appear to be affected by the type of stimulant medication was used during pregnancy.
Women who used stimulant ADHD medication during pregnancy were also at an elevated risk of having a caesarean birth or having a baby with a 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 risk of a small amount with the use of ADHD medications during the early stages of pregnancy may be offset by the greater benefits to both mother and child of continuing treatment for the woman's disorder. Physicians should discuss the issue with their patients and, when possible, assist them in developing strategies to improve coping skills that may minimize the negative impact of her condition on her daily functioning and relationships.
Medication Interactions
Doctors are increasingly confronted with the dilemma of whether to maintain treatment or stop during pregnancy as more women are diagnosed with ADHD. Most of the time, these decisions are taken 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 research suggests on the subject and their own judgments for each individual patient.
Particularly, the subject of possible risks to the baby can be tricky. Many of the studies on this issue are based on observational data rather than controlled research and their findings are often contradictory. The majority of studies limit their analysis to live births, which may underestimate the teratogenic impact that can lead to abortions or terminations of pregnancy. The study presented in this journal club addresses these issues by looking at data from both live and deceased births.
The conclusion is that while certain studies have demonstrated a positive association between ADHD medications and the risk of certain birth defects, other studies have found no connection and the majority of studies demonstrate a neutral or slightly negative effect. As a result, a careful risk/benefit assessment must be conducted in every situation.
For many women with ADHD who suffer from ADHD, the decision to stop taking medication is difficult, if not impossible. In fact, in an article published in the Archives of Women's Mental Health psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can increase depression, feelings of isolation and family conflict for patients with ADHD. A loss of medication may also affect the ability to drive safely and to perform work-related tasks which are essential aspects of everyday life for those suffering from ADHD.
She suggests that women who are not sure whether to take the medication or stop due to pregnancy educate family members, coworkers and friends about the condition, its impact on daily functioning and the benefits of keeping the current treatment regimen. It can also help a woman feel supported in her decision. It is also worth noting that certain medications are able to pass through the placenta, so if the patient decides to stop taking her ADHD medication during pregnancy and breastfeeding, she should be aware that traces of the drug could be transferred to the infant.
Birth Defects Risk
As the use and use of ADHD medications to treat the symptoms of attention deficit hyperactivity disorder (ADHD), increases, so does concern about the possible effects of the drugs on foetuses. A study that was published in the journal Molecular Psychiatry adds to the body of knowledge on this subject. With two massive data sets researchers were able examine more than 4.3 million pregnancies and see whether stimulant medications increased the risk of birth defects. Researchers discovered that although the risk overall is low, first-trimester ADHD medication exposure was associated with slightly higher risk of certain heart defects, like ventriculoseptal defects.
The researchers of the study didn't find any association between early medication usage and other congenital anomalies like facial deformities, or club feet. The findings are in line with previous studies revealing an increase, but not significant, in the risk of developing cardiac malformations in women who started taking ADHD medications prior to more info the birth of their child. This risk increased in the later part of pregnancy, when many women are forced to stop taking their medication.
Women who were taking ADHD medication during the first trimester were more likely to need a caesarean or have a low Apgar after birth and had a baby that required help breathing at birth. The authors of the study were unable to remove bias in selection since 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 aid in the clinical decisions of physicians who see pregnant women. The researchers suggest that while discussing the risks and benefits are important, the decision on whether to continue or stop taking medication should be according to the severity of each woman's ADHD symptoms and her needs.
The authors also caution that even though stopping the medication is an option, it isn't a recommended practice because of the high rate of depression and other mental health issues among women who are pregnant or who are recently postpartum. Further, the research suggests that women who choose to stop their medications are more likely to experience difficulties adapting to life without them after the birth of their baby.
Nursing
The responsibilities of a new mother can be overwhelming. Women who suffer from ADHD who have to manage their symptoms while attending doctor appointments and preparing for the arrival of their child and adjusting to new household routines are often faced with a number of difficulties. As such, many women decide to continue taking their ADHD medications throughout the course of pregnancy.
The majority of stimulant medicines are absorbed through breast milk in small amounts, therefore the risk to the breastfeeding infant is minimal. However, the amount of medication exposure to the newborn may differ based on dosage, how often it is administered and the time of the day it is administered. In addition, various 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 completely known.
Some physicians may discontinue stimulant medication during a woman’s pregnancy due to the absence of research. This is a complicated decision for the patient, who must weigh the benefit of continuing her medication against the potential risks to the fetus. Until more information becomes available, GPs can ask pregnant patients if they have any history of ADHD or if they intend to take medication during the perinatal period.
A increasing number of studies have shown that most women can safely continue taking their ADHD medication during pregnancy and breastfeeding. In the end, more and more patients choose to do so and, in consultation with their physician, they have discovered that the benefits of keeping their current medication far outweigh any risks.
Women who suffer from ADHD who plan to breastfeed should seek advice from a specialist psychiatrist before becoming pregnant. They should discuss their medication with their prescriber and discuss the advantages and disadvantages of continued treatment, including non-pharmacological strategies. Psychoeducation should also be provided to help pregnant women suffering from ADHD understand their symptoms and the root cause, learn about available treatments and to reinforce existing strategies for managing. This should be a multidisciplinary effort including obstetricians, GPs and psychiatrists. Pregnancy counseling should consist of a discussion of a treatment plan for the mother and the child, as well as monitoring for signs of deterioration, and, if necessary, adjustments to the medication regimen.