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 medications could affect the foetus.
A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus don't develop neurological developmental disorders such as impaired vision or hearing seizures, febrile seizures or IQ impairment. The authors acknowledge the need for higher-quality studies.
Risk/Benefit Analysis
Women who are pregnant and take ADHD medication must consider the benefits of taking it against the potential risks to the foetus. Physicians don't have the data to provide clear 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 used ADHD medications in early pregnancy did not face an increased risk of fetal heart malformations or major birth defects that are structural. Researchers conducted a large population-based case control study to examine the prevalence of structural defects that were major in infants who were born to mothers who were taking stimulants during pregnancy. Pediatric cardiologists, clinical geneticists and other experts examined the cases to ensure that the classification was correct and to reduce any bias.
The research conducted by the researchers had some limitations. The researchers were unable to, in the first place to distinguish the effects of the medication from the disorder. This limitation makes it difficult to determine whether the small associations observed in the exposed groups are due to the use of medication or the confounding effect of comorbidities. In addition, the researchers did not study the long-term effects of offspring on their parents.
The study did reveal that infants whose mothers took ADHD medication during pregnancy were at a slightly more risk of being admitted to the neonatal intensive care unit (NICU) than those who were born without any medication or taken off their medication prior to or during pregnancy. This was due to central nervous system-related disorders and the increased risk for admission was not found to be influenced by the stimulant medication was used during pregnancy.
Women who were taking stimulant ADHD medication during pregnancy were also at an increased chance of having a caesarean section or having a baby with an low Apgar score (less than 7). These increases did not seem to be influenced by the kind of medication used during pregnancy.
The researchers suggest that the low risk associated with the use of ADHD medications during the early stages of pregnancy may be offset by the greater benefits to both the mother and child of continuing treatment for the woman's condition. Physicians should discuss this with their patients and, where they are able, assist them in developing strategies to improve their coping abilities that may minimize the impact of her disorder on her daily life and relationships.
Medication Interactions
Many doctors are faced with the decision of whether to keep treatment or stop it during pregnancy as more women are diagnosed with ADHD. Most of the time, these decisions are taken in the absence of any evidence that is clear and definitive regardless, so doctors must weigh what they know, the experiences of other doctors, and what research suggests about the subject, along with their own best judgment for each patient.
The issue of risk to infants is difficult to determine. The research that has been conducted on this topic is based on observations rather than controlled studies and the results are conflicting. adhd treatment without medication focus on live-births, which could underestimate the severity of teratogenic effects that can lead to terminations or abortions of pregnancy. The study presented in this journal club addresses these limitations by looking at data from both live and deceased births.
Conclusion: While some studies have revealed a positive correlation between ADHD medications and certain birth defects However, other studies haven't shown such a relationship. Most studies show a neutral, or even slight negative effect. Therefore an accurate risk-benefit analysis must be conducted in every situation.
It isn't easy, but not impossible, for women with ADHD to stop taking their medication. In fact, in an article recently published in Archives of Women's Mental Health psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can lead to increased depression, feelings of isolation, and family conflict for those suffering from the disorder. A loss of medication may also affect the ability to drive safely and complete work-related tasks, which are crucial aspects of everyday life for those with ADHD.
She recommends that women who are unsure about whether or not to stop taking medication because of their pregnancy, consider informing family members, friends, and coworkers on the condition, its effects on daily life, and the benefits of keeping the current treatment plan. It can also make the woman feel more comfortable when she is struggling with her decision. It is also worth noting that certain drugs can be absorbed through the placenta so if the patient decides to stop her ADHD medication during pregnancy and breastfeeding, she must be aware of the possibility that traces of the medication could be passed on to the baby.
Risk of Birth Defects
As the use and abuse of ADHD medication to treat symptoms of attention deficit disorder hyperactivity disorder (ADHD), increases, so does concern about the potential effects of these drugs on foetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge on this issue. Researchers utilized two massive data sets to study more than 4.3 million pregnancy and determine whether stimulant medications caused birth defects. While the overall risk is 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 ventriculo-septal defect (VSD).
The researchers of the study found no link between the use of early medications and other congenital abnormalities, such as facial clefting or club foot. The findings are in line with previous studies that have shown a small but significant increase in the risk of cardiac malformations in women who started taking ADHD medications before the time of 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 in the first trimester were more likely to require a caesarean delivery, have an insufficient Apgar after delivery, and have a baby that needed breathing assistance when they were born. The authors of the study were not able to remove bias in selection since they limited their study to women who did not have any other medical conditions that might have contributed to the findings.
The researchers hope their research will help inform the clinical decisions of doctors who encounter pregnant women. The researchers advise that while discussing the risks and benefits are important, the decision on whether to continue or stop medication should be made in light of the severity of each woman's ADHD symptoms and the needs of the woman.
The authors warn that, while stopping the medication is an option to consider, it is not advised due to the high prevalence of depression and other mental disorders in women who are expecting or recently gave birth. Additionally, the research suggests that women who decide to stop taking their medication are more likely to experience difficulties getting used to life without them after the birth of their baby.
Nursing
It can be a stressful experience to become a mom. Women with ADHD who have to deal with their symptoms while attending physician appointments and making preparations for the arrival of their child and adjusting to new household routines can experience severe challenges. Many women opt to continue taking their ADHD medication during pregnancy.
The risk to a breastfeeding infant is not too high since the majority of stimulant medications is absorbed through breast milk at low levels. The amount of exposure to medications can vary depending upon the dosage and frequency of administration as well as the time of day. Additionally, individual medications enter the infant's system differently through the gastrointestinal tract and breast milk, and the effect of this on a newborn isn't yet fully understood.
Some physicians may discontinue stimulant medication during a woman's pregnancy due to the absence of research. This is a difficult decision for the patient, who must weigh the benefits of continuing her medication against the potential risks to the foetus. As long as there is no more information, doctors should inquire with all pregnant patients about their history of ADHD and if they plan or are taking to take medication during the perinatal time.
Numerous studies have demonstrated that women can continue taking their ADHD medication in a safe manner during pregnancy and while breast-feeding. In response, a rising number of patients are choosing to do this. They have discovered, in consultation with their physicians, that the benefits of retaining their current medication outweigh risk.
It is crucial for women suffering from ADHD who are considering breastfeeding to seek out a specialist psychiatrist's advice prior to becoming pregnant. They should review their medications with their physician and discuss the pros and cons of continued treatment, including non-pharmacological management strategies. Psychoeducation should also be provided to help pregnant people with ADHD be aware of their symptoms and the root cause Learn about the available treatment options and strengthen existing coping strategies. This should include a multidisciplinary approach with the GP doctors, obstetricians and psychiatrists. Pregnancy counseling should include 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.