ADHD Medication During Pregnancy and Breastfeeding
The decision to stop or keep ADHD medication during pregnancy and breastfeeding is challenging for women with the condition. Little data exists about how long-term exposure to these drugs could affect the fetus.
A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication during the uterus do not develop neurological disorders like impaired vision or hearing, febrile seizures, or IQ impairment. The authors acknowledge that more high-quality research is needed.
Risk/Benefit Analysis
Pregnant women who use ADHD medications must weigh the advantages of taking them against the potential risks to the fetus. Physicians don't have the information needed to provide clear recommendations, but they can provide information about benefits and risks that can aid pregnant women in making informed choices.
A study published in Molecular Psychiatry concluded that women who took ADHD medication during their early pregnancy were not at a greater risk of fetal malformations or structural birth defects. Researchers used a large population-based case control study to examine the prevalence of major structural defects in infants born to mothers who took stimulants during pregnancy. Clinical geneticists and pediatric cardiologists looked over the cases to ensure accurate case classification and to minimize the possibility of bias.
The study of the researchers had some limitations. The researchers were not able to, in the first place to distinguish the effects caused by the medication from the disorder. This limitation makes it difficult for researchers to determine whether the small associations observed among the exposed groups were due to the use of medication or confounded by comorbidities. The researchers did not examine the long-term effects for the offspring.
The study found 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 use any medication during pregnancy, or had quit taking the 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 were taking stimulant ADHD medication during pregnancy were also at an increased chance of having a caesarean birth or having a baby with an low Apgar score (less than 7). These increases appeared to be unrelated to the type of medication taken during pregnancy.
Researchers suggest that the minor risk of using ADHD medications during early pregnancies may be offset by the more beneficial outcomes for both baby and mother of continued treatment for the woman’s disorder. Physicians should discuss the issue with their patients and, if possible, help them develop strategies for improving their coping skills that may minimize the impact of her disorder on her daily life and relationships.
Medication Interactions
Doctors are increasingly faced with the decision of whether to maintain treatment or stop it during pregnancy as more women are diagnosed with ADHD. These decisions are often taken without clear and authoritative evidence. Instead, doctors must take into account their own experience and experience, as well as the experiences of other doctors and the research on the topic.
The issue of risk to the infant can be difficult to determine. A lot of studies on this issue are based on observational data rather than controlled research and their conclusions are often contradictory. Most studies focus on live births, which can underestimate the severity of teratogenic effects which can cause abortions or terminations of pregnancy. The study that is discussed in the journal club addresses these shortcomings, by examining both information on deceased and live births.
The conclusion: While some studies have found that there is a positive correlation between ADHD medications and the possibility of certain birth defects, other studies have found no connection, and most studies have a neutral or slight negative effect. In all cases, a careful study of the benefits and risks is required.
It can be difficult, if not impossible for women with ADHD to stop taking their medication. In fact, 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 those suffering from the disorder. In addition, a decrease in medication can affect the ability to do job-related tasks and drive safely which are essential aspects of a normal life for many people with ADHD.
She suggests that women who are not sure whether to continue taking the medication or stop due to pregnancy educate family members, colleagues, and their friends about the condition, the impact on daily functioning and the advantages of staying on the current treatment regimen. It can also help a woman feel supported in her decision. Certain medications can be passed through the placenta. If a patient decides to stop taking her ADHD medication while breastfeeding, it is crucial to be aware that the drug could be transferred to the infant.
Risk of here Birth Defects
As the use of ADHD medication to treat the symptoms of attention deficit hyperactivity disorder (ADHD) grows, so do concerns about what impact the medications could have on foetuses. A study that was published in the journal Molecular Psychiatry adds to the body of information on this topic. Using two massive data sets researchers were able analyze more than 4.3 million pregnancies and see whether stimulant medication use increased the risk of birth defects. Although the risk overall is low, the researchers found that exposure in the first trimester to ADHD medications was associated with an increased risk of specific heart defects, like ventriculo-septal defects (VSD).
The researchers of the study could not find any association between the use of early medications and other congenital anomalies like facial deformities, or club feet. The results are in line with previous studies that have shown an insignificant, but small increase in the number of cardiac malformations among women who began taking ADHD medication before the birth of their child. This risk increased during the latter half 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 have caesarean sections, a low Apgar score after delivery and a baby who needed breathing assistance during birth. The authors of the study could not remove bias in selection since they restricted the 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 physicians who see pregnant women. The researchers advise that while discussing risks and benefits are important, the choice on whether to continue or stop medication should be made according to the severity of each woman's ADHD symptoms and her needs.
The authors caution that, although stopping the medication is an option to consider, it is not recommended due to the high prevalence of depression and mental health issues for women who are pregnant or recently gave birth. Furthermore, research suggests that women who decide to stop taking their medication are more likely to experience a difficult time adapting to life without them after the birth of their baby.
Nursing
The responsibilities that come with being a new mother can be overwhelming. Women who suffer from ADHD who have to deal with 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. Many women choose to continue taking their ADHD medication during pregnancy.
The risk for breastfeeding infant is not too high since the majority of stimulant medications is absorbed through breast milk at low levels. The rate of medication exposure will differ based on dosage, frequency of administration and the time of day. In addition, different drugs enter the infant's system through the gastrointestinal tract, or through breast milk. The impact on a newborn's health is not completely comprehended.
Some doctors may decide to stop stimulant medications during a woman's pregnancy due to the absence of research. It is a difficult decision for the mother, who must weigh the benefits of taking her medication as well as the potential risks to the foetus. In the meantime, until more information is available, GPs may ask pregnant patients whether they have a background of ADHD or if they plan to take medication during the perinatal period.
Many studies have shown that women can continue taking their ADHD medication in a safe manner during pregnancy and breast-feeding. In the end, an increasing number of patients opt to do this and after consulting with their doctor, they have found that the benefits of maintaining their current medication far outweigh any potential risks.
Women who suffer from ADHD who are planning to nurse should seek advice from an expert psychiatrist prior to becoming pregnant. They should discuss their medication with their physician and discuss the advantages and disadvantages of continuing treatment, including non-pharmacological strategies. Psychoeducation is also required to help pregnant women with ADHD understand the symptoms and underlying disorder. They should also learn about treatment options and build coping mechanisms. This should involve an approach that is multidisciplinary, including the GP doctors, obstetricians and psychiatrists. The pregnancy counselling should consist of the discussion of a treatment plan for both the mother and child, and monitoring for signs of deterioration, and when necessary, making adjustments to the medication regimen.