ADHD Medication During Pregnancy and Breastfeeding
The choice of whether to stop or continue ADHD medications during breastfeeding and pregnancy is a challenge for women suffering from the condition. Little data exists about how long-term exposure to these medications may affect the fetus.
A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication during the uterus do not develop neurological developmental disorders such as impaired vision or hearing seizures, febrile seizures, or IQ impairment. The authors acknowledge that more high quality research is needed.
Risk/Benefit Analysis
Women who are expecting and taking ADHD medication must consider the benefits of taking it against the potential dangers for the baby. Physicians do not have the information needed to provide clear recommendations but they can provide information about benefits and risks that can assist pregnant women in making informed choices.
A study published in Molecular Psychiatry concluded that women who took ADHD medication during their early pregnancy did not have a higher risk of fetal malformations or structural birth defects. The researchers used a large population-based case-control study to assess the risk of major structural birth defects in infants born to mothers who took stimulants during the early stages of pregnancy and those who had not. Pediatric cardiologists and clinical geneticists reviewed the cases to ensure correct case classification and to minimize the possibility of bias.
The study conducted by the researchers was not without its limitations. The most important issue was that they were unable to separate the effects of the medication from the effects of the disorder at hand. This makes it difficult for researchers to establish whether the small associations observed among the groups exposed were due to medication use, or if they were confounded by the presence of comorbidities. Additionally the study did not study long-term offspring outcomes.
The study found that infants whose mother took ADHD medication during pregnancy had a slightly higher chance of being admitted to the neonatal care unit (NICU) as compared to mothers who didn't take any medication during pregnancy or had stopped taking their medication before or during pregnancy. This was due to central nervous system disorders. The higher risk of admission was not influenced by the stimulant medication used during pregnancy.
Women who were taking stimulant ADHD medications during pregnancy also had a higher likelihood of having to have a caesarean section or a baby that scored low on the Apgar scale (less than 7). These risks did not appear to be affected by the kind of medication used during pregnancy.
Researchers suggest that the minor risks posed by the use of ADHD medications in early pregnancies could be offset by the more beneficial outcomes for both baby and mother of continued treatment for the woman's condition. Physicians should talk to their patients about this and try to help them improve coping skills which may reduce the impact of her disorder in her daily functioning and her relationships.
Medication Interactions
More and more doctors are faced with the decision of whether to maintain treatment or stop it during pregnancy as more women are diagnosed with ADHD. The majority of these decisions are taken in the absence of clear and authoritative evidence either way, so physicians have to weigh their experience, the experiences of other doctors, and what research suggests about the subject as well as their best judgment for each individual patient.
Particularly, medication for adhd of possible risks to the baby can be tricky. The research on this subject is based on observations rather than controlled studies and a lot of the results are conflicting. Additionally, the majority of studies limit their analysis to live births, which can undervalue the serious teratogenic effects that can result in abortion or termination of the pregnancy. The study discussed in this journal club addresses these limitations by analyzing data on live and deceased births.
Conclusion 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 that there is a neutral, or slight negative impact. In each case, a careful evaluation of the benefits and risks must be performed.
It can be challenging, if not impossible for women suffering from ADHD to stop taking their medication. In a recent piece 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. A loss of medication may also impact the ability to safely drive and perform work-related tasks, which are crucial aspects of normal life for people with ADHD.
She suggests that women who are unsure whether to continue taking the 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 plan. It can also make the woman feel more comfortable when she is struggling with her decision. Certain medications can pass through the placenta. If the patient decides to not take her ADHD medication while pregnant and breastfeeding, it's important to be aware that the drug may be transferred to her baby.
Birth Defects and Risk of
As the use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) grows as do concerns about the effects that the drugs could have on the fetuses. A recent study published in the journal Molecular Psychiatry adds to the existing information on this topic. With two massive data sets researchers were able to analyze more than 4.3 million pregnancies and determine whether stimulant medications increased the risk of birth defects. Although the risk overall remains low, the scientists discovered that the first-trimester exposure to ADHD medications was associated with a slightly higher rate of certain heart defects, such as ventriculo-septal defect (VSD).
The authors of the study didn't find any association between the use of early medications and congenital anomalies like facial deformities, or club feet. The findings are in line with previous studies showing the presence of a small, but significant increase in the risk of developing cardiac malformations in women who started taking ADHD medications prior to the time of pregnancy. The risk increased in the latter part of pregnancy when a large number of women stopped taking their medication.
Women who took ADHD medication during the first trimester were more likely to need a caesarean or have an insufficient Apgar after delivery, and have a baby who needed breathing assistance at birth. The authors of the study could not eliminate bias due to selection because 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 benefits and risks are important, the choice about whether to continue or stop taking medication should be in light of the severity of each woman's ADHD symptoms and her needs.
The authors warn that, although stopping the medication is a possibility to think about, it isn't advised due to the high prevalence of depression and other mental problems among women who are pregnant or have recently given birth. Furthermore, research suggests that women who choose to stop taking their medications are more likely to have a difficult time adapting to life without them following the birth of their baby.
Nursing
The responsibilities that come with being a new mother can be overwhelming. Women who suffer from ADHD who must work through their symptoms while attending doctor appointments and getting ready for the arrival of a baby and getting used to new routines at home can experience severe challenges. Therefore, many women choose to continue taking their ADHD medication throughout the pregnancy.
The risk to a breastfeeding infant is not too high since the majority of stimulant medication passes through breast milk at low levels. The amount of exposure to medications can vary depending upon the dosage, frequency of administration and the time of day. Additionally, individual medications enter the infant's system differently through the gastrointestinal tract as well as breast milk. The impact of this on a newborn infant is not fully understood.
Some doctors may decide to stop stimulant medication 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 her medication against the risk to the foetus. Until more information becomes available, GPs can ask pregnant patients whether they have a history of ADHD or if they plan to take medication during the perinatal stage.
Many studies have shown that women can continue taking their ADHD medication in a safe manner during pregnancy and breast-feeding. In response, an increasing number of patients are opting to continue their medication. They have discovered, in consultation with their physicians that the benefits of continuing their current medication far outweigh any risk.
Women with ADHD who plan to breastfeed should seek advice from an expert psychiatrist prior to becoming pregnant. They should discuss the medication they are taking with their physician, and the pros and cons for continuing treatment. This includes non-pharmacological methods. Psychoeducation should also be provided to help pregnant women suffering from ADHD understand their symptoms and underlying disorder, learn about available treatment options and strengthen existing strategies for managing. This should be a multidisciplinary process together with obstetricians, GPs, and psychiatrists. Pregnancy counseling should include a discussion of a treatment plan for the mother and child, as well as monitoring for signs of deterioration and, if needed, adjustments to the medication regime.