ADHD Medication During Pregnancy and Breastfeeding
Women suffering from ADHD face a difficult decision about whether to continue or stop taking ADHD medication during pregnancy and breast-feeding. Little data exists about how long-term exposure to these drugs may affect the fetus.
A recent study published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological disorders such as impaired hearing or vision, febrile seizures, or IQ impairment. The authors acknowledge the need for higher-quality research.
Risk/Benefit Analysis
Pregnant women who take ADHD medications need to balance the benefits of taking them against the potential risks to the fetus. Physicians don't have the data to give clear advice however they can provide information on the risks and benefits to assist pregnant women to make informed choices.
A study published in Molecular Psychiatry concluded that women who took ADHD medication during early pregnancy were not at a greater risk of fetal malformations, or structural birth defects. Researchers used a vast, population-based case-control study to determine the prevalence of major structural birth defects in infants born to mothers who had taken stimulants during the early stages of pregnancy, and those who did not. Pediatric cardiologists and clinical geneticists examined the cases to ensure an accurate classification of the cases and to reduce the possibility of bias.
However, the researchers' study had its limitations. Researchers were unable to, in the first place, to separate the effects of the medication from the disorder. That limitation makes it difficult to determine whether the limited associations observed in the groups that were exposed are due to the use of medication or the confounding effect of comorbidities. Researchers also did not look at the long-term effects for the offspring.
The study did reveal that infants whose mothers had taken ADHD medications during pregnancy were at slightly more risk of being admitted to the neonatal intensive care unit (NICU) than those who were born without any medication or had stopped their medications before or during pregnancy. This increase was caused by central nervous system disorders. The higher risk of admission was not influenced by the stimulant medications used during pregnancy.
Women who took stimulant ADHD medication during pregnancy also had an elevated risk of having a caesarean birth or having a baby born with a low Apgar score (less than 7). These increases did appear to be unrelated to the type 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 to both baby and mother of continued treatment for the woman’s disorder. Physicians should talk to their patients about this issue and as much as possible, assist them develop coping skills that may reduce the effects of her disorder on her daily functioning and her relationships.
Medication Interactions
As more women than ever are being diagnosed with ADHD and being treated with medication, the question of whether or not to stop treatment during pregnancy is a question that doctors are having to have to face. Often, these decisions are made in the absence of any evidence that is clear and definitive in either case, which means that doctors must weigh their knowledge, the experiences of other doctors, and what the research suggests on the subject and their own judgments for each individual patient.
Particularly, the subject of potential risks for the baby can be tricky. The research on this subject is based on observations rather than controlled studies, and the results are contradictory. The majority of studies limit their analysis to live births, which can underestimate the teratogenic impact that can lead to terminations or abortions of pregnancy. The study discussed in this journal club addresses these limitations by analyzing data on live and deceased births.
Conclusion: While some studies have revealed an association between ADHD medications and certain birth defects, other studies have not found a correlation. Most studies show that there is a neutral, or somewhat negative, effect. In all cases it is imperative to conduct a thorough study of the benefits and risks is required.
It isn't easy, but not impossible, for women with 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 being isolated. A loss of medication may also affect the ability to safely drive and complete work-related tasks, which are vital aspects of daily life for those suffering from ADHD.
She recommends women who are uncertain about whether to continue or stop taking medication because of their pregnancy consider the possibility of educating friends, family members and colleagues about the condition, its impact on daily functioning, and on the advantages of continuing the current treatment regimen. Educating them can also help the woman feel supported in her struggle with her decision. It is important to note that certain medications can pass through the placenta, so if a woman decides to stop taking her ADHD medication during pregnancy and breastfeeding, she must be aware of the possibility that traces of the medication could be transferred to the child.
Birth Defects and Risk of
As the use and abuse of ADHD medications to treat the symptoms of attention deficit hyperactivity disorder (ADHD), increases as does the check here concern about the possible effects of the drugs on the fetuses. A study that was published in the journal Molecular Psychiatry adds to the body of knowledge on this subject. Researchers utilized two massive datasets to analyze more than 4.3 million pregnant women and determine if the use of stimulant medications increased the risk of birth defects. Researchers found that while the risk overall is low, first-trimester ADHD exposure to medication was associated with slightly higher rates of specific heart defects like ventriculoseptal defect.
The authors of the study did not find any association between early medication usage and congenital anomalies like facial deformities, or club feet. The results are in agreement with previous studies that showed the existence of a slight, but significant increase in the number of cardiac malformations among women who started taking ADHD medication prior to the time of pregnancy. The risk increased in the latter half of pregnancy when many women stopped taking their medication.
Women who were taking ADHD medication during the first trimester were more likely need a caesarean or have an insufficient Apgar after delivery and have a baby that needed breathing assistance when they were born. However, the authors of the study were unable to eliminate bias due to selection by restricting the study to women who didn't have other medical issues that could have contributed to these findings.
Researchers hope their research will help doctors when they see pregnant women. They recommend that, while the discussion of the benefits and risks is important however, the decision to stop or maintain treatment must be based on each woman's needs and the severity of her ADHD symptoms.
The authors caution that, although stopping the medication is an option to think about, it isn't advised due to the high prevalence of depression and other mental disorders for women who are pregnant or have recently given birth. Further, the research suggests that women who choose to stop their medications are more likely to have difficulties adjusting to life without them following the baby's arrival.
Nursing
The responsibilities that come with being a new mom can be overwhelming. Women who suffer from ADHD who have to manage their symptoms while attending doctor appointments and preparing for the arrival of a baby and getting used to new routines at home may face a lot of challenges. As such, many women elect to continue taking their ADHD medication throughout the pregnancy.
The risk to a breastfeeding infant is not too high since the majority of stimulant medications passes through breast milk in low amounts. However, the rate of exposure to medication by the newborn can vary depending on dosage, how often it is taken and at what time it is administered. Additionally, different medications enter the body of the baby differently through the gastrointestinal tract and breast milk, and the effect of this on a newborn isn't fully known.
Due to the absence of research, some doctors may be inclined to discontinue stimulant drugs during the pregnancy of a woman. This is a complicated decision for the patient, who must balance the benefits of keeping her medication against the potential dangers to the embryo. Until more information is available, doctors should ask all pregnant patients about their experience with ADHD and whether they are taking or planning to take medication during the perinatal time.
A increasing number of studies have proven that the majority of women are able to safely continue their ADHD medication during pregnancy and breastfeeding. This has led to an increasing number of patients opt to do this, and in consultation with their doctor they have found that the benefits of continuing their current medication outweigh any potential risks.
Women who suffer from ADHD who are planning to nurse should seek advice from a specialist psychiatrist prior to becoming pregnant. They should discuss the medication they are taking with their physician, and the pros and cons of continuing treatment. This includes non-pharmacological strategies. Psychoeducation should also be offered to help pregnant women suffering from ADHD recognize their symptoms and underlying disorder and learn about treatments and to reinforce existing strategies for managing. This should include a multidisciplinary approach with the GP doctors, obstetricians and psychiatrists. Counselling for pregnancy should include discussion of a management plan for both the mother and child, monitoring for signs of deterioration, and, if necessary, adjustments to the medication regimen.