ADHD Medication During Pregnancy and Breastfeeding
Women with ADHD must make a difficult decision on whether to keep or stop taking ADHD medication during pregnancy and breast-feeding. There is a lack of information about how long-term exposure to these drugs may affect the foetus.
A recent study published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological problems such as impaired hearing or vision, 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 benefits of using them against the risks to the foetus. Physicians don't have the data to give clear advice however they can provide information on risks and benefits to aid pregnant women in making informed decisions.
A study published in Molecular Psychiatry found that women who used ADHD medications during their early pregnancy did not face a significantly higher risk of fetal cardiac malformations or major birth defects that are structural. Researchers used a vast, population-based case-control study to evaluate the incidence of major structural birth defects in babies born to mothers who took stimulants during the early stages of pregnancy, and those who did not. Pediatric cardiologists and clinical geneticists examined 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 researchers were unable, in the first place to distinguish the effects caused by the medication from the disorder. This limitation makes it difficult for researchers to establish whether the small differences observed between the exposed groups were due to the use of medication or caused by comorbidities. In addition the researchers did not examine the long-term outcomes of offspring.
The study revealed that infants whose mother had taken 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 discontinued taking their medication prior to or during pregnancy. This increase was due to central nervous system disorders, and the increased risk of admission was not found to be influenced by the stimulant medications were used during pregnancy.
Women who took stimulant ADHD medications during pregnancy also had a higher risk of having to have a caesarean section or the baby was not scoring well on the Apgar scale (less than 7). These increases appear to be unrelated to the type of medication used during pregnancy.
Researchers suggest that the minor risk of using 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 disorder. Physicians should discuss the issue with their patients and, where possible, help them develop strategies for improving their coping skills that can lessen the negative impact of her condition on her daily life and relationships.
Medication Interactions
As more women than ever are diagnosed with ADHD and being treated with medication, the dilemma of whether or not to stop treatment during pregnancy is one that more and more doctors face. These decisions are often taken without clear and authoritative evidence. Instead, doctors must take into account their own experience in conjunction with the experiences of other doctors and the research that has been conducted on the subject.
The issue of risk to the infant can be difficult to determine. A lot of studies on this topic are based on observational data rather than controlled research, and their findings are often contradictory. Most studies restrict their analysis to live-births, which could underestimate the teratogenic impact leading to abortions or terminations of pregnancy. The study that is discussed in this journal club addresses these shortcomings by analyzing data on live and deceased births.
Conclusion: While some studies have found an association between ADHD medications and certain birth defects However, other studies haven't found a correlation. Most studies have shown an unintended, or somewhat negative, effect. Therefore an accurate risk-benefit analysis is required in every situation.
best adhd medication for adults uk can be challenging, if not impossible, for women suffering from ADHD to stop taking their medication. 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 cause depression, feelings of loneliness and family conflict for those suffering from the disorder. The loss of medication can also impact the ability to safely drive and to perform work-related tasks which are crucial aspects of daily life for people with ADHD.
She recommends women who are uncertain about whether to continue or discontinue medication due to their pregnancy should consider the possibility of educating friends, family members, and coworkers on the condition, its impact on daily life, and the benefits of keeping the current treatment plan. Educating them can also aid in ensuring that the woman feels supported in her struggle with her decision. Certain medications can pass through the placenta. If a patient decides not to take her ADHD medication while pregnant and breastfeeding, it is crucial to be aware that the medication may be transferred to her infant.
Risk of Birth Defects
As the use and misuse of ADHD medications to treat the symptoms of attention deficit hyperactivity disorder (ADHD) is increasing as does the 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 subject. Researchers utilized two massive datasets to analyze over 4.3 million pregnant women and determine if the use of stimulant medications caused birth defects. Researchers found that while the overall risk is low, first-trimester ADHD medication use was associated with slightly higher risk of specific heart defects such as ventriculoseptal defect.
The researchers of the study could not discover any connection between early medication usage and other congenital anomalies, like facial deformities, or club feet. The results 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 before the time of pregnancy. This risk increased during the latter half of pregnancy when a large number of women stopped taking their medication.
Women who took ADHD medications in the first trimester of their pregnancy were also more likely to have a caesarean section, a low Apgar score after delivery and a baby who required help breathing at birth. However the authors of the study were unable to eliminate bias due to selection by limiting the study to women who did not have any other medical issues that could be a contributing factor to these findings.
Researchers hope that their study will inform physicians when they meet pregnant women. They recommend that, while a discussion of the benefits and risks is important however, the decision to stop or keep treatment should be based on each woman's requirements and the severity of her ADHD symptoms.
The authors warn that, although stopping the medication is a possibility to look into, it is not advised because of the high incidence of depression and mental health issues in women who are expecting or have recently given birth. Additionally, research suggests that women who stop taking their medications will have a tough adjustment to life without them after the baby is born.
Nursing
The responsibilities of being a new mom can be overwhelming. Women with ADHD who must work through their symptoms while attending doctor appointments, making preparations for the arrival of a child and adjusting to new household routines are often faced with a number of difficulties. Many women decide to continue taking their ADHD medication during pregnancy.
The risk to breastfeeding infant is not too high since the majority of stimulant medications passes through breast milk at low levels. The amount of exposure to medications will vary based on the dosage the medication is administered, its frequency and the time of day. Additionally, different medications enter the infant's system differently through the gastrointestinal tract as well as breast milk and the impact of this on a newborn is not fully known.
Some doctors may stop taking stimulant medication during a woman's pregnancy due to the lack of research. This is a difficult decision for the woman who must weigh the advantages of taking her medication as well as the risks to the embryo. As long as there is no more information, doctors should inquire with all pregnant patients about their experience with ADHD and if they are planning or taking to take medication during the perinatal time.
Numerous studies have proven that women can continue to take their ADHD medication without risk during pregnancy and while breast-feeding. In response, a rising number of patients are choosing to continue their medication. They have concluded through consultation with their doctors, that the benefits of retaining their current medication outweigh any potential risks.
It is crucial for women suffering from ADHD who are thinking of breastfeeding to seek a specialist psychiatrist's guidance prior to becoming pregnant. They should discuss their medication with their prescriber and discuss the pros and cons for continuing treatment. This includes non-pharmacological strategies. Psychoeducation should also be provided to help pregnant people with ADHD be aware of their symptoms and the underlying disorder, learn about available treatments and to reinforce existing strategies for coping. This should be a multidisciplinary approach including obstetricians, GPs, and psychiatry. Counselling for pregnancy should include discussion of a management plan for both mother and child, monitoring for signs of deterioration and the need for adjustments to the medication regimen.