ADHD Medication During Pregnancy and Breastfeeding
Women with ADHD face a difficult decision about whether to continue or stop taking ADHD medication during pregnancy and breast-feeding. There aren't many studies on how exposure to ADHD for a long time could affect a pregnant fetus.
A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication during utero do not develop neurological conditions like hearing loss or impaired vision seizures, febrile seizures or IQ impairment. The authors acknowledge that further high-quality studies are required.
Risk/Benefit Analysis
Women who are pregnant and take ADHD medication need to weigh the benefits of taking it versus the risks to the fetus. Doctors don't have the data needed to give clear guidelines, but they can provide information regarding risks and benefits that assist 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 an higher risk of fetal cardiac malformations or major structural birth defects. The researchers used a large population-based study of case-control to determine the prevalence of major structural birth defects in infants born to mothers who took stimulants during the early stages of pregnancy and those who had not. Clinical geneticists, pediatric cardiologists and other experts reviewed the cases in order to ensure that the classification was correct and to reduce any bias.
However, the study was not without its flaws. In particular, they were unable to separate the effects of the medication from the disorder that is underlying. This limitation makes it difficult to determine whether the small differences observed in the groups that were exposed result from medication use or the confounding effect of comorbidities. The researchers also did not look at long-term outcomes for the offspring.
The study revealed that infants whose mother took ADHD medication during pregnancy had a higher risk of admission to the neonatal care unit (NICU) as compared to those whose mothers did not take any medication during pregnancy or quit taking the medication prior to or during pregnancy. The reason for this was central nervous system disorders. The higher risk of admission was not influenced by the stimulant medication used during pregnancy.
Women who took stimulant ADHD medication during pregnancy were also at an elevated risk of having a caesarean birth or having a baby with a low Apgar score (less than 7). These increases 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 can be offset by more beneficial outcomes for both mother and baby of continuing treatment for the woman’s disorder. Physicians should discuss this with their patients and, when possible, assist them in developing strategies to improve coping skills which can reduce the effects of her disorder on her daily functioning and relationships.
Medication Interactions
Many doctors are confronted with the dilemma of whether to keep treatment or stop during pregnancy as more women are diagnosed with ADHD. The majority of these decisions are made in the absence of any evidence that is clear and definitive either way, so physicians must weigh their knowledge from their own experiences, those of other doctors, and what the research says on the topic, along with their best judgment for each patient.
In particular, the issue of potential risks for the baby can be a challenge. Many of the studies on this subject are based on observational data rather than controlled research, and their conclusions are often contradictory. Most studies limit their analysis to live-births, which could underestimate the severity of teratogenic effects that can lead to terminations or abortions of pregnancy. The study discussed in this journal club addresses these shortcomings by looking at data from both live and deceased births.
The conclusion: While some studies have shown an association between ADHD medications and the risk of certain birth defects, other studies have not found any evidence of a link and the majority of studies show a neutral or even slight negative effect. In each case an in-depth study of the potential risks and benefits must be performed.
For many women with ADHD who suffer from ADHD, the decision to stop taking medication is difficult if not impossible. In a recent article published in the 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. Additionally, the loss of medication can affect the ability to do job-related tasks and drive safely that are crucial aspects of daily life for many people suffering from ADHD.
She suggests that women who aren't sure whether to continue taking medication or stop it due to their pregnancy educate family members, colleagues, and friends about the condition, the impact on daily functioning and the benefits of keeping the current treatment regimen. It can also help the woman feel supported as she struggles with her decision. Some medications can pass through the placenta. If a patient decides to stop taking her ADHD medication while pregnant and breastfeeding, it's important to be aware that the medication could be passed on to her baby.
Risk of Birth Defects
As the use and misuse of ADHD medication to treat symptoms of attention deficit disorder hyperactivity disorder (ADHD) increases, so does concern about the potential adverse effects of the drugs on the fetuses. A study that was published in the journal Molecular Psychiatry adds to the body of information on this topic. Utilizing two huge data sets researchers were able to look at more than 4.3 million pregnancies and see whether stimulant medications increased the risk of birth defects. Researchers found that while the risk overall is low, the first trimester ADHD exposure to medication was associated with slightly higher rates of specific heart defects like ventriculoseptal defect.
The researchers of the study could not find any association between early use of medication and other congenital anomalies, like facial deformities or club feet. The results are consistent with previous studies revealing an increase, but not significant, in the risk of cardiac malformations among women who started taking ADHD medications prior to pregnancy. The risk increased in the latter half of pregnancy when many women began to stop taking their medication.
Women who used ADHD medications in the first trimester of pregnancy were also more likely to have caesarean sections, a low Apgar score after delivery and a baby who required breathing assistance at birth. However, the authors of the study were unable to eliminate bias due to selection by limiting the study to women who didn't have other medical issues that could have contributed to these findings.
The researchers hope their research will help inform the clinical decisions of physicians who treat pregnant women. The researchers advise that, while discussing benefits and risks are important, the choice on whether to continue or stop medication should be based on the severity of each woman's ADHD symptoms and her needs.
The authors caution that, even though stopping the medication is a possibility to look into, it is not advised due to the high prevalence of depression and other mental disorders for women who are pregnant or recently gave birth. Further, research shows that women who stop taking their medication will have a harder time adjusting to a life without them once the baby is born.
Nursing
It can be overwhelming to become a mom. Women with ADHD who must work through their symptoms while attending doctor appointments as well as preparing for the arrival of a baby and adapting to new routines in the home may face a lot of challenges. Many women decide to continue taking their ADHD medication during pregnancy.
The majority of stimulant drugs are absorbed by breast milk in very small quantities, so the risk for breastfeeding infant is minimal. The amount of exposure to medications will vary based on the dosage, frequency of administration and time of day. In addition, various drugs enter the infant's system via the gastrointestinal tract or breast milk. The impact on the health of a newborn is not completely comprehended.
Some physicians may discontinue 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 her medication against the risk to the embryo. In the meantime, until more information is available, doctors should ask all pregnant patients about their experience with ADHD and if they are taking or planning to take medication during the perinatal time.
A increasing number of studies have proven that most women more info can safely continue their ADHD medication during pregnancy and while breastfeeding. In the end, an increasing number of patients are choosing to do so and after consulting with their doctor, they have discovered that the benefits of continuing their current medication far outweigh any potential risks.
Women who suffer from ADHD who are planning to nurse should seek advice from a specialist psychiatrist before becoming pregnant. They should review their medications with their physician and discuss the advantages and disadvantages of continuing treatment, including non-pharmacological management strategies. Psychoeducation should also be provided to help pregnant women suffering from ADHD recognize their symptoms and the underlying disorder and learn about treatment options and strengthen existing coping strategies. This should be a multidisciplinary process with the GPs, obstetricians and psychiatrists. Counselling for pregnancy should include the discussion of a treatment plan for both the mother and child, and monitoring for signs of deterioration and the need for adjustments to the medication regimen.