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 aren't enough data on how long-term exposure 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 more high-quality studies.
Risk/Benefit Analysis
Pregnant women who use ADHD medications need to balance the advantages of using them against the risks to the foetus. Doctors don't have enough data to make unambiguous recommendations however they can provide information on risks and benefits to aid pregnant women in making informed choices.
A study published in Molecular Psychiatry found that women who took ADHD medications during their early pregnancy did not have a significantly increased risk of fetal cardiac malformations or major structural birth defects. The researchers used a large population-based case-control study to determine the prevalence of major structural birth defects in infants born to mothers who had taken stimulants in the early stages of pregnancy and those who had not. Pediatric cardiologists and clinical geneticists looked over the cases to ensure an accurate case classification and to minimize the possibility of bias.
The study conducted by the researchers had some limitations. The most important issue was that they were not able to differentiate the effects of the medication from the disorder that is underlying. This makes it difficult to know whether the limited associations observed in the exposed groups result from medication use or confounding by comorbidities. The researchers also did not look at long-term outcomes for the offspring.
The study did reveal that babies whose mothers had taken ADHD medication during pregnancy were at a slightly higher risk of being admitted to the neonatal intensive care unit (NICU) than infants who whose mothers did not take any medication or had taken off their medication prior to or during pregnancy. This increase was caused by central nervous system disorders. The higher risk of admission was not influenced by the stimulant medication that was used during pregnancy.
Women who were taking stimulant ADHD medication during pregnancy were also at an increased risk of having a caesarean birth or having a baby with low Apgar score (less than 7). These increases appear to be independent of the type of medication taken during pregnancy.
The research suggests that the risk of a small amount with the use of ADHD medications during early pregnancy may be offset by the higher benefit to both mother and child of continuing treatment for the woman's condition. Physicians should discuss the issue with their patients and, when possible, assist them in developing strategies to improve their coping abilities which can reduce the impact of her disorder on her daily functioning and relationships.
Medication Interactions
As more women than ever before are being diagnosed with ADHD and treated with medication, the question of whether to continue or stop treatment during pregnancy is a question that more and more physicians face. These decisions are usually made without clear and authoritative evidence. Instead, physicians must consider their own expertise and experience, as well as the experiences of other doctors, and the research on the subject.
The issue of possible risks to the infant can be extremely difficult. Many of the studies on this subject are based on observational data rather than controlled research and their findings are often contradictory. In addition, most 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 that is discussed in the journal club addresses these shortcomings by analyzing data on live and deceased births.
The conclusion is that while some studies have shown a positive association between ADHD medications and the risk of certain birth defects, other studies have found no connection and the majority of studies show a neutral or even slightly negative impact. In the end, a careful risk/benefit analysis must be done in each situation.
It isn't easy, but not impossible, for women suffering from ADHD to stop taking their medication. In fact, in a recent article 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 these patients. In addition, a decrease in medication can affect the ability to do job-related tasks and drive safely, which are important aspects of daily life for a lot of people with ADHD.
She suggests that women who are not sure whether to continue taking the medication or discontinue it due to pregnancy should educate family members, colleagues, and their friends about the condition, its impact on daily functioning and the benefits of continuing the current treatment plan. In addition, educating them can help the woman feel supported as she struggles with her decision. Certain medications can be passed through the placenta. If a patient decides not to take her ADHD medication while pregnant and breastfeeding, it is important to be aware that the drug could be transferred to the baby.
Risk of Birth Defects
As the use and misuse of ADHD medication to treat symptoms of attention deficit disorder 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 regarding this subject. With two massive data sets, researchers were able to examine more than 4.3 million pregnancies to determine whether the use of stimulant medications increased the risk of birth defects. While the overall risk remains low, the researchers did find that first-trimester exposure to ADHD medicines was associated with a slightly higher rate of certain heart defects, such as ventriculoseptal defect (VSD).
The authors of the study found no link between early use of medication and congenital abnormalities like facial clefting, or club foot. The results are in the same vein as previous studies that showed a small, but significant increase in cardiac malformations for women who started taking ADHD medication prior to the time of the time of pregnancy. The risk was higher in the latter half of pregnancy, when a lot of women begin to discontinue their medication.
Women who took ADHD medications during the first trimester of their pregnancies were also more likely to have caesarean section, low Apgar score after delivery and a baby that required breathing assistance during birth. However the authors of the study were not able to eliminate selection bias by limiting the study to women who didn't have other medical issues that could have contributed to these findings.
Researchers hope that their research will provide doctors with information when they encounter pregnant women. The researchers recommend that, while discussing benefits and risks are crucial, the decision regarding whether or not to stop taking medication should be according to the severity of each woman's ADHD symptoms and the needs of the woman.
The authors warn that, although stopping the medication is a possibility to look into, it is not advised due to the high rate depression and mental health issues in women who are expecting or have recently given birth. Further, the research suggests that women who decide to stop taking their medications are more likely to experience difficulties getting used to life without them following the baby's arrival.
Nursing
The responsibilities of a new mother can be overwhelming. Women suffering from ADHD can face severe challenges when they must manage their symptoms, go to doctor appointments, prepare for the birth of a baby and adjust to a new routine. This is why many women choose to continue taking their ADHD medication throughout the pregnancy.
The majority of stimulant drugs are absorbed by breast milk in low amounts, therefore the risk to breastfeeding infant is minimal. The rate of exposure to medication will differ based on dosage, frequency of administration and the time of day. Additionally, different medications enter the baby's system differently through the gastrointestinal tract and breast milk. The impact of this on a newborn isn't fully understood.
Some physicians may discontinue stimulant medications during a woman's pregnancy due to the absence of research. It is a difficult decision for the woman, who must weigh the advantages of continuing her medication against the risks to the fetus. Until more information becomes available, doctors can inquire about pregnant patients whether they have any history of ADHD or if they are planning to take medication during the perinatal period.
A increasing number of studies have revealed that women can continue to take their ADHD medication here during pregnancy and while breastfeeding. In response, a growing number of patients are opting to continue their medication. They have concluded, in consultation with their doctors that the benefits of continuing their current medication outweigh any potential risks.
It's important for women with ADHD who are considering 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 of continued treatment, including non-pharmacological strategies. Psychoeducation is also necessary to help pregnant women with ADHD recognize the signs and underlying disorder. They should also be informed about treatment options and strengthen the coping mechanisms. This should be a multidisciplinary effort including obstetricians, GPs, and psychiatry. Pregnancy counseling should consist of a discussion of a treatment plan for the mother and the child, as well as monitoring for indicators of deterioration, and, if necessary adjustments to the medication regimen.