ADHD Medication During Pregnancy and Breastfeeding
The decision to stop or continue ADHD medications during pregnancy and breastfeeding is a difficult decision for women suffering from the condition. There aren't many studies on how long-term exposure may affect the fetus.
A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication during the uterus do not develop neurological conditions like hearing loss or impaired vision seizures, febrile seizures or IQ impairment. The authors acknowledge the need for higher-quality research.
Risk/Benefit Analysis
Women who are pregnant and taking ADHD medications must weigh the advantages of taking them against potential risks to the fetus. Physicians don't have the data to give clear advice but they can provide information on risks and benefits to assist pregnant women to make informed decisions.
A study published in Molecular Psychiatry concluded that women who took ADHD medication during early pregnancy were not at a higher risk of fetal malformations or structural birth defects. 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 early pregnancy, and those who did not. Pediatric cardiologists, clinical geneticists and other experts examined the cases to make sure that the classification was correct and to eliminate any bias.
However, the researchers' study was not without its flaws. In particular, they were not able to differentiate the effects of the medication from the effects of the disorder that is underlying. That limitation makes it difficult to determine whether the small differences observed in the groups that were exposed are due to the use of medication or comorbidities that cause confusion. The researchers also did not examine long-term outcomes for the offspring.
The study did reveal that infants whose mothers took ADHD medication during pregnancy were at a greater risk of being admitted to the neonatal intensive care unit (NICU) than infants whose mothers had not taken any medication or cut back on their medications prior to or during pregnancy. This increase was due to central nervous system-related disorders and the increased risk for admission was not found to be influenced by the stimulant medications were taken during pregnancy.
Women who took stimulant ADHD medication during pregnancy were also at an increased risk of having a caesarean birth or having a baby born with an low Apgar score (less than 7). These increases did not appear to be affected by the kind of medication used during pregnancy.
The research suggests that the low risk associated with the use of ADHD medications during the early stages of pregnancy could be offset by the higher benefit to both mother and child from continued treatment for the woman's disorder. Physicians should discuss the issue with their patients and, where possible, help them develop strategies to improve their coping abilities that can lessen the negative impact of her condition on her daily functioning and relationships.
Interactions with Medication
Doctors are increasingly faced with the decision of whether to keep treatment or stop 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 from their own experiences, those of other doctors, and what the research suggests about the subject, along with their best judgment for each individual patient.
Particularly, the subject of possible risks to the infant can be difficult. A lot of studies on this topic are based on observational evidence rather than controlled research, and their conclusions are often contradictory. Most studies limit their analysis to live births, which can underestimate the teratogenic impact that can lead to abortions or terminations of pregnancy. The study that is discussed in this journal club addresses these shortcomings by examining data on both live and deceased births.
Conclusion Some studies have shown a positive correlation between ADHD medications and certain birth defects However, other studies haven't established a link. The majority of studies show that there is a neutral, or somewhat negative, effect. In the end an accurate risk-benefit analysis must be conducted in every situation.
For a lot of women with ADHD, the decision to discontinue medication can be difficult, if not impossible. In a recent article 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. In addition, a decrease in medication may affect the ability to do job-related tasks and drive safely that are crucial aspects of daily life for a lot of people with ADHD.
She recommends women who are uncertain about whether or not to stop taking medication because of their pregnancy consider informing family members, friends and colleagues on the condition, its impact on daily functioning, and the benefits of keeping the current treatment regimen. In addition, educating them can make the woman feel more comfortable as she struggles with her decision. It is also worth noting that some medications can pass through the placenta therefore, if a patient 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 infant.
Birth Defects and Risk of
As the use of ADHD medications to treat symptoms of attention deficit hyperactivity disorder (ADHD) grows there are concerns over the impact that these drugs might have on the fetuses. A recent study published in the journal Molecular Psychiatry adds to the existing knowledge about this subject. Researchers used two massive datasets to analyze over 4.3 million pregnancies and determine if stimulant medication use increased the risk of birth defects. Although the risk overall remains low, the researchers did find that first-trimester exposure to ADHD medications was associated with an increased risk of certain heart defects such as ventriculoseptal defect (VSD).
The researchers of the study found no connection 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 have shown the existence of a slight, but significant increase in the number of cardiac malformations among women who began taking ADHD medication before the time of pregnancy. The risk increased in the latter part of pregnancy, when a lot of women stopped taking their medication.
Women who used ADHD medications in the first trimester of their pregnancy were also more likely to undergo caesarean sections, a low Apgar score after delivery and a baby who required help breathing at birth. However the researchers of the study were not able to eliminate bias due to selection by restricting the study to women who didn't have any other medical issues that could be a contributing factor to these findings.
Researchers hope that their research will inform physicians when they meet pregnant women. The researchers recommend that, while discussing risks and benefits 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 requirements.
The authors also caution that even though stopping the medication is an option, it is not a recommended practice because of the high incidence of depression and other mental health problems in women who are pregnant or who are recently post-partum. Additionally, the research suggests that women who choose to stop their medications are more likely to have a difficult time getting used to life without them after the baby's arrival.
Nursing
It can be a stressful experience to become a mom. Women with ADHD who have to manage their symptoms while attending doctor appointments and preparing for the arrival of a child and getting used to new routines at home can experience severe challenges. This is why many women decide to continue taking their ADHD medication throughout the pregnancy.
The majority of stimulant medications are absorbed through breast milk in low amounts, therefore the risk to the nursing infant is very low. The rate of exposure to medication can vary depending upon the dosage and frequency of administration as well as the time of the day. Additionally, individual medications enter the body of the baby differently through the gastrointestinal tract as well as breast milk. The impact of this on a newborn infant is not yet fully understood.
Some physicians may discontinue stimulant medication during a woman’s pregnancy due to the lack of research. This is a difficult decision for the patient, who must balance the benefits of keeping her medication with the potential dangers to the foetus. Until more information becomes available, GPs can inquire about pregnant patients whether they have any background of ADHD or if they are planning to take medication during the perinatal stage.
Many studies have shown that women can continue taking their ADHD medication without risk during pregnancy and while breast-feeding. In the end, an increasing number of patients opt to do this and, in consultation with their physician, they have discovered that the benefits of continuing their current medication outweigh any potential risks.
adhd adults medication with ADHD who are planning to breastfeed should seek advice from a specialist psychiatrist prior to becoming pregnant. They should discuss the medication they are taking with their physician as well as the pros and cons for continuing treatment. This includes non-pharmacological methods. Psychoeducation should also be provided to help pregnant people with ADHD be aware of their symptoms and the root cause Learn about the available treatment options and reinforce existing coping strategies. This should include an approach that is multidisciplinary, including the GP doctors, obstetricians and psychiatrists. Pregnancy counseling should include discussion of a treatment plan for the mother as well as the child, as well as monitoring for signs of deterioration, and, if necessary modifications to the medication regime.