ADHD Medication During Pregnancy and Breastfeeding
Women with ADHD must make a difficult decision about whether to continue or stop taking ADHD medication during pregnancy and breast-feeding. There aren't enough data 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 in the uterus don't develop neurological disorders like impaired vision or hearing seizures, febrile seizures, or IQ impairment. The authors acknowledge the need for more high-quality studies.
Risk/Benefit Analysis
Women who are pregnant and take ADHD medication should evaluate the benefits of using it versus the dangers for the baby. Physicians don't have the data to make unambiguous recommendations, but can provide information about risks and benefits to aid pregnant women in making an informed decision.
A study published in Molecular Psychiatry found that women who took ADHD medications during their early pregnancy did not face a significantly increased risk of fetal heart malformations or major birth defects that are structural. The researchers used a large, population-based case-control study to assess the risk of major structural birth defects in babies born to mothers who had taken stimulants during early pregnancy and those who had not. Clinical geneticists, pediatric cardiologists and other experts reviewed the cases in order to ensure that the classification was accurate and to minimize any bias.
The study conducted by the researchers had some limitations. Researchers were unable, in the first place, to separate the effects caused by the medication from the disorder. This makes it difficult to determine whether the small associations observed in the exposed groups result from medication use or comorbidities that cause confusion. Additionally the researchers did not study the long-term effects of offspring on their parents.
The study showed that infants whose mothers had taken ADHD medication during pregnancy had a slightly greater risk of being admitted to the neonatal care unit (NICU) in comparison to those whose mothers didn't take any medication during pregnancy or quit taking the medication prior to or during pregnancy. This increase was caused by central nervous system disorders. The higher risk of admission was not affected by the stimulant medications used during pregnancy.
Women who took stimulant ADHD medications during pregnancy also had a higher chance of having to have an emergency caesarean section or having a baby that scored low on the Apgar scale (less than 7). These risks did not seem to be influenced by the kind of medication used during pregnancy.
Researchers suggest that the small risks posed by the use of ADHD medications in early pregnancies could be offset by the greater benefits to both baby and mother of continued treatment for the woman's condition. Physicians should discuss this with their patients and, where 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
Many doctors are faced with the decision of whether to maintain treatment or stop during pregnancy as more women are diagnosed with ADHD. Often, these decisions are taken in the absence of solid and reliable evidence either way, so physicians must weigh what they know about their experiences, the experiences of other doctors, and what research suggests on the subject and their best judgment for each individual patient.
The issue of possible risks to the infant can be extremely difficult. The research on this subject is based on observation instead of controlled studies and the results are contradictory. Most studies restrict their analysis to live births, which can underestimate the severity of teratogenic effects which can cause abortions or terminations of pregnancy. The study that is discussed in the journal club addresses these limitations by analyzing the data from deceased and live births.
The conclusion The conclusion: While some studies have shown an association between ADHD medications and the possibility of certain birth defects, other studies have not found any evidence of a link and the majority of studies show a neutral or even slightly negative impact. As a result, a careful risk/benefit assessment is required in every situation.
For many women with ADHD, the decision to stop taking medication is difficult, if not impossible. In fact, in an article recently published in the Archives of Women's Mental Health psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can lead to increased depression, feelings of isolation, and family conflict for those suffering from the disorder. In addition, a decrease in medication can affect the ability to perform work-related tasks and safely drive that are crucial aspects of daily life for many people with ADHD.
She suggests that women who are unsure whether to continue taking the medication or stop due to pregnancy, educate their family members, coworkers and their friends about the condition, its effects on daily functioning, and the benefits of continuing the current treatment. It can also help women feel supported in her decision. Certain medications can pass through the placenta. If the patient decides to stop taking her ADHD medication while pregnant and breastfeeding, it's important to be aware that the drug may be transferred to her infant.
Birth Defects Risk
As the use and misuse of ADHD drugs to treat symptoms of attention deficit disorder hyperactivity disorder (ADHD) is increasing as does the concern about the potential effects of these drugs on fetuses. A study that was published in the journal Molecular Psychiatry adds to the existing information on this topic. Researchers used two huge data sets to study over 4.3 million pregnancies and determine if stimulant medication use increased the risk of birth defects. Although the risk overall is low, the researchers discovered that the first-trimester exposure to ADHD medications was associated with an increased risk of certain heart defects like ventriculo-septal defects (VSD).
The authors of the study could not discover any connection between the use of early medications and congenital anomalies like facial deformities, or club feet. The findings are in line with previous studies that have shown a small but significant increase in the risk of heart malformations among women who started taking ADHD medications prior to pregnancy. The risk increased in the latter stages of pregnancy when many women began to stop taking their medication.
Women who took ADHD medication during the first trimester were more likely require a caesarean delivery or have a low Apgar after delivery and have a baby who needed help breathing after birth. However, the authors of the study were not able to eliminate selection bias by restricting the study to women who did not have any other medical conditions that could have contributed to the findings.
The researchers hope their research will aid in the clinical decisions of physicians who treat pregnant women. The researchers advise that while discussing benefits and risks are crucial, the decision about whether to continue or stop taking 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 an option to look into, it is not recommended due to the high prevalence of depression and mental health issues among women who are pregnant or recently gave birth. Further, research shows that women who stop taking their website medication will have a tough time adjusting to a life without them after the baby is born.
Nursing
It can be overwhelming to become a mom. Women with ADHD may face a lot of challenges when they must manage their symptoms, attend doctor appointments and prepare for the birth of a baby and adjust to new routines. Many women decide to continue taking their ADHD medication during pregnancy.
The risk to a breastfeeding infant is not too high since the majority of stimulant medications is absorbed through breast milk at low levels. However, the amount of exposure to medications by the newborn may differ based on dosage, how often it is taken and the time of the day it is administered. In addition, different medications enter the baby’s system through the gastrointestinal tract, or through breast milk. The effect on the health of a newborn isn't completely known.
Some doctors may stop taking stimulant medication during a woman's pregnancy due to the absence of research. This is a complicated decision for the patient, who must balance the benefit of continuing her medication against the possible dangers to the embryo. As long as more information is available, GPs can ask pregnant patients if they have any history of ADHD or if they plan to take medication in the perinatal period.
A growing number of studies have proven that most women can safely continue to take their ADHD medication while they are pregnant and nursing. In the end, many patients are choosing to do so and, in consultation with their physician, they have found that the benefits of continuing their current medication outweigh any potential risks.
It's important for women with ADHD who are thinking of breastfeeding to seek a specialist psychiatrist's guidance prior to becoming pregnant. They should review their medications with their doctor and discuss the advantages and disadvantages of continued treatment, including non-pharmacological strategies. Psychoeducation is also required to help pregnant women with ADHD be aware of the symptoms and underlying disorder. They should also be informed about treatment options and strengthen coping mechanisms. This should involve an approach that is multidisciplinary, including the GP, obstetricians and psychiatry. Counselling for pregnancy should include the discussion of a treatment plan for both the mother and child, and monitoring for signs of deterioration, and when necessary, making adjustments to the medication regimen.