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. Little data exists about how long-term exposure to these medications could affect the foetus.
A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological issues such as impaired hearing or vision, febrile seizures or IQ impairment. The authors acknowledge the need for more high-quality research.
Risk/Benefit Analysis
Women who are pregnant and take ADHD medication should evaluate the benefits of using it against the possible risks for the baby. The doctors don't have the information to make unambiguous recommendations, but can provide information on the risks and benefits to assist pregnant women to make informed choices.
A study published in Molecular Psychiatry found that women who were taking ADHD medications during their early pregnancy did not have a significantly higher risk of fetal cardiac malformations or major structural birth defects. Researchers conducted a massive sample-based case control study to assess the frequency of major structural defects in infants who were born to mothers who took stimulants during pregnancy. Clinical geneticists, pediatric cardiologists and other experts looked over the cases to make sure that the classification was accurate and to minimize any bias.
However, the researchers' study had its limitations. The most important issue was that they were unable to distinguish the effects of the medication from those of the underlying disorder. This limitation makes it difficult to know whether the small differences observed in the groups that were exposed are due to the use of medication or confounding by comorbidities. Additionally the study did not study long-term offspring outcomes.
The study did find that babies whose mothers had taken ADHD medication during pregnancy were at a greater risk of being admitted to the neonatal intensive care unit (NICU) than those who whose mothers did not take any medication or stopped their medications before or during pregnancy. This increase was caused by central nervous system disorders. The increased risk of admission was not affected by the stimulant medication that was used during pregnancy.
Women who took stimulant ADHD medication during pregnancy also had an increased risk of having a caesarean birth or having a baby with an low Apgar score (less than 7). These increases did not seem to be influenced by the kind of medication used during pregnancy.
The researchers suggest that the risk of a small amount with the use of ADHD medications during early pregnancy could be offset by the greater benefit to both the mother and child from continued treatment for the woman's condition. Physicians should discuss the issue with their patients and, if they are able, assist them in developing strategies for improving their coping skills that may minimize the impact of her disorder on her daily life and relationships.
Medication Interactions
Doctors are increasingly faced with the decision of whether to keep treatment or stop as more women are diagnosed with ADHD. Often, these decisions are made without clear and authoritative evidence either way, so physicians must weigh what they know, the experiences of other doctors, and what the research suggests on the subject as well as their own best judgment for each patient.
Particularly, the issue of potential risks for the baby can be a challenge. Many of the studies on this topic are based on observational evidence instead of controlled research and their findings are often contradictory. The majority of studies focus on live births, which can underestimate the teratogenic impact which can cause abortions or terminations of pregnancy. The study that is discussed in this journal club addresses these limitations by analyzing data on live and deceased births.
The conclusion 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 demonstrate a neutral or slightly negative effect. Therefore an accurate risk-benefit analysis is required in every instance.
It can be challenging, if not impossible, for women suffering from ADHD to stop taking their medication. 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 lead to depression and feelings of loneliness. A loss of medication may also affect the ability to safely drive and perform work-related tasks, which are vital aspects of normal life for those suffering from ADHD.
She suggests that women who aren't sure whether to continue taking medication or discontinue it due to pregnancy educate family members, coworkers and friends about the condition, the impact on daily functioning and the benefits of continuing the current treatment regimen. It will also help a woman feel confident about her decision. Some medications can pass through the placenta. If a patient decides to not take her ADHD medication while pregnant and breastfeeding, it is important to be aware that the medication could be transferred to the baby.
Birth Defects and Risk of
As the use of ADHD medication to treat the symptoms of attention deficit hyperactivity disorder (ADHD) increases, so do concerns about the effects that the drugs could have on fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge regarding this issue. Utilizing two huge data sets, researchers were able to look at more than 4.3 million pregnancies to determine whether stimulant medications increased the risk of birth defects. Researchers discovered that, while the risk overall is low, first-trimester ADHD exposure to medication was associated with slightly higher rates of certain heart defects, such as ventriculoseptal defect.
The authors of the study didn't find any association between early medication usage and other congenital anomalies, such as facial deformities or club feet. The results are in agreement with previous studies that have shown an insignificant, but small increase in cardiac malformations for women who began taking ADHD medication before pregnancy. This risk increased during the latter stages of pregnancy when many women stopped taking their medication.
Women who took ADHD medication in the first trimester of their pregnancies were also more likely to experience caesarean sections, a low Apgar score after delivery and a baby who required help breathing at birth. However, adhd medication uk of the study were not able to eliminate selection bias by limiting the study to women who did not have other medical issues that could have contributed to the findings.
The researchers hope their study will help inform the clinical decisions of doctors who treat pregnant women. They advise that while discussing risks and benefits is important but the decision to stop or maintain medication should be based on the woman's needs and the severity of her ADHD symptoms.
The authors warn that, even though stopping the medication is an option to think about, it isn't recommended due to the high rate depression and other mental disorders in women who are expecting or recently gave birth. Further, the research suggests that women who choose to stop taking their medications are more likely to experience difficulties getting used to life without them after the birth of their baby.
Nursing
It can be a challenge becoming a mother. Women with ADHD who must work through their symptoms while attending physician appointments, getting ready for the arrival of a child and getting used to new routines at home may face a lot of challenges. 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. adult adhd medication of exposure to medications can vary depending upon the dosage the medication is administered, its frequency and the time of the day. In addition, various drugs enter the infant's system through the gastrointestinal tract or breast milk. The impact on a newborn's health is not completely understood.
Because of the lack of evidence, some doctors may be inclined to discontinue stimulant medications during the course of pregnancy. It is a difficult decision for the woman who must weigh the benefits of her medication against the risk to the fetus. Until more information becomes available, GPs may ask pregnant patients if they have a history of ADHD or if they are planning to take medication in the perinatal phase.
A increasing number of studies have shown that the majority of women are able to safely continue to take their ADHD medication during pregnancy and breastfeeding. In response, an increasing number of patients are opting to do this. They have found through consultation with their doctors that the benefits of keeping their current medication outweigh potential risks.
Women who suffer from ADHD who are planning to breastfeed should seek the advice of an expert psychiatrist prior to becoming pregnant. They should discuss their medication with their doctor, and the pros and cons for continuing treatment. This includes non-pharmacological methods. Psychoeducation should also be provided to help pregnant women suffering from ADHD recognize their symptoms and the underlying disorder Learn about the available treatments and to reinforce existing strategies for managing. This should be a multidisciplinary process with the GPs, obstetricians and psychiatrists. Pregnancy counseling should consist of a discussion of a treatment plan for the mother and child, and monitoring for signs of deterioration, and, if needed modifications to the medication regimen.