ADHD Medication During Pregnancy and Breastfeeding
Women suffering from ADHD have to make a difficult choice regarding whether or not to stop taking ADHD medication during pregnancy and breastfeeding. There isn't much information on how long-term exposure to these drugs may affect the fetus.
A recent study 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 higher-quality research.
Risk/Benefit Analysis
Women who are pregnant and taking ADHD medication must evaluate the benefits of using it against the possible risks for the fetus. Physicians don't have the necessary data to make unequivocal recommendations, but they can provide information regarding risks and benefits that aid pregnant women in making informed choices.
A study published in Molecular Psychiatry concluded that women who were taking ADHD medication during early pregnancy were not at a greater risk of fetal malformations, or structural birth defects. Researchers conducted a large sample-based case control study to compare the incidence of structural defects that were major in infants who were born to mothers who used stimulants during pregnancy. Clinical geneticists and pediatric cardiologists examined the cases to ensure correct classification of the cases and to reduce the chance of bias.
However, the researchers' study had its limitations. The researchers were not able in the beginning, to separate the effects triggered by the medication from the disorder. This makes it difficult for researchers to determine whether the small associations observed among the exposed groups were due to the use of medication or if they were confounded by the presence of comorbidities. In addition, the researchers did not study the long-term outcomes of offspring.
The study did show that infants whose mothers took ADHD medication during pregnancy were at slightly higher risk of being admitted to the neonatal intensive care unit (NICU) than those whose mothers had not taken any medication or cut back on their medications prior to or during pregnancy. This was due to central nervous system-related disorders and the increased risk of admission did not appear to be affected by the type of stimulant medications were taken during pregnancy.
Women who took stimulant ADHD medication during pregnancy also had an increased risk of having a caesarean section or having a baby born with an low Apgar score (less than 7). These increases appeared to be unrelated to the type of medication taken during pregnancy.
The research suggests that the low risk associated with the use of ADHD medications during the early stages of pregnancy may be offset by the greater benefits to both the mother and child of continuing treatment for the woman's condition. Physicians should discuss this 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
More and more doctors are faced with the decision of whether to keep treatment or stop as more women are diagnosed with ADHD. These decisions are usually made without clear and authoritative evidence. Instead, doctors must take into account their own experience in conjunction with the experiences of other doctors, and the research on the subject.
The issue of risk to the infant can be difficult to determine. A lot of studies on this issue are based on observational evidence rather than controlled research, and their conclusions are often contradictory. Furthermore, most studies restrict their analysis to live births, which may underestimate severe teratogenic effects that lead to abortion or termination of the pregnancy. The study that is discussed in the journal club addresses these limitations by analyzing data on live and deceased births.
Conclusion: While some studies have shown a positive correlation between ADHD medications and certain birth defects However, other studies haven't found a correlation. her response show an unintended, or slight negative impact. As a result, a careful risk/benefit assessment must be conducted in every situation.
It can be challenging, if not impossible, for women with ADHD to stop taking their medication. In an article recently published in the 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 those suffering from the disorder. The loss of medication can also impact the ability to drive safely and to perform work-related tasks which are vital aspects of daily life for people with ADHD.
She suggests that women who are unsure whether to continue taking medication or discontinue it due to pregnancy educate family members, colleagues, and friends about the condition, the impact on daily functioning and the advantages of staying on the current treatment. It can also make the woman feel more comfortable when she is struggling with her decision. It is also worth noting that certain medications are able to pass through the placenta, so if the patient decides to discontinue her ADHD medication during pregnancy and breastfeeding, she must be aware that the effects of the medication could be passed on to the baby.
Birth Defects and Risk of
As the use and misuse of ADHD medication to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases, so does concern about the possible effects of the drugs on the fetuses. A study that was published in the journal Molecular Psychiatry adds to the existing knowledge about this subject. Utilizing two huge data sets researchers were able analyze more than 4.3 million pregnancies and see whether the use of stimulant medications increased the risk of birth defects. Researchers found that while the risk overall is low, the first trimester ADHD medication exposure was associated with slightly higher rates of certain heart defects, like ventriculoseptal defects.
The researchers of the study found no connection between early use of medication and other congenital abnormalities, such as facial clefting or club foot. The results are in line with previous studies that have shown a small, but significant increase in the number of cardiac malformations among women who started taking ADHD medication before the time of pregnancy. The risk was higher in the latter half of pregnancy, when a lot of women are forced to stop taking their ADHD medication.
Women who took ADHD medications during the first trimester of their pregnancies were also more likely to experience caesarean section, low Apgar score following delivery, and a baby that required breathing assistance during birth. The authors of the study were not able to eliminate bias due to selection because they limited their study to women with no other medical conditions that might have contributed to the findings.
Researchers hope that their research will provide doctors with information when they meet pregnant women. The researchers advise 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 the needs of the woman.
The authors also warn that while discontinuing the medications is an option, it is not a recommended practice because of the high rate of depression and other mental health problems for women who are expecting or who are recently post-partum. Additionally, the research suggests that women who decide to stop their medications are more likely to have difficulties adapting to life without them after the baby's arrival.
Nursing
The responsibilities of being a new mom can be overwhelming. Women who suffer from ADHD who must work through their symptoms while attending physician appointments, making preparations for the arrival of a child and getting used to new routines at home may face a lot of challenges. Therefore, many women elect to continue taking their ADHD medications throughout the course of pregnancy.
The majority of stimulant drugs are absorbed by breast milk in low quantities, so the risk to breastfeeding infant is minimal. The rate of medication exposure will differ based on dosage, frequency of administration and time of day. In addition, different drugs enter the infant's system via the gastrointestinal tract or breast milk. The effect on the health of a newborn isn't fully comprehended.
Some physicians may discontinue stimulant medication during a woman's pregnancy due to the absence of research. This is a difficult decision for the woman who must weigh the advantages of taking her medication as well as the risks to the embryo. In the meantime, until more information is available, GPs may inquire about pregnant patients if they have any background of ADHD or if they intend to take medication during the perinatal phase.
A growing number of studies have revealed that women can continue their ADHD medication while they are pregnant and nursing. In response, a rising number of patients are opting to continue their medication. They have concluded after consulting with their doctors that the benefits of retaining their current medication far outweigh any risk.
Women who suffer from ADHD who are planning to nurse should seek the advice of a specialist psychiatrist before becoming pregnant. They should discuss their medication with their doctor and discuss the advantages and disadvantages of continued treatment, including non-pharmacological management strategies. Psychoeducation should also be offered to help pregnant women suffering from ADHD be aware of their symptoms and the underlying disorder Learn about the available treatment options and strengthen existing coping strategies. This should include an approach that is multidisciplinary, including the GP doctors, obstetricians and psychiatrists. The pregnancy counselling should consist of the discussion of a plan for management for both the mother and child, as well as monitoring for signs of deterioration and when necessary, making adjustments to the medication regimen.