ADHD Medication During Pregnancy and Breastfeeding
The decision to stop or keep ADHD medication during breastfeeding and pregnancy is a difficult decision for women suffering from the condition. There aren't enough data on how exposure to ADHD for a long time could affect a pregnant fetus.
A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication during utero do not develop neurological developmental disorders such as hearing or vision impairment, febrile seizures, or IQ impairment. The authors acknowledge that more high quality studies are required.
Risk/Benefit Analysis
Women who are pregnant and taking ADHD medication must consider the benefits of taking it versus the risks to the foetus. Doctors don't have enough data to provide clear recommendations but they can provide information about risks and benefits to assist pregnant women to make informed decisions.
A study published in Molecular Psychiatry found that women who were taking ADHD medications in early pregnancy did not face an increased risk of fetal heart malformations or major birth defects that are structural. Researchers conducted a large, population-based case-control study to determine the prevalence of major structural birth defects in babies born to mothers who had taken stimulants in early pregnancy and those who had not. Pediatric cardiologists and clinical geneticists examined the cases to ensure accurate case classification and to limit the possibility of bias.
The study of the researchers was not without limitations. Most important, they were unable to separate the effects of the medication from the effects of the disorder that is underlying. That limitation makes it difficult to know whether the small associations observed in the groups that were exposed are due to medication use or confounding by comorbidities. In addition the study did not examine the long-term effects of offspring on their parents.
The study did find that infants whose mothers took ADHD medication during pregnancy were at a slightly more risk of being admitted to the neonatal intensive care unit (NICU) than those whose mothers had not taken any medication or stopped their medications before or during pregnancy. This increase was caused by central nervous system disorders. The higher risk of admission was not affected by the stimulant medication used during pregnancy.
Women who were taking stimulant ADHD medication during pregnancy were also at an increased risk of having a caesarean section or having a baby with low Apgar score (less than 7). These increases appear to be unrelated to the type of medication used during pregnancy.
Researchers suggest that the small risks associated with the use ADHD medications during early pregnancies may be offset by the greater benefits to both mother and baby from continuing treatment for the woman’s disorder. Doctors should discuss with their patients about this and, if possible, help them develop coping skills that could reduce the effects of her disorder on her daily life and relationships.
Medication Interactions
Doctors are increasingly confronted with the dilemma of whether to maintain treatment or stop as more women are diagnosed with ADHD. These decisions are often taken without clear and authoritative evidence. Instead, physicians must weigh their own knowledge, the experience of other doctors, and the research on the subject.
The issue of possible risks to the infant can be particularly tricky. A lot of studies on this subject are based on observational evidence instead of controlled research and their findings are often contradictory. In addition, most studies limit their analysis to live births, which can underestimate the severity of teratogenic effects that could lead to abortion or termination of the pregnancy. The study that is discussed in the journal club addresses these issues by analyzing both the data from deceased and live births.
Conclusion Some studies have shown a positive correlation between ADHD medications and certain birth defects however, other studies haven't shown such a relationship. The majority of studies show that there is a neutral, or somewhat negative, effect. Therefore adhd medication online -benefit analysis must be conducted in every situation.
It can be challenging, if not impossible for women with ADHD to stop taking their medication. In fact, in an article 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 patients with ADHD. In addition, a decrease in medication may affect the ability to perform job-related tasks and drive safely that are crucial aspects of daily life for many people suffering from ADHD.
She suggests that women who aren't sure whether to continue taking the medication or stop due to pregnancy educate family members, coworkers and their friends about the condition, its impact on daily functioning and the benefits of keeping the current treatment plan. It can also aid in ensuring that the woman feels supported as she struggles with her decision. It is important to remember that certain medications can pass through the placenta, therefore, if a patient decides to stop her ADHD medication during pregnancy and breastfeeding, she must be aware that traces of the medication could be passed on to the baby.
Risk of Birth Defects
As the use of ADHD medications to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases there are concerns over the impact that these drugs might have on the fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge on this issue. With two massive data sets, researchers were able to analyze more than 4.3 million pregnancies and determine whether stimulant medication use increased the risk of birth defects. While the overall risk is low, the researchers found that exposure in the first trimester to ADHD medications was associated with a slightly higher rate of certain heart defects, like ventriculo-septal defects (VSD).
The researchers of the study did not discover any link between early medication usage and other congenital anomalies like facial deformities, or club feet. The results are consistent with previous studies showing a small but significant increase in the risk of developing cardiac malformations among women who started taking ADHD medications before pregnancy. This risk increased during the latter stages of pregnancy when a large number of women stopped taking their medication.
Women who used ADHD medications in the first trimester of their pregnancy were also more likely to experience caesarean section, low Apgar score following delivery, and a baby that required help breathing at birth. However the researchers of the study were unable to eliminate bias due to selection by restricting the study to women who didn't have any other medical issues that could have contributed to these findings.
The researchers hope that their research will help inform the clinical decisions of physicians who see pregnant women. They suggest that although the discussion of risks and benefits is important however, the decision to stop or continue medication should be based on the woman's needs and the severity of her ADHD symptoms.
The authors also warn that while discontinuing the medications is an option, it is not a recommended practice because of the high incidence of depression and other mental health problems for women who are expecting or who are recently post-partum. Further, research shows that women who stop taking their medications will have a harder time adjusting to a life without them after the baby is born.
Nursing
The responsibilities of being a new mother can be overwhelming. Women who suffer from ADHD may face a lot of challenges when they must deal with their symptoms, attend doctor appointments and prepare for the birth of a baby and adjust to new routines. As such, many women elect to continue taking their ADHD medication throughout the pregnancy.
The majority of stimulant drugs are absorbed through breast milk in small amounts, so the risk for breastfeeding infant is minimal. However, the frequency of exposure to medication by the newborn can vary depending on the dosage, frequency it is administered, and the time of day the medication is administered. Additionally, adhd treatment without medication enter the infant's system through the gastrointestinal tract or through breast milk. The impact on the health of a newborn is not fully known.
Some doctors may stop taking stimulant medication during a woman’s pregnancy due to the absence of research. This is a difficult decision for the patient, who must balance the benefits of keeping her medication against the possible dangers to the foetus. Until more information is available, doctors should ask all pregnant patients about their history of ADHD and whether they plan or are taking to take medication during the perinatal time.
A increasing number of studies have revealed that most women can safely continue to take their ADHD medication while they are pregnant and nursing. In response, an increasing number of patients are choosing to do this. They have concluded through consultation with their doctor, that the benefits of keeping their current medication outweigh any risk.
Women who suffer from ADHD who are planning to nurse should seek advice from an expert psychiatrist prior to becoming pregnant. They should review their medications with their physician and discuss the pros and cons 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 root cause, learn about available treatment options and reinforce existing strategies for coping. This should be a multidisciplinary approach with the GPs, obstetricians, and psychiatrists. Pregnancy counseling should consist of a discussion of a treatment plan for the mother and the child, and monitoring for indicators of deterioration, and, if needed adjustments to the medication regime.