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 many studies regarding how exposure over time may affect the fetus.
A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological issues such as hearing loss or vision, febrile seizures or IQ impairment. The authors acknowledge the need for higher-quality research.
Risk/Benefit Analysis
Pregnant women who use ADHD medications need to balance the benefits of taking them against the potential risks to the foetus. Physicians do not have the information needed to provide clear recommendations but they can provide information about risks and benefits that assist pregnant women in making informed decisions.
A study published in Molecular Psychiatry found that women who were taking ADHD medications during early pregnancy did not face a significantly increased risk of fetal heart malformations or major birth defects that are structural. Researchers used a large sample-based case control study to assess the frequency of structural defects that were major in infants born to mothers who were taking stimulants during pregnancy. Clinical geneticists and pediatric cardiologists examined the cases to ensure correct classification of the cases and to reduce the possibility of bias.
The study of the researchers was not without limitations. Researchers were unable in the beginning to distinguish the effects caused by the medication from the disorder. This limitation makes it difficult for researchers to establish whether the few associations observed between the groups exposed were due to medication use or confounded by the presence of comorbidities. Additionally, the researchers did not study long-term offspring outcomes.
The study found that infants whose mother took ADHD medication during pregnancy had a slightly greater risk of being admitted to the neonatal care unit (NICU) as compared to mothers who did not take any medication during pregnancy or had stopped taking their medication before or during pregnancy. This was due to central nervous system-related disorders and the increased risk for admission was not found to be affected by the type of stimulant medications were taken during pregnancy.
Women who were taking stimulant ADHD medication during pregnancy also had an increased chance of having a caesarean section or having a child with an low Apgar score (less than 7). These increases did not appear to be influenced by the kind of medication used during pregnancy.
Researchers suggest that the small risks associated with the use ADHD medications in early pregnancies can be offset by greater benefits for mother and baby from continuing treatment for the woman's disorder. Doctors should discuss with their patients about this issue and, if possible, help them develop coping strategies that can lessen the effects of her disorder on her daily life and relationships.
Medication Interactions
Doctors are increasingly confronted with the dilemma of whether to keep treatment or stop during pregnancy as more women are diagnosed with ADHD. These decisions are usually made without clear and reliable evidence. Instead, doctors must consider their own expertise and experience, as well as the experiences of other doctors, and the research on the topic.
The issue of potential risks to the infant can be particularly tricky. The research on this subject is based on observation rather than controlled studies, and a lot of the results are conflicting. Additionally, the majority of studies limit their analysis to live births, which may underestimate the severity of teratogenic effects that could result in abortion or termination of the pregnancy. The study presented in the journal club addresses these limitations by analyzing the data from deceased and live births.
Conclusion Some studies have revealed a positive correlation between ADHD medications and certain birth defects However, other studies haven't found a correlation. Most studies have shown that there is a neutral, or slightly negative, effect. In every case an in-depth evaluation of the risks and benefits is required.
For women suffering from ADHD who suffer from ADHD, the decision to stop medication can be difficult, if not impossible. 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 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 which are essential aspects of a normal life for a lot of people with ADHD.
She recommends women who are uncertain about whether to keep or stop medication in light of their pregnancy, consider educating family members, friends and colleagues on the condition, its effects on daily functioning, and the advantages of continuing the current treatment plan. Educating them can also aid in ensuring that the woman feels supported when she is struggling with her decision. It is also worth noting that certain medications can pass through the placenta, so if a woman decides to stop her ADHD medication during pregnancy and breastfeeding, she must be aware of the possibility that traces of the drug could be transferred to the infant.
Risk of Birth Defects
As the use and abuse of ADHD medication to treat symptoms of attention deficit hyperactivity disorder (ADHD), increases the concern over the potential effects of these drugs on the fetuses. Recent research published in the journal Molecular Psychiatry has added to the body knowledge on this subject. Researchers used two massive datasets to analyze more than 4.3 million pregnancies and determine if the use of stimulant medications increased the risk of birth defects. Researchers discovered that although the risk overall is low, first-trimester ADHD exposure to medication was associated with slightly higher risk of specific heart defects such as ventriculoseptal defect.
The researchers of the study found no connection between the use of early medications and other congenital anomalies, like facial clefting, or club foot. The results are in line with previous studies which showed an insignificant, but small increase in cardiac malformations for women who started taking ADHD medication before pregnancy. This risk increased during the latter part of pregnancy, when a lot of women are forced to stop taking their medication.
Women who used ADHD medications in the first trimester of their pregnancies were also more likely to undergo caesarean sections, a low Apgar score following delivery, and a baby who required breathing assistance at birth. The authors of the study could not eliminate bias due to selection because they restricted read more the study to women with no other medical conditions that could have contributed to the findings.
Researchers hope that their research will inform physicians when they meet pregnant women. They suggest that although a discussion of risks and benefits is important however, the decision to stop or keep medication should be based on the woman's requirements and the severity of her ADHD symptoms.
The authors also caution that even though stopping the medication is an option, it isn't an option to consider due to the high rate of depression and other mental health issues among women who are pregnant or who are recently post-partum. Furthermore, research suggests that women who decide to stop taking their medication are more likely to have difficulties adapting to life without them after the baby's arrival.
Nursing
It can be a challenge to become a mom. Women who suffer from ADHD may face a lot of challenges when they have to manage their symptoms, attend doctor appointments and prepare for the birth of their child and adjust to new routines. This is why many women choose to continue taking their ADHD medications throughout the course of pregnancy.
The majority of stimulant drugs are absorbed through breast milk in very small quantities, so the risk to the nursing infant is very low. The rate of exposure to medication will vary based on the dosage and frequency of administration as well as time of day. Additionally, different medications enter the baby's system differently through the gastrointestinal tract and breast milk. The impact of this on a newborn is not fully known.
Due to the absence of research, some physicians might be tempted to stop taking stimulant medication during a woman's pregnancy. It is a difficult decision for the mother, who must weigh the benefits of continuing her medication against the risk to the fetus. As long as more information is available, doctors can ask pregnant patients if they have an history of ADHD or if they are planning to take medication during the perinatal stage.
A increasing number of studies have shown that women can continue to take their ADHD medication during pregnancy and breastfeeding. In the end, more and more patients are choosing to do so and, after consulting with their doctor, they have found that the benefits of continuing their current medication far exceed any risk.
It is essential for women with ADHD who are considering breastfeeding to seek a specialist psychiatrist's advice prior becoming pregnant. They should discuss the medication they are taking with their physician, and the pros and cons for continuing treatment. This includes non-pharmacological methods. Psychoeducation is also required to help women with ADHD be aware of their symptoms and the underlying disorder Learn about the available treatment options and reinforce existing coping strategies. This should be a multidisciplinary process including obstetricians, GPs, and psychiatrists. Counselling for pregnancy should include the discussion of a plan for management for both mother and child, as well as monitoring for signs of deterioration, and, if necessary, adjustments to the medication regimen.