ADHD Medication During Pregnancy and Breastfeeding
Women with ADHD face a difficult decision about whether to continue or stop taking ADHD medication during pregnancy and breast-feeding. There aren't enough medication for adhd on how exposure to ADHD for a long time could affect the fetus.
A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus don't develop neurological conditions like hearing or vision impairment seizures, 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 need to weigh the benefits of taking it versus the risks to the baby. Doctors don't have enough data to make unambiguous recommendations but they can provide information about risks and benefits to assist pregnant women to make informed choices.
A study published in Molecular Psychiatry found that women who used ADHD medications during their early pregnancy did not face a significantly increased risk of fetal heart 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 used stimulants during pregnancy. Pediatric cardiologists, clinical geneticists and other experts looked over the cases to make sure that the classification was correct and to minimize any bias.
However, the researchers' study was not without its flaws. The researchers were not able to, in the first place to differentiate the effects caused by the medication from the disorder. This limitation makes it difficult for researchers to determine whether the few associations observed between the exposed groups were due to the use of medications or caused by co-morbidities. Additionally, the researchers did not look at long-term offspring outcomes.
The study did reveal that infants whose mothers had taken ADHD medications during pregnancy were at a more risk of being admitted to the neonatal intensive care unit (NICU) than infants who were born without any medication or had cut back on their medications prior to or during pregnancy. This was due to central nervous system disorders. The increased risk of admission was not influenced by the stimulant medications used during pregnancy.
Women who took stimulant ADHD medications during pregnancy also had a higher likelihood of having to have an emergency caesarean section or having the baby was not scoring well on the Apgar scale (less than 7). These increases did appear to be unrelated to the type of medication taken during pregnancy.
The researchers suggest that the small risk associated with the use of ADHD medications during the early stages of pregnancy could be offset by the higher benefit to both mother and child from continued treatment for the woman's disorder. Doctors should discuss with their patients about this issue and as much as possible, assist them develop coping strategies that can lessen the impact of her disorder in her daily functioning and her relationships.
Medication Interactions
Doctors are increasingly confronted with the dilemma of whether to maintain treatment or stop it during pregnancy as more women are diagnosed with ADHD. These decisions are often taken without clear and authoritative evidence. Instead, physicians must consider their own expertise and experience, as well as the experiences of other doctors, and the research on the topic.
The issue of possible risks to the infant can be extremely difficult. Many studies on this topic are based on observational data instead of controlled research and their findings are often contradictory. The majority of studies focus on live-births, which could underestimate the teratogenic impact leading to terminations or abortions of pregnancy. The study discussed in the journal club addresses these shortcomings, by examining both information on deceased and live births.
Conclusion: While some studies have revealed a positive correlation between ADHD medications and certain birth defects However, other studies haven't established a link. Most studies show an unintended, or slight negative impact. In all cases it is imperative to conduct a thorough evaluation of the benefits and risks should be conducted.
For a lot of women with ADHD, the decision to stop taking medication is difficult, if not impossible. In a recent piece published in Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can cause depression and feelings of loneliness. A loss of medication may also affect the ability to drive safely and to perform work-related tasks which are essential aspects of everyday life for people with ADHD.
She recommends women who are uncertain about whether to continue or discontinue medication due to their pregnancy should consider informing family members, friends, and coworkers on the condition, its effects on daily life, and the advantages of continuing the current treatment regimen. It will also help a woman feel confident about her decision. Certain medications can pass through the placenta. If a woman decides not to take her ADHD medication while pregnant and breastfeeding, it's important to be aware that the medication could be transferred to the infant.
Risk of Birth Defects
As the use and misuse of ADHD medication to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases the concern over the possible effects of the drugs on fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge on this issue. Using two massive data sets researchers were able examine more than 4.3 million pregnancies and determine whether the use of stimulant medications increased the risk of birth defects. While the overall risk remains low, the researchers found that exposure in the first trimester to ADHD medications was linked to a slightly higher rate of certain heart defects, such as ventriculo-septal defect (VSD).
The authors of the study did not discover any connection between the use of early medications and other congenital anomalies, such as facial deformities or club feet. The results are consistent with previous studies showing a small but significant increase in the risk of heart malformations in women who started taking ADHD medications prior to the birth of their child. This risk increased during the latter stages of pregnancy when a large number of women stopped taking their medication.
Women who took ADHD medications in the first trimester of their pregnancy were also more likely to experience a caesarean section, a low Apgar score following delivery, and a baby who required help breathing at birth. The authors of the study were not able to eliminate selection bias because they limited their 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 advise that while discussing the benefits and risks is important but the decision to stop or continue treatment should be based on the woman's needs and the severity of her ADHD symptoms.
The authors warn that, while stopping the medication is an option to look into, it is not recommended due to the high rate depression and mental health issues among women who are pregnant or have recently given birth. Further, the research suggests that women who choose to stop taking their medication are more likely to have difficulties getting used to life without them following the birth of their baby.
Nursing
The responsibilities of a new mom can be overwhelming. Women suffering from 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 a new routine. Many women choose to continue taking their ADHD medication during pregnancy.
The majority of stimulant medications are absorbed through breast milk in low quantities, so the risk to nursing infant is very low. However, the rate of exposure to medications by the newborn may differ based on the dosage, frequency it is administered, and at what time the medication is administered. Additionally, different drugs enter the infant's system through the gastrointestinal tract, or through breast milk. The effect on the health of a newborn is not fully known.
Some doctors may decide to stop stimulant medication during a woman’s pregnancy due to the absence of research. It's a difficult choice for the mother, who must weigh the advantages of taking her medication as well as the potential risks to the fetus. Until more information is available, doctors should ask all pregnant patients about their history of ADHD and if they are taking or planning to take medication during the perinatal time.
Numerous studies have demonstrated that women can continue taking their ADHD medication without risk while breastfeeding and during pregnancy. In response, a growing number of patients are opting to do this. They have discovered, in consultation with their doctors that the benefits of retaining their current medication outweigh potential risks.
It is essential for women with ADHD who are thinking of breastfeeding to seek out a specialist psychiatrist's advice prior becoming pregnant. They should discuss their medication with their physician and discuss the advantages and disadvantages of continuing treatment, including non-pharmacological strategies. Psychoeducation is also needed to help pregnant women suffering from ADHD understand the symptoms and underlying disorder. They should also learn about treatment options and reinforce strategies for coping. This should be a multidisciplinary process together with obstetricians, GPs, and psychiatrists. Counselling for pregnancy should include the discussion of a treatment plan for both the mother as well as the child, and monitoring for signs of deterioration, and when necessary, making adjustments to the medication regimen.