ADHD Medication During Pregnancy and Breastfeeding
Women suffering from ADHD face a difficult decision about whether to continue or stop taking ADHD medication during pregnancy and breast-feeding. There aren't enough data on how exposure to ADHD for a long time could affect a fetus.
A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological disorders such as impaired hearing or vision, febrile seizures or IQ impairment. The authors acknowledge the need for higher-quality studies.
Risk/Benefit Analysis
Pregnant women who use ADHD medications need to balance the benefits of taking them against the potential risks to the fetus. The doctors don't have the information to give clear advice, but can provide information about risks and benefits to aid pregnant women in making informed choices.
A study published in Molecular Psychiatry concluded that women who were taking ADHD medication in early pregnancy did not have a greater risk of fetal malformations or structural birth defects. Researchers used a large population-based case control study to examine the prevalence of structural defects that were major in infants born to mothers who took stimulants during pregnancy. Clinical geneticists, pediatric cardiologists and other experts looked over the cases to ensure that the classification was correct and to reduce any bias.
However, the study was not without its flaws. In particular, they were unable to separate the effects of the medication from the effects of the disorder at hand. This limitation makes it difficult for researchers to determine if the few associations observed between the exposed groups were due to medication use, or if they were caused by comorbidities. In addition the study did not look at the long-term outcomes of offspring.
The study did reveal that babies whose mothers had taken ADHD medications during pregnancy were at a more risk of being admitted to the neonatal intensive care unit (NICU) than those who whose mothers did not take any medication or had cut back on their medications prior to or during pregnancy. The reason for this was central nervous system-related disorders and the increased risk for admission was not found to be affected by the type of stimulant medications were used during pregnancy.
Women who took stimulant ADHD medications during pregnancy also had a higher risk 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 appeared to be independent of the type of medication used during pregnancy.
Researchers suggest that the minor risks posed by the use of ADHD medications in early pregnancies can be offset by greater benefits for mother and baby from continuing treatment for the woman’s disorder. source for this article should discuss with their patients about this and as much as possible, assist them develop coping skills that may reduce the effects of her disorder on her daily life and relationships.
Medication Interactions
As more women than ever before are being diagnosed with ADHD and being treated with medication, the question of whether or not to discontinue treatment during pregnancy is a question that doctors are having to confront. These decisions are usually taken without clear and authoritative evidence. Instead, physicians must consider their own expertise, the experience of other doctors, and the research on the subject.
Particularly, the subject of potential risks for the infant can be difficult. The research on this subject is based on observations instead of controlled studies and a lot of the results are in conflict. Most studies focus on live births, which may underestimate the teratogenic impact that can lead to terminations or abortions of pregnancy. The study that is discussed in this journal club addresses these limitations by analyzing data on live and deceased births.
Conclusion Some studies have revealed an association between ADHD medications and certain birth defects, other studies have not established a link. The majority of studies show an unintended, or slight negative effect. In each case an in-depth study of the risks and benefits must be performed.
It can be difficult, if not impossible, for women with ADHD to stop taking their medication. In a recent article 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 decrease in medication could also affect the ability to drive safely and perform work-related tasks, which are vital aspects of daily life for those suffering from ADHD.
She suggests that women who are unsure whether to continue taking the medication or stop it due to their pregnancy educate family members, coworkers and acquaintances about the condition, the effects on daily functioning, and the advantages of staying on the current treatment plan. It will also help a woman feel more confident in her decision. It is important to remember that some drugs can be absorbed through the placenta so if the patient decides to stop her ADHD medication during pregnancy and breastfeeding, she should be aware that the effects of the drug could be transferred to the infant.
Birth Defects and Risk of
As the use and use of ADHD drugs to treat symptoms of attention deficit disorder hyperactivity disorder (ADHD) is increasing the concern over the potential effects of these drugs on foetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge regarding this topic. Utilizing two huge 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. Researchers found that while the overall risk is low, the 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 didn't discover any connection between early medication usage and other congenital anomalies like facial deformities or club feet. The results are in line with previous studies which showed the existence of a slight, but significant increase in cardiac malformations for women who began taking ADHD medication before the time of pregnancy. The risk grew in the later part of pregnancy, as many women decide to stop taking their ADHD medications.
Women who were taking ADHD medication during the first trimester were more likely to require a caesarean delivery, have an insufficient Apgar after delivery, and have a baby that needed help breathing when they were born. The researchers of the study were not able to eliminate selection bias because they restricted the study to women who did not have any other medical conditions that might have contributed to the findings.
The researchers hope that their research will serve to inform the clinical decisions of doctors who treat pregnant women. They recommend that, while discussing risks and benefits is important but the decision to stop or continue medication should be based on the woman's needs and the severity of her ADHD symptoms.
The authors caution that, although stopping the medication is an option to consider, it is not advised because of the high incidence of depression and other mental disorders for women who are pregnant or have recently given birth. Further, the research suggests that women who choose to stop taking their medications are more likely to have a difficult time adjusting to life without them following the birth of their baby.
Nursing
The responsibilities of a new mother can be overwhelming. Women who suffer from ADHD who have to manage their symptoms while attending doctor appointments as well as preparing for the arrival of their child and getting used to new routines at home may face a lot of challenges. Many women choose to continue taking their ADHD medication during pregnancy.
The risk for nursing infant is low because the majority of stimulant medication is absorbed through breast milk at a low level. However, the rate of exposure to medications by the newborn can vary depending on dosage, how often it is administered and the time of day the medication is administered. In addition, various drugs enter the infant's system via the gastrointestinal tract, or through breast milk. The effect on the health of a newborn is not completely known.
Some doctors may decide to stop stimulant medication during a woman’s pregnancy due to the lack of research. It's a difficult choice for the woman who must weigh the benefits of taking her medication as well as the risks to the embryo. As long as there is no more information, doctors should inquire with all pregnant patients about their experience with ADHD and whether they plan or are taking to take medication during the perinatal period.
Many studies have shown that women can continue to take their ADHD medication safely during pregnancy and breast-feeding. In the end, many patients opt to do this and in consultation with their physician, they have found that the benefits of continuing their current medication far outweigh any risks.
Women who suffer from ADHD who are planning to breastfeed should seek the advice of a specialist psychiatrist before becoming pregnant. They should discuss their medication with their physician and discuss the advantages and disadvantages of continued treatment, including non-pharmacological management strategies. Psychoeducation should also be provided to help women with ADHD recognize their symptoms and the root cause Learn about the available treatments and to reinforce existing coping strategies. This should involve an approach that is multidisciplinary, including the GP, obstetricians and psychiatry. Pregnancy counseling should include discussion of a treatment plan for the mother and the child, as well as monitoring for signs of deterioration and, if necessary, adjustments to the medication regime.