ADHD Medication During Pregnancy and Breastfeeding
Women with ADHD must make a difficult decision on whether to keep or stop taking ADHD medication during pregnancy and breast-feeding. There isn't much information on how long-term exposure to these drugs may affect the foetus.
A recent study published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological disorders like hearing loss or vision, febrile seizures or IQ impairment. The authors acknowledge the need for higher-quality studies.
Risk/Benefit Analysis
Pregnant women who take ADHD medications must weigh the benefits of taking them against the potential risks to the fetus. Doctors don't have enough data to give clear advice however they can provide information about risks and benefits to aid pregnant women in making informed choices.
A study published in Molecular Psychiatry found that women who used ADHD medications during early pregnancy did not have a significantly increased risk of fetal cardiac malformations or major structural birth defects. Researchers conducted a massive population-based study of case control to examine the prevalence of major structural defects in infants who were born to mothers who took stimulants during pregnancy. Clinical geneticists and pediatric cardiologists looked over the cases to ensure an accurate case classification and to limit the chance of bias.
The study of the researchers was not without limitations. The researchers were unable to, in the first place, to separate the effects of the medication from the disorder. This limitation makes it difficult for researchers to determine whether the few associations observed between the groups that were exposed to the use of medications, or if they were confounded by the presence of comorbidities. The researchers also did not examine long-term outcomes for the offspring.
The study did show that infants whose mothers had taken ADHD medications during pregnancy were at a greater risk of being admitted to the neonatal intensive care unit (NICU) than infants who whose mothers did not take any medication or cut back on their medications prior to or during pregnancy. This increase was caused by central nervous system disorders. The increased risk of admission was not influenced by the stimulant medication used during pregnancy.
Women who took stimulant ADHD medications during pregnancy also had a higher likelihood of having to have a caesarean section or a baby that scored low on the Apgar scale (less than 7). These risks did not seem to be influenced by the kind of medication used during pregnancy.
Researchers suggest that the small risk of using ADHD medications in early pregnancies could be offset by the greater benefits for baby and mother of continued treatment for the woman's disorder. Physicians should speak with their patients about this and, if possible, help them develop coping strategies that can lessen the impact of her disorder in her daily life and relationships.
Medication Interactions
As more women than ever before are being diagnosed with ADHD and treated with medication, the issue of whether to continue or discontinue treatment during pregnancy is one that more and more doctors have to face. Often, these decisions are made in the absence of clear and authoritative evidence in either case, which means that doctors must weigh their knowledge about their experiences, the experiences of other doctors, and what the research suggests on the subject and their own judgments for each individual patient.
Particularly, the subject of potential risks for the baby can be tricky. Many studies on this issue are based on observational evidence rather than controlled research, and their findings are often contradictory. Additionally, the majority of studies limit their analysis to live births, which could undervalue the serious teratogenic effects that can lead to abortion or termination of the pregnancy. The study presented in this journal club addresses these limitations by analyzing data on live and deceased births.
The conclusion The conclusion: While certain studies have demonstrated a positive association between ADHD medications and the possibility of certain birth defects, others have found no connection and the majority of studies have a neutral or slightly negative impact. In the end, a careful risk/benefit analysis must be done in each case.
For women suffering from ADHD and ADD, the decision to stop taking medication is difficult, if not impossible. In a recent article in 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 those suffering from the disorder. Additionally, the loss of medication may affect the ability to complete jobs and drive safely which are essential aspects of a normal life for many people with ADHD.
She suggests women who are uncertain about whether or not to stop medication in light of their pregnancy should consider educating family members, friends and colleagues about the condition, its impact on daily functioning, and the advantages of staying on the current treatment regimen. It can also help a woman feel more confident in her decision. Certain medications can pass through the placenta. If the patient decides to not take her ADHD medication while pregnant and breastfeeding, it is crucial to be aware that the drug may be transferred to her baby.
Birth Defects and Risk of
As the use and misuse of ADHD medications to treat the symptoms of attention deficit hyperactivity disorder (ADHD) increases as does the concern about the possible effects of the drugs on fetuses. A study that was published in the journal Molecular Psychiatry adds to the body of information on this topic. Researchers utilized two massive data sets to study more than 4.3 million pregnant women and determine whether stimulant medications caused birth defects. Researchers found that while the overall risk is low, first-trimester ADHD medication exposure was associated with slightly higher rates of certain heart defects, like ventriculoseptal defect.
The researchers of the study did not discover any connection between early use of medication and other congenital anomalies like facial deformities, or club feet. The results are in the same vein as previous studies that have shown an insignificant, but small increase in cardiac malformations for women who started taking ADHD medication prior to the time of the time of pregnancy. The risk was higher in the latter half of pregnancy, when a lot of women decide to stop taking their medication.
Women who used ADHD medications in the first trimester of their pregnancies were also more likely to undergo a caesarean section, a low Apgar score after delivery and a baby who needed breathing assistance at birth. The researchers of the study could not eliminate bias due to selection because they restricted the study to women without other medical conditions that might have contributed to the findings.
Researchers hope that their research will provide doctors with information when they encounter pregnant women. They suggest that although the discussion of the risks and benefits is crucial however, the decision to stop or continue treatment 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 that is recommended due to the high incidence of depression and other mental health issues among women who are pregnant or recently post-partum. Further, the research suggests that women who choose to stop their medications are more likely to experience difficulties adapting to life without them following the baby's arrival.
Nursing
The responsibilities of a new mother can be overwhelming. Women suffering from ADHD are often faced with a number of difficulties when they must deal with their symptoms, go to doctor appointments and prepare for the birth of their child and adjust to new routines. Many women choose to continue taking their ADHD medication during pregnancy.
The majority of stimulant drugs are absorbed by breast milk in small amounts, therefore the risk to nursing infant is very low. However, the rate of medication exposure to the newborn can vary depending on dosage, frequency it is administered, and at what time the medication is administered. In addition, various medications are introduced into the baby's system through the gastrointestinal tract, or through breast milk. The impact on the health of a newborn isn't completely understood.
Some physicians may discontinue stimulant medication during a woman’s pregnancy due to the lack of research. This is a difficult choice for the patient, who must balance the benefits of continuing her medication against the possible dangers to the foetus. Until more information becomes available, doctors can ask pregnant patients if they have a history of ADHD or if they intend to take medication during the perinatal stage.
A growing number of studies have shown that most women can safely continue their ADHD medication during pregnancy and breastfeeding. As a result, an increasing number of patients are choosing to do so and, in consultation with their doctor they have discovered that the benefits of continuing their current medication exceed any risk.
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 doctor as well as the pros and cons for continuing treatment. This includes non-pharmacological strategies. Psychoeducation should also be offered to help pregnant people with ADHD understand their symptoms and the underlying disorder, learn about available treatments and to reinforce existing strategies for coping. This should involve a multidisciplinary approach with the GP, obstetricians and psychiatry. adhd and depression medication should consist of a discussion of a treatment plan for the mother and the child, as well as monitoring for indicators of deterioration, and, if needed adjustments to the medication regimen.