ADHD Medication During Pregnancy and Breastfeeding
The decision to stop or continue ADHD medication during breastfeeding and pregnancy is challenging for women with the condition. There aren't many studies on how exposure to ADHD for a long time could affect a fetus.
A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication during utero do not develop neurological conditions like hearing loss or impaired vision seizures, febrile seizures or IQ impairment. The authors acknowledge that further high-quality studies are required.
Risk/Benefit Analysis
Women who are pregnant and taking ADHD medication must consider the benefits of taking it against the possible risks to the foetus. Doctors don't have enough data to provide clear recommendations, but can provide information on the risks and benefits to aid pregnant women in making informed decisions.
A study published in Molecular Psychiatry found that women who used ADHD medications during early pregnancy did not face an increased risk of fetal cardiac malformations or major structural birth defects. Researchers conducted a large sample-based case control study to compare the incidence of structural defects that were major in infants who were born to mothers who were taking stimulants during pregnancy. Clinical geneticists and pediatric cardiologists examined the cases to ensure accurate case classification and to limit the possibility of bias.
The study conducted by the researchers was not without its limitations. The researchers were unable to, in the first place to distinguish the effects triggered by the medication from the disorder. This makes it difficult for researchers to establish whether the few associations observed between the groups exposed were due to the use of medication, or if they were confounded by co-morbidities. In addition the study did not examine the long-term effects of offspring on their parents.
The study found that babies whose mothers had taken ADHD medication during pregnancy had a greater risk of being admitted to the neonatal care unit (NICU) in comparison to those whose mothers did not use any medication during pregnancy or had stopped taking their medication before or during pregnancy. This increase was caused by central nervous system disorders. The higher 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 an emergency caesarean section or having one whose baby scored low on the Apgar scale (less than 7). These increases appeared to be independent of the type of medication taken during pregnancy.
Researchers suggest that the minor risk of using ADHD medications in early pregnancies can be offset by greater benefits to both mother and baby of continuing treatment for the woman's condition. Physicians should talk to their patients about this and, if possible, help them develop coping skills that can lessen the effects of her disorder on her daily functioning and her relationships.
Medication Interactions
More and more doctors are faced with the decision of whether to continue treatment or stop during pregnancy as more women are diagnosed with ADHD. These decisions are often made without clear and reliable evidence. Instead, doctors have to weigh their own knowledge in conjunction with the experiences of other physicians and the research on the subject.
Particularly, the subject of possible risks to the baby can be a challenge. A lot of studies on this issue are based on observations instead of controlled research and their findings are often contradictory. In addition, most studies limit their analysis to live births, which can underestimate severe teratogenic effects that lead to abortion or termination of the pregnancy. The study that is discussed in this journal club addresses these issues by examining data on both live and deceased births.
Conclusion A few 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 slight negative impact. In each case an in-depth evaluation of the benefits and risks should be conducted.
It isn't easy, but 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. The loss of medication can affect the ability to safely drive and complete work-related tasks, which are crucial aspects of daily life for those suffering from ADHD.
She suggests women who are uncertain about whether or not to stop medication in light of their pregnancy, consider informing family members, friends and colleagues about the condition, its effects on daily functioning, and the advantages of continuing the current treatment plan. It can also make the woman feel more comfortable as she struggles with her decision. It is also worth noting that certain medications are able to be absorbed through the placenta so if a woman decides to stop her ADHD medication during pregnancy and breastfeeding, she should 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 medications could have on fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge regarding this topic. Using two massive data sets researchers were able to examine more than 4.3 million pregnancies to determine whether stimulant medication use increased the risk of birth defects. Researchers found that while the risk overall is low, first-trimester ADHD exposure to medication was associated with slightly higher risk of specific heart defects like ventriculoseptal defect.
The researchers of the study didn't find any association between early use of medication and other congenital anomalies such as facial deformities or club feet. The results are in line with previous studies showing the presence of a small, but significant increase in the risk of developing cardiac malformations among women who started taking ADHD medications prior to the time of the time of pregnancy. This risk increased in the later part of pregnancy, as many women decide to stop taking their ADHD medication.
Women who were taking ADHD medication in the first trimester were more likely to require a caesarean delivery or have an insufficient Apgar after delivery and have a baby who needed breathing assistance after birth. how to treat adhd without medication in adults of the study could not remove bias in selection since they limited the study to women without other medical conditions that could have contributed to the findings.
The researchers hope their research will help inform the clinical decisions of doctors who encounter pregnant women. They recommend that, while a discussion of the risks and benefits is crucial, the decision to stop or maintain 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 a possibility to look into, it is not advised due to the high rate depression and other mental disorders for women who are pregnant or have recently given birth. Furthermore, research suggests that women who choose to stop their medications are more likely to experience difficulties getting used to life without them after the baby's arrival.
Nursing
It can be a stressful experience to become a mother. Women who suffer from ADHD who must work through their symptoms while attending doctor appointments, making preparations for the arrival of a baby and adjusting to new household routines can experience severe challenges. As such, many women elect to continue taking their ADHD medications throughout pregnancy.
The majority of stimulant medications pass through breast milk in small amounts, so the risk to the nursing infant is very low. However, the amount of exposure to medications by the newborn can vary depending on the dosage, frequency it is administered, and the time of the day it is administered. Additionally, individual medications enter the baby's system differently through the gastrointestinal tract as well as breast milk, and the effect of this on a newborn is not yet fully understood.
Due to the absence of evidence, some doctors may recommend stopping stimulant drugs during the course of pregnancy. It's a difficult choice for the mother, who must weigh the advantages of her medication against the risks to the fetus. Until more information becomes available, doctors may ask pregnant patients whether they have a background of ADHD or if they are planning to take medication in the perinatal period.
A increasing number of studies have revealed that the majority of women are able to safely continue to take their ADHD medication while they are pregnant and nursing. This has led to an increasing number of patients opt to do this, and in consultation with their physician, they have discovered that the benefits of maintaining their current medication outweigh any potential risks.
Women with ADHD who plan to breastfeed should seek advice from a specialist psychiatrist before becoming pregnant. They should discuss their medication with their doctor and discuss the advantages and disadvantages of continuing treatment, including non-pharmacological strategies. Psychoeducation should also be provided to help pregnant women suffering from ADHD recognize their symptoms and the underlying disorder, learn about available treatments and to reinforce existing coping strategies. This should be a multidisciplinary process with the GPs, obstetricians, and psychiatry. The pregnancy counselling should consist of the discussion of a treatment plan for both the mother and child, monitoring for signs of deterioration, and when necessary, making adjustments to the medication regimen.