ADHD Medication During Pregnancy and Breastfeeding
The decision to stop or keep ADHD medications during pregnancy and breastfeeding is a difficult decision for women suffering from the condition. There is a lack of information about how long-term exposure to these medications could affect the fetus.
A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication during utero do not develop neurological disorders such as impaired vision or hearing seizures, febrile seizures, or IQ impairment. The authors acknowledge that further high-quality studies are required.
Risk/Benefit Analysis
Pregnant women who use ADHD medications must weigh the advantages of using them against the risks to the fetus. Physicians don't have the information needed to give clear guidelines but they can provide information about the risks and benefits to assist pregnant women in making informed choices.
A study published in Molecular Psychiatry concluded that women who took ADHD medication in early pregnancy were not at a greater risk of fetal malformations, or structural birth defects. Researchers conducted a large population-based study of case-control to determine the prevalence of major structural birth defects in infants born to mothers who took stimulants during the early stages of pregnancy, as well as those who had not. Clinical geneticists and pediatric cardiologists reviewed the cases to ensure accurate classification of the cases and to reduce the possibility of bias.
The research conducted by the researchers had some limitations. The researchers were unable, in the first place to differentiate the effects triggered by the medication from the disorder. That limitation makes it difficult to know whether the limited associations observed in the groups that were exposed are due to medication use or the confounding effect of comorbidities. Researchers also did not examine long-term outcomes for the offspring.
The study found that infants whose mother had taken ADHD medication during pregnancy were at a slightly higher chance of being admitted to the neonatal care unit (NICU), compared to those whose mothers didn't take any medication during pregnancy or had stopped taking their medication before or during pregnancy. This increase was due to central nervous system-related disorders and the higher risk of admission did not appear to be influenced by the stimulant medication was used during pregnancy.
Women who were taking stimulant ADHD medications during pregnancy also had a higher chance of having to have caesarean sections or one whose baby scored low on the Apgar scale (less than 7). These risks did not appear to be affected by the type of medication that was used during pregnancy.
The researchers suggest that the risk of a small amount with the use of ADHD medications during early pregnancy may be offset by the higher benefit to both the mother and child from continued treatment for the woman's disorder. Physicians should speak with their patients about this and, if possible, help them develop coping strategies that may reduce the effects of her disorder on her daily functioning and her relationships.
Medication Interactions
As more women than ever are being diagnosed with ADHD and treated with medication, the issue of whether to continue or stop treatment during pregnancy is a question that more and more doctors confront. The majority of these decisions are made in the absence of clear and authoritative evidence regardless, so doctors must weigh their knowledge about their experiences, the experiences of other doctors, and what research suggests about the subject as well as their own best judgment for each patient.
The issue of possible risks to infants is difficult to determine. Many studies on this topic are based on observations instead of controlled research and their findings are often contradictory. 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 the journal club addresses these issues, by examining both information on deceased and live births.
The conclusion: While some studies have found that there is a positive correlation between ADHD medications and the risk of certain birth defects, other studies have found no connection, and most studies have a neutral or slightly negative effect. As a result, a careful risk/benefit analysis must be done in each instance.
It can be difficult, if not impossible, for women with ADHD to stop taking their medication. In fact, in an article recently published in Archives of Women's Mental Health, psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can lead to increased depression, feelings of loneliness and family conflict for patients with ADHD. In addition, a decrease in medication can interfere with the ability to do work-related tasks and safely drive, which are important aspects of a normal life for many people with ADHD.
She recommends women who are uncertain about whether or not to stop taking medication because of their pregnancy should consider informing family members, friends and colleagues on the condition, its impact on daily functioning, and on the advantages of continuing the current treatment plan. It can also make the woman feel more comfortable in her struggle with her decision. It is important to remember that some medications can be absorbed 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 can be transferred to the child.
Birth Defects and Risk of
As the use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) grows, so do concerns over the impact that these drugs might have on foetuses. Recent research published in the journal Molecular Psychiatry has added to the body knowledge on this subject. With two massive data sets researchers were able to 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 discovered that the first-trimester exposure to ADHD medications was linked to an increase in the risk of certain heart defects, such as ventriculoseptal defect (VSD).
The authors of the study could not discover any link between early use of medication and other congenital anomalies, like facial deformities or club feet. The findings are in line with previous studies revealing the presence of 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 in the later part of pregnancy, when many women are forced to stop taking their ADHD medication.
Women who were taking ADHD medication during the first trimester were more likely require a caesarean delivery or have an insufficient Apgar after delivery, and have a baby that needed breathing assistance at birth. The authors of the study could not eliminate bias due to selection because they limited the study to women without 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. The researchers advise that, while discussing the risks and benefits are important, the decision on whether to continue or stop medication should be made according to the severity of each woman's ADHD symptoms and her requirements.
The authors caution that, although stopping the medication is a possibility to consider, it is not recommended due to the high prevalence of depression and other mental disorders in women who are expecting or recently gave birth. Additionally, research suggests that women who stop taking their medications will have a harder transitioning to life without them once the baby is born.
Nursing
It can be a challenge becoming a mother. Women who suffer from ADHD are often faced with a number of difficulties when they have to manage their symptoms, attend doctor appointments and prepare for the birth of their child and adjust to a new routine. This is why many women choose to continue taking their ADHD medications throughout pregnancy.
The majority of stimulant medications are absorbed through breast milk in very small quantities, so the risk to the nursing infant is very low. The amount of exposure to medications can vary depending upon the dosage the medication is administered, its frequency and the time of day. In addition, various medications enter the baby’s system through the gastrointestinal tract or breast milk. The effect on the health of a newborn isn't completely comprehended.
Because of the lack of research, some physicians may recommend stopping stimulant medications during the pregnancy of a woman. It's a difficult choice for the woman who must weigh the benefits of taking her medication as well as the potential risks to the foetus. Until more information becomes available, GPs can inquire about pregnant patients if they have an history of ADHD or if they plan to take medication during the perinatal check here stage.
A increasing number of studies have shown that women can continue their ADHD medication while they are pregnant and nursing. As a result, many patients choose to do so and, in consultation with their doctor they have discovered that the benefits of continuing their current medication outweigh any risks.
It's important for women with ADHD who are contemplating breastfeeding to seek a specialist psychiatrist's guidance prior to becoming pregnant. They should discuss their medication with their doctor and discuss the pros and cons of continued treatment, including non-pharmacological management strategies. Psychoeducation should also be provided to help women with ADHD understand their symptoms and underlying disorder Learn about the available treatment options and strengthen existing strategies for managing. This should include an approach that is multidisciplinary, including the GP, obstetricians and psychiatry. Pregnancy counseling should consist of a discussion of a treatment plan for the mother as well as the child, as well as monitoring for signs of deterioration and, if necessary modifications to the medication regimen.