ADHD Medication During Pregnancy and Breastfeeding
Women with ADHD must make a difficult decision about whether to continue or stop taking ADHD medication during pregnancy and breastfeeding. Little data exists about how long-term exposure to these medications may affect the foetus.
A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication during the uterus do not develop neurological disorders like hearing loss or impaired vision seizures, febrile seizures, or IQ impairment. The authors acknowledge the need for higher-quality studies.
Risk/Benefit Analysis
Women who are pregnant and taking ADHD medication should consider the benefits of taking it versus the dangers for the fetus. Physicians don't have the data to make unambiguous recommendations however they can provide information about risks and benefits to help pregnant women make informed decisions.
A study published in Molecular Psychiatry concluded that women who were taking ADHD medication during early pregnancy did not have a higher risk of fetal malformations, or structural birth defects. The researchers used a large population-based study of case-control to evaluate the incidence of major structural birth defects in babies born to mothers who had taken stimulants in early pregnancy and those who had not. Clinical geneticists and pediatric cardiologists examined the cases to ensure accurate classification of the cases and to reduce the possibility of bias.
However, the study had its limitations. The most important issue was that they were not able to differentiate the effects of the medication from those of the disorder that is underlying. That limitation makes it difficult to know whether the small differences observed in the exposed groups are due to the use of medication or confounding by comorbidities. In addition the researchers did not look at long-term offspring outcomes.
The study did reveal that infants whose mothers took ADHD medication during pregnancy were at a higher 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-related disorders, and the increased risk for admission was not found to be influenced by which stimulant medications were taken during pregnancy.
Women who were taking stimulant ADHD medications during pregnancy also had a higher risk of having caesarean sections or one whose baby scored low on the Apgar scale (less than 7). These increases did appear to be unrelated to the type of medication used during pregnancy.
The research suggests that the low risk associated with the use of ADHD medications during early pregnancy could be offset by the greater benefit to both mother and child from continued treatment for the woman's condition. Doctors should discuss with their patients about this and, if possible, help them improve coping skills which could reduce the impact of her disorder in her daily functioning and her relationships.
Interactions with Medication
More and more doctors are confronted with the dilemma of whether to continue treatment or stop it during pregnancy as more women are diagnosed with ADHD. Often, these decisions are made without any evidence that is clear and definitive regardless, so doctors must weigh their knowledge, the experiences of other doctors, and what research says on the topic as well as their own best judgment for each patient.
Particularly, the subject of possible risks to the baby can be a challenge. The research that has been conducted on this topic is based on observation instead of controlled studies and a lot of the results are in conflict. Additionally, the majority of studies limit their analysis to live births, which can undervalue the serious teratogenic effects that can cause abortion or termination of the pregnancy. The study presented in this journal club addresses these limitations by looking at data from both live and deceased births.
Conclusion Some studies have shown a positive correlation between ADHD medications and certain birth defects, other studies have not established a link. The majority of studies show that there is a neutral, or somewhat negative, impact. As a result, a careful risk/benefit assessment must be conducted in every instance.
For women suffering from ADHD and ADD, the decision to stop taking medication can be difficult, if not impossible. In adhd medication uk buy online 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 those suffering from the disorder. Furthermore, a loss of medication can affect the ability to do job-related tasks and drive safely which are essential aspects of daily life for many people with ADHD.
She suggests that women who are not sure whether to continue taking the medication or stop due to pregnancy educate family members, coworkers, and friends about the condition, the impact on daily functioning and the benefits of continuing the current treatment plan. It can also make the woman feel more comfortable when she is struggling with her decision. Certain medications can pass through the placenta. If a patient decides to not take her ADHD medication while pregnant and breastfeeding, it's important to be aware that the drug could be passed on to her baby.
Risk of Birth Defects
As the use and abuse of ADHD medication to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases, so does concern about the potential adverse effects of the drugs on fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge on this topic. With two massive data sets researchers were able to look at more than 4.3 million pregnancies to determine whether stimulant medication use increased the risk of birth defects. While the overall risk remains low, the scientists found that exposure in the first trimester to ADHD medicines was associated with an increase in the risk of certain heart defects such as ventriculo-septal defect (VSD).
The researchers of the study found no connection between the use of early medications and other congenital abnormalities, such as facial clefting or club foot. The results are in line with previous studies which showed an insignificant, but small increase in cardiac malformations for women who began taking ADHD medication prior to the time of pregnancy. The risk was higher in the later part of pregnancy, when a lot of women are forced to stop taking their medication.
Women who took ADHD medication in the first trimester were more likely require a caesarean delivery and also have a low Apgar after delivery and had a baby that required help breathing after birth. The authors of the study could not remove bias in selection since they limited the study to women with no other medical conditions that might have contributed to the findings.
The researchers hope their research will serve to inform the clinical decisions of physicians who see pregnant women. They recommend that, while a discussion of the benefits and risks is important however, the decision to stop or keep treatment should be based on each woman's needs and the severity of her ADHD symptoms.
The authors warn that, while stopping the medication is an option to think about, it isn't recommended due to the high prevalence of depression and mental health issues among women who are pregnant or have recently given birth. Additionally, research suggests that women who stop taking their medications will have a difficult transitioning to life without them once the baby is born.
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 and making preparations for the arrival of a child and adjusting to new household routines can experience severe challenges. Therefore, many women decide to continue taking their ADHD medication throughout the pregnancy.
The majority of stimulant medicines are absorbed through breast milk in very small quantities, so the risk for infant who is breastfeeding is low. However, the rate of medication exposure to the newborn can vary depending on the dosage, frequency it is administered and the time of the day it is administered. In addition, individual medications enter the infant's system differently through the gastrointestinal tract as well as breast milk and the impact of this on a newborn isn't well known.
Some doctors may stop taking stimulant medications during a woman's pregnancy due to the lack of research. This is a difficult choice for the patient, who must weigh the benefit of continuing her medication with the potential risks to the embryo. Until more information is available, doctors should inquire with all pregnant patients about their history of ADHD and whether they are taking or planning to take medication during the perinatal period.
Many studies have shown that women can continue to take their ADHD medication without risk while breastfeeding and during pregnancy. In response, a rising number of patients are choosing to continue their medication. They have discovered after consulting with their physicians, that the benefits of keeping their current medication outweigh any risk.
It is crucial for women suffering from ADHD who are thinking of breastfeeding to seek a specialist psychiatrist's advice prior becoming pregnant. They should review their medications with their physician and discuss the pros and cons of continued treatment, including non-pharmacological strategies. Psychoeducation is also required to help pregnant women with ADHD understand the symptoms and the underlying disorder. They should also learn about treatment options and build the coping mechanisms. This should be a multidisciplinary approach, which includes the GP, obstetricians and psychiatry. adhd without medication 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 regime.