ADHD Medication During Pregnancy and Breastfeeding
The decision to stop or keep ADHD medications during pregnancy and breastfeeding is a challenge for women suffering from the condition. Little data exists about how long-term exposure to these medications may affect the foetus.
A recent study published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological issues such as impaired hearing or vision, febrile seizures, or IQ impairment. The authors acknowledge the need for more high-quality research.
Risk/Benefit Analysis
Pregnant women who use ADHD medications need to balance the advantages of taking them against the potential risks to the foetus. Doctors don't have the data needed to provide clear recommendations, but they can provide information regarding the risks and benefits to aid pregnant women in making informed decisions.
A study published in Molecular Psychiatry concluded that women who took ADHD medication in early pregnancy were not at higher risk of fetal malformations or structural birth defects. The researchers used a large, population-based case-control study to determine the prevalence of major structural birth defects in babies born to mothers who had taken stimulants in the early stages of pregnancy, and those who did not. Pediatric cardiologists and clinical geneticists looked over the cases to ensure an accurate case classification and to limit the possibility of bias.
The study of the researchers was not without its limitations. The researchers were unable in the beginning, to separate the effects of 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. In addition the researchers did not look at the long-term effects of offspring on their parents.
The study did reveal that infants whose mothers had taken ADHD medication during pregnancy were at a higher risk of being admitted to the neonatal intensive care unit (NICU) than infants who whose mothers did not take any medication or had cut back on their medications prior to or during pregnancy. This was due to central nervous system disorders. The increased risk of admission was not affected by the stimulant medication that was used during pregnancy.
Women who took stimulant ADHD medications during pregnancy also had a higher chance of having to have caesarean sections or a baby that scored low on the Apgar scale (less than 7). These increases 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 the early stages of pregnancy may be offset by the greater benefit for both mother and child of continuing treatment for the woman's condition. Physicians should talk to 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.
Medication Interactions
More and more doctors are faced with the decision of whether to maintain treatment or stop during pregnancy as more women are diagnosed with ADHD. The majority of these decisions are made without clear and authoritative evidence regardless, so doctors must weigh what they know from their own experiences, those of other doctors, and what the research suggests about the subject as well as their own best judgment for each individual patient.
The issue of potential risks for infants can be extremely difficult. Many of the studies on this issue are based on observations instead of controlled research and their conclusions are often contradictory. The majority of studies limit their analysis to live-births, which could underestimate the teratogenic impact which can cause abortions or terminations of pregnancy. The study discussed in this journal club addresses these issues by analyzing data on live and deceased births.
Conclusion A few studies have revealed an association between ADHD medications and certain birth defects, other studies have not found a correlation. Most studies have shown an unintended, or slightly negative, impact. Therefore, a careful risk/benefit analysis must be conducted in every case.
For women suffering from ADHD, the decision to stop medication can be difficult, if not impossible. In fact, in a recent article in Archives of Women's Mental Health psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can cause depression, feelings of loneliness and family conflict for these patients. The loss of medication can affect the ability to drive safely and perform work-related tasks, which are vital aspects of everyday life for people with ADHD.
She recommends that women who are unsure about whether to continue or stop taking medication because of their pregnancy consider educating family members, friends, and coworkers on the condition, its impact on daily functioning, and on the advantages of staying on the current treatment plan. In addition, educating them can make the woman feel more comfortable in her struggle with her decision. It is also worth noting that some medications are able to pass through the placenta so if a woman decides to discontinue her ADHD medication during pregnancy and breastfeeding, she should be aware that traces of the drug can be passed on to the baby.
Birth Defects Risk
As the use of ADHD medication to treat the symptoms of attention deficit hyperactivity disorder (ADHD) grows, so do concerns about the effects that the medications could have on the fetuses. A recent study published in the journal Molecular Psychiatry adds to the existing information on this topic. With two massive data sets researchers were able look at more than 4.3 million pregnancies and see whether the use of stimulant medications increased the risk of birth defects. Researchers discovered that although the risk overall is low, first-trimester ADHD medication exposure was associated with slightly higher rates of certain heart defects, such as ventriculoseptal defect.
The researchers behind the study found no association between early medication use and other congenital anomalies, such as facial clefting or club foot. The findings are in line with previous studies that have shown the presence of a small, but significant increase in the risk of heart malformations in women who started taking ADHD medications before the time of pregnancy. The risk increased in the latter stages of pregnancy, when a lot of women began to stop taking their medication.
Women who used ADHD medications during the first trimester of pregnancy were also more likely to have caesarean sections, a low Apgar score following delivery, and a baby who needed breathing assistance during birth. The researchers of the study were not able to eliminate bias due to selection because they limited their study to women with no other medical conditions that might have contributed to the findings.
Researchers hope their research will inform physicians when they meet pregnant women. They suggest that although discussing the risks and benefits is crucial but the decision to stop or continue treatment should be based on the woman's needs and the severity of her ADHD symptoms.
The authors also caution that, while stopping the medication is an option, it is not an option to consider due to the high prevalence of depression and other mental health problems for women who are expecting or recently post-partum. Additionally, research suggests that women who stop taking their medication will have a harder time adjusting to a life without them after the baby is born.
Nursing
It can be a stressful experience to become a mom. Women who suffer from ADHD who have to deal with their symptoms while attending doctor appointments and preparing for the arrival of their child and adjusting to new household routines are often faced with a number of difficulties. As such, many women elect to continue taking their ADHD medication throughout the pregnancy.
The majority of stimulant medications are absorbed by breast milk check here in low amounts, so the risk for nursing infant is very low. However, the frequency of medication exposure to the newborn can vary depending on dosage, frequency it is administered and at what time it is administered. Additionally, different medications are introduced into the baby's system through the gastrointestinal tract, or through breast milk. The effect on the health of a newborn isn't fully known.
Due to the absence of evidence, some doctors may be inclined to discontinue stimulant medication during the pregnancy of a woman. This is a difficult choice for the patient, who must weigh the benefit of continuing her medication against the potential dangers to the foetus. Until more information is available, GPs should ask all pregnant patients about their history of ADHD and whether they are planning or taking to take medication during the perinatal time.
A increasing number of studies have revealed that women can continue their ADHD medication during pregnancy and while breastfeeding. This has led to many patients opt to do this and after consulting with their doctor, they have discovered that the benefits of keeping their current medication far exceed any risk.
Women with ADHD who are planning to breastfeed should seek the advice of an expert psychiatrist prior to becoming pregnant. They should review their medications with their doctor and discuss the advantages and disadvantages of continued treatment, including non-pharmacological management strategies. Psychoeducation is also necessary to help pregnant women with ADHD recognize the signs and the underlying disorder. They should also learn about treatment options and reinforce coping mechanisms. This should be a multidisciplinary effort with the GPs, obstetricians, and psychiatrists. Counselling for pregnancy should include the discussion of a treatment plan for both the mother as well as the child, monitoring for signs of deterioration and, if necessary, adjustments to the medication regimen.