ADHD Medication During Pregnancy and Breastfeeding
Women with ADHD face 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 drugs may affect the fetus.
A recent study published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological disorders such as impaired hearing or vision, febrile seizures, or IQ impairment. The authors acknowledge the need for more high-quality studies.
Risk/Benefit Analysis
Pregnant women who use ADHD medications need to balance the benefits of using them against the risks to the fetus. Doctors don't have the information needed to provide clear recommendations but they can provide information regarding the risks and benefits to assist pregnant women in making informed choices.
A study published in Molecular Psychiatry found that women who took ADHD medications during their early pregnancy did not have an increased risk of fetal cardiac malformations or major birth defects that are structural. Researchers conducted a massive population-based case control study to compare the incidence of structural defects that were major in infants born to mothers who used stimulants during pregnancy. Clinical geneticists, pediatric cardiologists and other experts reviewed the cases in order to ensure that the classification was correct and to reduce any bias.
However, the study was not without its flaws. Most important, they were unable to distinguish the effects of the medication from the disorder at hand. That limitation makes it difficult to determine whether the small associations observed in the groups that were exposed are due to the use of medication or confounding by comorbidities. Researchers also did not look at the long-term effects for the offspring.
The study did find that babies whose mothers had taken ADHD medication during pregnancy were at a more risk of being admitted to the neonatal intensive care unit (NICU) than those whose mothers had not taken any medication or 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 medications used during pregnancy.
Women who took stimulant ADHD medications during pregnancy also had a higher chance of having to have an emergency caesarean section or having a baby that scored low on the Apgar scale (less than 7). These increases didn't appear 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 more beneficial outcomes for both baby and mother of continued treatment for the woman’s disorder. Physicians should discuss the issue with their patients and, when they are able, assist them in developing strategies to improve their coping abilities that may minimize the effects of her disorder on her daily life and relationships.
Medication Interactions
Many doctors are faced with the decision of whether to maintain 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 in either case, which means that doctors must weigh their knowledge, the experiences of other doctors, and what the research suggests on the subject, along with their own judgments for each individual patient.
Particularly, the issue of possible risks to the infant can be difficult. Many studies on this issue are based on observations rather than controlled research, and their findings are often contradictory. In addition, most studies limit their analysis to live births, which could underestimate severe teratogenic effects that lead to abortion or termination of the pregnancy. The study discussed in this journal club addresses these limitations 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 found a correlation. Most studies show that there is a neutral, or somewhat negative, effect. As a result, a careful risk/benefit assessment must be done in each instance.
It can be difficult, if not impossible, for women with ADHD to stop taking their medication. In a recent article in Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can lead to depression and feelings of being isolated. A decrease in medication could also impact the ability to drive safely and complete work-related tasks, which are essential aspects of daily life for those suffering from ADHD.
She suggests that women who aren't sure whether to take the medication or discontinue it due to pregnancy educate family members, coworkers and their friends about the condition, its impact on daily functioning and the benefits of keeping the current treatment. It can also help women feel supported in her decision. It is important to note that certain medications are able to pass through the placenta therefore, if a patient decides to stop her ADHD medication during pregnancy and breastfeeding, she must be aware of the possibility that traces of the drug could 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) increases as do concerns over the impact that these drugs might have on fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge regarding this issue. Researchers used two huge datasets to analyze over 4.3 million pregnant women and determine whether stimulant medications caused birth defects. Researchers discovered that although the overall risk is low, first-trimester ADHD medication use was associated with slightly higher rates of certain heart defects, like ventriculoseptal defects.
The researchers of the study could not discover any connection between early medication usage and other congenital anomalies like facial deformities or club feet. The results are in the same vein as previous studies that showed a small, but significant increase in the number of cardiac malformations among women who started taking ADHD medication prior to the time of pregnancy. This risk increased in the later part of pregnancy, when a lot of women begin to discontinue their ADHD medications.
Women who took 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 that required breathing assistance during birth. However the authors of the study were not able to eliminate selection bias by restricting the study to women who didn't have other medical issues that could have contributed to the findings.
Researchers hope that their research will help doctors when they meet pregnant women. The researchers advise that while discussing benefits and risks are important, the choice regarding whether or not to stop medication should be in light of the severity of each woman's ADHD symptoms and the needs of the woman.
The authors also caution that even though stopping the medication is an option, it is not an option to consider due to the high rate of depression and other mental health issues in women who are pregnant or who are recently postpartum. Further, the research suggests that women who choose to stop their medications are more likely to experience a difficult time adapting to life without them after the baby's arrival.
Nursing
The responsibilities that come with being a new mother can be overwhelming. Women with ADHD may face a lot of challenges when they must deal with their symptoms, attend doctor appointments, prepare for the birth of a child and adjust to new routines. This is why many women decide to continue taking their ADHD medications throughout the course of pregnancy.
The risk for nursing infant is low because the majority of stimulant medication passes through breast milk at a low level. However, the amount of exposure to medications by the infant can differ based on the dosage, frequency it is administered and at what time it is administered. Additionally, individual medications enter the baby's system differently through the gastrointestinal tract and breast milk and the impact of this on a newborn isn't well understood.
Some physicians may discontinue stimulant medication during a woman's pregnancy due to the lack of research. It's a difficult choice for the woman, who must weigh the benefits of her medication against the potential risks to the foetus. In the meantime, until more information is available, GPs can ask pregnant patients whether they have any history of ADHD or if they are planning to take medication in the perinatal phase.
Many studies have shown that women can continue to take their ADHD medication safely while breastfeeding and during pregnancy. In the end, many patients choose to do so and, after consulting with their doctor, they have found that the benefits of maintaining their current medication outweigh any risks.
Women who suffer from ADHD who are planning to nurse should seek the advice of a specialist psychiatrist prior to becoming pregnant. They should discuss the medication they are taking with their physician and discuss the pros and cons for continuing treatment. This includes non-pharmacological methods. Psychoeducation is also needed to help pregnant women suffering from ADHD recognize the signs and underlying disorder. They should also be educated about treatment options and strengthen strategies for coping. This should involve a multidisciplinary approach with the GP, obstetricians and psychiatry. add adhd medication should include a discussion of a treatment plan for the mother as well as the child, and monitoring for signs of deterioration, and, if needed modifications to the medication regimen.