ADHD Medication During Pregnancy and Breastfeeding
Women with ADHD have to make a difficult choice on whether to keep or stop taking ADHD medication during pregnancy and breastfeeding. Little data exists about how long-term exposure to these medications could affect the fetus.
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 that further high-quality research is needed.
Risk/Benefit Analysis
Women who are pregnant and taking ADHD medication should evaluate the benefits of using it versus the risks to the fetus. Physicians do not have the information needed to give clear guidelines but they can provide information on the risks and benefits to aid pregnant women in making informed choices.
A study published in Molecular Psychiatry found that women who were taking ADHD medications in early pregnancy did not have an higher risk of fetal cardiac malformations or major structural birth defects. The researchers used a large population-based study of case-control to evaluate the incidence of major structural birth defects in infants born to mothers who had taken stimulants during early pregnancy and those who had not. Pediatric cardiologists and clinical geneticists looked over the cases to ensure correct classification of the cases and to reduce the chance of bias.
The study of the researchers was not without its limitations. Researchers were unable, in the first place to distinguish the effects of the medication from the disorder. This limitation makes it difficult to determine whether the small differences observed in the exposed groups result from medication use or confounding by comorbidities. The researchers also did not study the long-term effects for the offspring.
The study showed that babies whose mothers took ADHD medication during pregnancy had a slightly higher chance of being admitted to the neonatal care unit (NICU), compared to those whose mothers did not take any medication during pregnancy or had discontinued taking their medication prior to or during pregnancy. The reason for this was central nervous system disorders. medication for adhd uk increased risk of admission was not affected by the stimulant medication that was used during pregnancy.
Women who used stimulant ADHD medication during pregnancy were also at an elevated chance of having a caesarean birth or having a baby born with low Apgar score (less than 7). These increases appear to be unrelated to the type of medication used during pregnancy.
Researchers suggest that the minor risks associated with the use ADHD medications in early pregnancies may be offset by the greater benefits for mother and baby of continuing treatment for the woman’s disorder. Physicians should talk to their patients about this and try to help them develop coping strategies that may reduce the effects of her disorder on her daily functioning and her relationships.
Interactions with Medication
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. Most of the time, these decisions are made without clear and authoritative evidence regardless, so doctors must weigh their knowledge from their own experiences, those of other doctors, and what research says on the topic and their own judgments for each individual patient.
In particular, the issue of potential risks for the baby can be tricky. The research that has been conducted on this topic is based on observations rather than controlled studies, and a lot of the results are conflicting. Most studies limit their analysis to live-births, which could underestimate the severity of teratogenic effects leading to terminations or abortions of pregnancy. The study discussed in this journal club addresses these shortcomings by analyzing data on live and deceased births.
The conclusion The conclusion: While some studies have found a positive association between ADHD medications and the possibility of certain birth defects, other studies have found no such relationship, and most studies show a neutral or even slight negative effect. In each case, a careful evaluation of the benefits and risks is required.
It can be challenging, if not impossible, for women suffering from ADHD to stop taking their medication. In an article published in the 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 those suffering from the disorder. A decrease in medication could also affect the ability to drive safely and perform work-related tasks, which are essential aspects of normal life for those suffering from ADHD.
She suggests that women who aren't sure whether to continue taking medication or stop due to pregnancy should educate family members, coworkers and their friends about the condition, its effects on daily functioning, and the benefits of keeping the current treatment plan. In addition, educating them can aid in ensuring that the woman feels supported as she struggles with her decision. Some medications can pass through the placenta. If the patient decides to not take her ADHD medication while pregnant and breastfeeding, it is important to be aware that the medication could be transferred to the baby.
Birth Defects and Risk of
As the use of ADHD medication to treat the symptoms of attention deficit hyperactivity disorder (ADHD) increases, so do concerns over the impact that these drugs could have on the fetuses. Recent research published in the journal Molecular Psychiatry has added to the body knowledge on this issue. Utilizing two huge data sets researchers were able analyze more than 4.3 million pregnancies and determine whether stimulant medications increased the risk of birth defects. Researchers discovered that, while the overall risk is low, first-trimester ADHD medication exposure was associated with slightly higher rates of specific heart defects like ventriculoseptal defect.
The researchers of the study didn't discover any link between early medication usage and other congenital anomalies, such as facial deformities or club feet. The results are in agreement with previous studies that have shown a small, but significant increase in the number of cardiac malformations among women who began taking ADHD medication before the time of pregnancy. This risk increased in the later part of pregnancy, when many women decide to stop taking their ADHD medications.
medication for add adults who used ADHD medications during the first trimester of their pregnancy were also more likely to undergo caesarean section, low Apgar score following delivery, and a baby who required breathing assistance at birth. The researchers of the study could not eliminate bias due to selection because they restricted the study to women without other medical conditions that could 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 recommend that, while discussing risks and benefits are important, the decision regarding whether or not to stop taking medication should be based on the severity of each woman's ADHD symptoms and her requirements.
The authors warn that, even though stopping the medication is an option to think about, it isn't advised due to the high prevalence of depression and other mental disorders among women who are pregnant or who have recently given birth. Additionally, the research suggests that women who choose to stop taking their medications are more likely to experience a difficult time adjusting to life without them after the baby's arrival.
Nursing
The responsibilities of a new mother can be overwhelming. Women who suffer from ADHD who must work through their symptoms while attending physician appointments, making preparations for the arrival of their child and adjusting to new household routines can experience severe challenges. Therefore, many women choose to continue taking their ADHD medications throughout pregnancy.
The majority of stimulant drugs pass through breast milk in small amounts, therefore the risk to infant who is breastfeeding is low. medication adhd adults of medication exposure can vary depending upon the dosage and frequency of administration as well as the time of day. Additionally, different medications enter the body of the baby differently through the gastrointestinal tract and breast milk. The impact of this on a newborn infant is not well understood.
Some doctors may decide to stop stimulant medications during a woman's pregnancy due to the absence of research. This is a complicated decision for the patient, who must balance the benefits of keeping her medication with the potential dangers to the foetus. 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 in a safe manner while breastfeeding and during pregnancy. As a result, an increasing number of patients are choosing to do so, and in consultation with their doctor they have found that the benefits of maintaining their current medication far exceed any risk.
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 their medication with their doctor, and the pros and cons of continuing treatment. This includes non-pharmacological strategies. Psychoeducation is also necessary to help pregnant women with ADHD understand the symptoms and underlying disorder. They should also learn about treatment options and reinforce the coping mechanisms. This should be a multidisciplinary approach together with obstetricians, GPs and psychiatrists. Pregnancy counselling should include discussion of a management plan for both the mother as well as the child, as well as monitoring for signs of deterioration, and when necessary, making adjustments to the medication regimen.