ADHD Medication During Pregnancy and Breastfeeding
Women with ADHD must make a difficult decision regarding whether or not to stop taking ADHD medication during pregnancy and breastfeeding. There aren't enough data on how long-term exposure may affect the fetus.
A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological issues such as hearing loss or vision, febrile seizures or IQ impairment. The authors acknowledge that more high quality studies are needed.
Risk/Benefit Analysis
Women who are expecting and taking ADHD medication must evaluate the benefits of using it against the potential risks to the baby. Physicians do not have the information needed to give clear guidelines, but they can provide information about risks and benefits that assist pregnant women in making informed choices.
A study published in Molecular Psychiatry concluded that women who took ADHD medication during early pregnancy were not at greater risk of fetal malformations, or structural birth defects. The researchers used a large, population-based case-control study to evaluate the incidence of major structural birth defects in babies born to mothers who took stimulants during the early stages of pregnancy, as well as those who had not. Pediatric cardiologists and clinical geneticists examined the cases to ensure correct classification of the cases and to reduce the chance of bias.
The study conducted by the researchers had some limitations. In particular, they were unable to separate the effects of the medication from the effects of the disorder at hand. This limitation makes it difficult to know whether the limited associations observed in the exposed groups are due to medication use or comorbidities that cause confusion. The researchers did not study the long-term effects for the offspring.
The study revealed that babies whose mothers had taken ADHD medication during pregnancy had a higher chance of being admitted to the neonatal care unit (NICU) in comparison to those whose mothers didn't take any medication during pregnancy or had stopped taking their medication before or during pregnancy. The reason for this was central nervous system-related disorders and the increased risk for admission did not appear to be influenced by the stimulant medications were taken during pregnancy.
Women who took stimulant ADHD medications during pregnancy also had a higher risk of having to have a caesarean section or the baby was not scoring well on the Apgar scale (less than 7). These increases appeared to be unrelated to the type of medication taken during pregnancy.
Researchers suggest that the minor risk of using ADHD medications in early pregnancies can be offset by greater benefits to both baby and mother of continued treatment for the woman's condition. Physicians should speak with their patients about this issue and, if possible, help them improve coping skills which could reduce the effects of her disorder on her daily functioning and her relationships.
Medication Interactions
As more women than ever are diagnosed with ADHD and being treated with medication, the dilemma of whether to keep or end treatment during pregnancy is a question that more and more physicians face. These decisions are frequently taken without clear and authoritative evidence. Instead, doctors must weigh their own knowledge in conjunction with the experiences of other physicians and the research on the topic.
The issue of risk to infants is particularly tricky. Many studies on this subject are based on observations instead of controlled research and their findings are often contradictory. The majority of studies limit their analysis to live births, which can underestimate the severity of teratogenic effects leading to terminations or abortions of pregnancy. The study discussed in the journal club addresses these limitations, by examining both the data from deceased and live births.
The conclusion The conclusion: While certain studies have demonstrated that there is a positive correlation between ADHD medications and the possibility of certain birth defects, other studies have not found any evidence of a link and the majority of studies have a neutral or slight negative effect. Therefore, a careful risk/benefit assessment must be conducted in every instance.
For many women with ADHD, the decision to discontinue medication can be difficult, if not impossible. In a recent article in the Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can cause depression and feelings of isolation. A decrease in medication could also impact the ability to drive safely and perform work-related tasks, which are essential aspects of everyday life for people with ADHD.
She suggests women who are unsure about whether to keep or stop medication in light of their pregnancy consider informing family members, friends and colleagues on the condition, its effects on daily life, and the advantages of continuing the current treatment regimen. In addition, educating them can make the woman feel more comfortable when she is struggling with her decision. Some medications can pass through the placenta. If the patient decides not to take her ADHD medication while breastfeeding, it is important to be aware that the medication could be passed on to her baby.
Risk of Birth Defects
As the use and misuse of ADHD medication to treat symptoms of attention deficit hyperactivity disorder (ADHD), increases as does the concern about the potential adverse effects of the drugs on the fetuses. A study that was published in the journal Molecular Psychiatry adds to the existing information on this topic. Researchers utilized two massive data sets to examine over 4.3 million pregnancies and determine whether stimulant medications increased birth defects. Although the risk overall is low, the researchers discovered that the first-trimester exposure to ADHD medications was associated with an increased risk of certain heart defects such as ventriculo-septal defect (VSD).
The read more researchers of the study found no association between early use of medication and other congenital anomalies, such as facial clefting or club foot. The results are in line with previous studies which showed a small, but significant increase in cardiac malformations for women who started taking ADHD medication before the time of pregnancy. This risk increased in the later part of pregnancy, when a lot of women are forced to stop taking their medication.
Women who took ADHD medication during the first trimester were more likely to require a caesarean delivery or have an insufficient Apgar after delivery and have a baby that needed breathing assistance at birth. However the authors of the study were not able to eliminate selection bias by limiting the study to women who didn't have other medical issues that could have contributed to the findings.
Researchers hope their research will provide doctors with information when they meet pregnant women. They advise that while the discussion of risks and benefits is important but the decision to stop or continue medication should be based on each woman's requirements and the severity of her ADHD symptoms.
The authors caution that, although stopping the medication is an option to look into, it is not advised due to the high prevalence of depression and mental health issues for women who are pregnant or have recently given birth. Research has also shown that women who stop taking their medication will have a tough transitioning to life without them once the baby is born.
Nursing
The responsibilities of a new mother can be overwhelming. Women suffering from ADHD may face a lot of challenges when they must deal with their symptoms, go to doctor appointments and prepare for the birth of a child and adjust to a new routine. Many women opt to continue taking their ADHD medication during pregnancy.
The risk to breastfeeding infant is not too high since the majority of stimulant medications passes through breast milk at a low level. The rate of medication exposure will vary based on the dosage and frequency of administration as well as the time of day. 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 yet fully known.
Due to the absence of research, some physicians may be inclined to discontinue stimulant drugs during a woman's pregnancy. This is a complicated decision for the patient, who must weigh the benefits of keeping her medication with the potential dangers to the embryo. As long as there is no more information, doctors should inquire with all pregnant patients about their history of ADHD and whether they are planning or taking to take medication during the perinatal period.
A increasing number of studies have revealed that most women can safely continue their ADHD medication during pregnancy and breastfeeding. In the end, more and more patients opt to do this and after consulting with their doctor, they have found that the benefits of keeping their current medication outweigh any risks.
Women who suffer from ADHD who are planning to breastfeed should seek advice from a specialist psychiatrist before becoming pregnant. They should discuss the medication they are taking with their physician and discuss the pros and cons of continuing treatment. This includes non-pharmacological strategies. Psychoeducation should also be provided to help pregnant women suffering from ADHD recognize their symptoms and the underlying disorder and learn about treatment options and reinforce existing coping strategies. This should involve 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 indicators of deterioration, and, if necessary, adjustments to the medication regime.