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. There aren't enough data on how long-term exposure may affect the foetus.
A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication during utero do not develop neurological disorders such as impaired vision or hearing, febrile seizures, or IQ impairment. The authors acknowledge the need for more high-quality research.
Risk/Benefit Analysis
Pregnant women who take ADHD medications must weigh the advantages of taking them against potential risks to the fetus. The doctors don't have the information to give clear advice however they can provide information on the risks and benefits to aid pregnant women in making an informed decision.
A study published in Molecular Psychiatry concluded that women who were taking ADHD medication during their early pregnancy did not have a greater risk of fetal malformations, or structural birth defects. The researchers used a large population-based case-control study to assess the risk of major structural birth defects in babies born to mothers who had taken stimulants during early pregnancy, as well as those who had not. Pediatric cardiologists and clinical geneticists examined the cases to ensure accurate case classification and to limit the possibility of bias.
However, the study was not without its flaws. Researchers were unable, in the first place to differentiate the effects of the medication from the disorder. This makes it difficult to know whether the limited associations observed in the exposed groups result from medication use or the confounding effect of comorbidities. Researchers also did not look at long-term outcomes for offspring.
The study showed that infants whose mother took ADHD medication during pregnancy had a higher risk of admission to the neonatal care unit (NICU), compared to those whose mothers didn't take any medication during pregnancy, or had discontinued taking their medication prior to or during pregnancy. This was due to central nervous system-related disorders and the increased risk of admission was not found to be affected by the type of stimulant medications were taken during pregnancy.
Women who were taking stimulant ADHD medication during pregnancy also had an elevated chance of having a caesarean section or having a baby with low Apgar score (less than 7). These increases appear to be independent of 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 continued treatment for the woman's disorder. Doctors should discuss with their patients about this and try to help them improve coping skills which could reduce the effects of her disorder on her daily life and relationships.
Medication Interactions
As more women than ever before are being diagnosed with ADHD and being treated with medication, the dilemma of whether or not to end treatment during pregnancy is a question that more and more physicians confront. These decisions are frequently made without clear and authoritative evidence. Instead, doctors have to weigh their own knowledge in conjunction with the experiences of other physicians and the research on the topic.
In particular, the issue of potential risks to the infant can be difficult. The research that has been conducted on this topic is based on observation rather than controlled studies and a lot of the results are contradictory. The majority of studies restrict their analysis to live births, which can underestimate the severity of teratogenic effects leading to abortions or terminations of pregnancy. The study discussed in the journal club addresses these shortcomings by analyzing the data from deceased and live births.
The conclusion: While some studies have shown an association between ADHD medications and the possibility of certain birth defects, others have found no such relationship and the majority of studies show a neutral or even slight negative effect. Therefore, a careful risk/benefit assessment is required in every instance.
It can be challenging, if not impossible for women with ADHD to stop taking their medication. 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 lead to depression and feelings of being isolated. Additionally, the loss of medication may affect the ability to complete job-related tasks and drive safely that are crucial aspects of daily life for many people suffering from ADHD.
She iampsychiatry.com recommends that women who are unsure about whether to keep or stop medication in light of their pregnancy, consider educating family members, friends and colleagues about the condition, its impact on daily functioning, and the advantages of staying on the current treatment plan. It can also help women feel supported in her decision. It is also worth noting that some medications can be absorbed through the placenta so if a woman decides to stop taking her ADHD medication during pregnancy and breastfeeding, she must be aware of the possibility that traces of the medication could be transferred to the infant.
Risk of Birth Defects
As the use and use of ADHD drugs to treat symptoms of attention deficit disorder hyperactivity disorder (ADHD) increases as does the concern about the potential effects of these drugs on foetuses. Recent research published in the journal Molecular Psychiatry has added to the body knowledge on this subject. Researchers used two huge datasets to analyze more than 4.3 million pregnancies and determine if the use of stimulant medications caused birth defects. Researchers discovered that although the overall risk is low, the first trimester ADHD medication exposure 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 findings are in line with previous studies revealing a small but significant increase in the risk of developing cardiac malformations among women who started taking ADHD medications prior to the time of the time of pregnancy. The risk was higher during the latter part of pregnancy, as many women are forced to stop taking their medication.
Women who took ADHD medications during the first trimester of their pregnancies were also more likely to experience a caesarean section, a low Apgar score following delivery, and a baby who required help breathing at birth. However the researchers of the study were not able to eliminate selection bias by restricting the study to women who did not have any other medical issues that could be a contributing factor to these findings.
The researchers hope their research will help inform the clinical decisions of physicians who encounter pregnant women. They recommend that, while discussing the benefits and risks is important however, the decision to stop or keep medication should be based on the woman's needs and the severity of her ADHD symptoms.
The authors also advise that even though stopping the medication is an option, it isn't an option that is recommended due to the high incidence of depression and other mental health problems in women who are pregnant or who are recently postpartum. Additionally, research suggests that women who stop taking their medications will have a tough time adjusting to a life without them after the baby is born.
Nursing
The responsibilities that come with being a new mother can be overwhelming. Women with ADHD who have to manage their symptoms while attending physician appointments and making preparations for the arrival of a baby and adjusting to new household routines may face a lot of challenges. Many women decide to continue taking their ADHD medication during pregnancy.
The risk to breastfeeding infant is minimal because the majority of stimulant medication passes through breast milk at low levels. The rate of exposure to medication can vary depending upon the dosage, frequency of administration and time of day. In addition, different medications enter the baby’s system through the gastrointestinal tract or breast milk. The impact of these medications on a newborn's health is not fully comprehended.
Due to the absence of research, some doctors may recommend stopping stimulant medications during a woman's pregnancy. It is a difficult decision for the mother, who must weigh the advantages of her medication against the potential risks to the fetus. Until more information becomes available, GPs can ask pregnant patients whether they have a history of ADHD or if they plan to take medication in the perinatal stage.
Many studies have shown that women can continue to take their ADHD medication in a safe manner while breastfeeding and during pregnancy. In response, a growing number of patients are opting to continue their medication. They have found, in consultation with their physicians, that the benefits of continuing their current medication far outweigh any risk.
It's important for women with ADHD who are contemplating breastfeeding to seek a specialist psychiatrist's advice prior becoming pregnant. They should discuss their medication with their prescriber as well as the pros and cons of continuing treatment. This includes non-pharmacological strategies. Psychoeducation is also needed to help pregnant women with ADHD recognize the signs and underlying disorder. They should also learn about treatment options and strengthen strategies for coping. This should involve a multidisciplinary approach, which includes the GP, obstetricians and psychiatry. Pregnancy counselling should include the discussion of a treatment plan for both the mother and child, as well as monitoring for signs of deterioration, and the need for adjustments to the medication regimen.