ADHD Medication During Pregnancy and Breastfeeding
Women with ADHD have to make a difficult choice about whether to continue or stop taking ADHD medication during pregnancy and breast-feeding. There are few data regarding how exposure over time may affect the pregnant fetus.
A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication in utero do not develop neurological developmental disorders such as hearing loss or impaired vision seizures, febrile seizures or IQ impairment. The authors acknowledge that more high quality studies are required.
Risk/Benefit Analysis
Women who are pregnant and taking ADHD medication should evaluate the benefits of using it versus the risks for the foetus. Physicians do not have the data needed to make unequivocal recommendations however they can provide information about benefits and risks that can help pregnant women make informed decisions.
A study published in Molecular Psychiatry found that women who were taking ADHD medications in early pregnancy did not have a significantly higher risk of fetal cardiac malformations or major structural birth defects. Researchers conducted a large population-based case control study to compare the incidence of major structural defects in infants born to mothers who were taking stimulants during pregnancy. Pediatric cardiologists, clinical geneticists and other experts looked over the cases to confirm that the classification was accurate and to eliminate any bias.
The research conducted by the researchers was not without limitations. The most important issue was that they were unable to separate the effects of the medication from the disorder at hand. This makes it difficult to know whether the small differences observed in the exposed groups result from medication use or confounding by comorbidities. The researchers did not examine the long-term effects for the offspring.
The study found that babies whose mothers took ADHD medication during pregnancy were at a slightly higher chance of being admitted to the neonatal care unit (NICU) in comparison to mothers who didn't take any medication during pregnancy, or had quit taking the medication prior to or during pregnancy. The reason for this was central nervous system-related disorders, and the higher risk of admission was not found to be influenced by which stimulant medication was used during pregnancy.
Women who were taking stimulant ADHD medications during pregnancy also had a higher risk of having caesarean sections or the baby was not scoring well on the Apgar scale (less than 7). These increases did not appear to be affected by the type of medication that was used during pregnancy.
Researchers suggest that the minor risk of using ADHD medications in early pregnancies can be offset by more beneficial outcomes for both mother and baby of continuing treatment for the woman's condition. Doctors should discuss with their patients about this and as much as possible, assist them improve coping skills which may reduce the effects of her disorder on her daily life and relationships.
Interactions with Medication
As more women than ever are diagnosed with ADHD and being treated with medication, the dilemma of whether to continue or discontinue treatment during pregnancy is a question that more and more physicians confront. The majority of these decisions are made without clear and authoritative evidence regardless, so doctors have to weigh their experience from their own experiences, those of other doctors, and what research suggests on the subject and their best judgment for each individual patient.
In particular, the issue of possible risks to the infant can be difficult. Many studies on this issue are based on observational data rather than controlled research, and their conclusions are often contradictory. In addition, most studies limit their analysis to live births, which could underestimate severe teratogenic effects that cause abortion or termination of the pregnancy. The study presented in this journal club addresses these shortcomings by looking at data from both live and deceased births.
Conclusion A few studies have found a positive correlation between ADHD medications and certain birth defects however, other studies haven't found a correlation. Most studies show a neutral, or even slight negative impact. In all cases it is imperative to conduct a thorough evaluation of the risks and benefits is required.
For many women with ADHD who suffer from ADHD, the decision to discontinue medication is difficult if not impossible. In fact, in a recent article in the Archives of Women's Mental Health psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can lead to increased depression, feelings of loneliness and family conflict for patients with ADHD. A adhd medications decrease in medication could also impact the ability to safely drive and perform work-related tasks, which are crucial aspects of everyday life for those with ADHD.
She suggests that women who are not sure whether to take the medication or discontinue it due to pregnancy, educate their family members, coworkers, and acquaintances about the condition, the effects on daily functioning, and the advantages of staying on the current treatment regimen. In addition, educating them can aid in ensuring that the woman feels supported in her struggle with her decision. It is important to remember that some medications can pass through the placenta so if a woman decides to stop taking her ADHD medication during pregnancy and breastfeeding, she should be aware of the possibility that traces of the drug could be transferred to the infant.
Risk of Birth Defects
As the use of ADHD medication to treat the symptoms of attention deficit hyperactivity disorder (ADHD) grows, so do concerns over the impact that these medications could have on the fetuses. A recent study published in the journal Molecular Psychiatry adds to the body of knowledge about this subject. Researchers used two huge data sets to study more than 4.3 million pregnancies and determine if stimulant medication use increased the risk of birth defects. While the overall risk is low, the researchers discovered that the first-trimester exposure to ADHD medications was linked to an increased risk of certain heart defects, like ventriculo-septal defects (VSD).
The authors of the study found no link between the use of early medications and congenital abnormalities such as facial clefting or club foot. The findings are in line with previous studies showing an increase, but not significant, in the risk of heart malformations among women who started taking ADHD medications prior to the time of the birth of their child. This risk increased during the latter half of pregnancy when a large number of women decided to stop taking their medication.
Women who were taking ADHD medication during the first trimester were more likely to need a caesarean, have a low Apgar after birth and have a baby who needed breathing assistance at birth. However, the authors of the study were not able to eliminate bias due to selection by limiting the study to women who did not have any other medical issues that could have contributed to these findings.
Researchers hope that their research will help doctors when they meet pregnant women. They advise that while discussing the risks and benefits is crucial, the decision to stop or keep treatment must be based on each 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 a recommended practice because of the high rate of depression and other mental health problems among women who are pregnant or who are recently post-partum. Additionally, the research suggests that women who decide to stop taking their medications are more likely to have difficulties adapting to life without them following the baby's arrival.
Nursing
It can be overwhelming to become a mom. Women suffering from ADHD are often faced with a number of difficulties 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 majority of stimulant medicines are absorbed through breast milk in low amounts, therefore the risk to breastfeeding infant is minimal. However, the rate of exposure to medication by the newborn can vary depending on dosage, how often it is taken and the time of the day it is administered. In addition, different drugs enter the infant's system via the gastrointestinal tract or through breast milk. The effect on the health of a newborn is not completely understood.
Because of the lack of evidence, some doctors may recommend stopping stimulant drugs during a woman's pregnancy. This is a difficult decision for the patient, who must balance the benefits of continuing her medication against the potential risks to the embryo. As long as there is no more information, GPs should ask all pregnant patients about their history of ADHD and if they are taking or planning to take medication during the perinatal period.
A increasing number of studies have proven that most women can safely continue their ADHD medication while they are pregnant and nursing. In response, an increasing number of patients are opting to do this. They have found through consultation with their doctor that the benefits of retaining their current medication outweigh any risk.
It's important for women with ADHD who are contemplating breastfeeding to seek a specialist psychiatrist's guidance prior to becoming pregnant. They should discuss their medication with their doctor and discuss the pros and cons for continuing treatment. This includes non-pharmacological strategies. Psychoeducation is also needed to help pregnant women with ADHD be aware of the symptoms and underlying disorder. They should also learn about treatment options and strengthen coping mechanisms. This should be a multidisciplinary approach with the GPs, obstetricians, and psychiatry. Counselling for pregnancy should include the discussion of a treatment plan for both mother and child, as well as monitoring for signs of deterioration and when necessary, making adjustments to the medication regimen.