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 breast-feeding. There aren't enough data on how long-term exposure may affect a pregnant fetus.
A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus don't develop neurological developmental disorders such as hearing or vision impairment seizures, febrile seizures or IQ impairment. The authors acknowledge that further high-quality research is needed.
Risk/Benefit Analysis
Pregnant women who use ADHD medications must weigh the advantages of taking them against the potential risks to the fetus. Physicians do not have the necessary data to provide clear recommendations but they can provide information about risks and benefits that assist pregnant women in making informed decisions.
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. Researchers used a vast, population-based case-control study to evaluate the incidence of major structural birth defects in infants born to mothers who had taken stimulants in the early stages of pregnancy, as well as those who had not. Clinical geneticists and pediatric cardiologists looked over the cases to ensure accurate case classification and to minimize the chance of bias.
The study of the researchers was not without its limitations. The researchers were not able, in the first place to distinguish the effects triggered by the medication from the disorder. This makes it difficult to determine whether the small 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 did find that infants whose mothers had taken ADHD medication during pregnancy were at a greater risk of being admitted to the neonatal intensive care unit (NICU) than infants who whose mothers did not take any medication or taken off their medication prior to or during pregnancy. The reason for this was central nervous system disorders. The higher risk of admission was not affected by the stimulant medications used during pregnancy.
Women who were taking stimulant ADHD medication during pregnancy also had an increased risk of having a caesarean delivery or having a baby with a low Apgar score (less than 7). These increases appear to be independent of the type of medication taken during pregnancy.
adult adhd medication suggest that the risk of a small amount with the use of ADHD medications during early pregnancy could be offset by the higher benefit for both mother and child of continued treatment for the woman's condition. Physicians should discuss this with their patients and, where they are able, assist them in developing strategies to improve coping skills that can lessen 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 issue of whether or not to discontinue treatment during pregnancy is a question that more and more physicians confront. These decisions are usually taken without clear and authoritative evidence. Instead, doctors have to take into account their own experience, the experience of other doctors, and the research that has been conducted on the subject.
The issue of possible risks to the infant can be particularly tricky. A lot of studies on this subject are based on observations rather than controlled research, and their findings are often contradictory. Furthermore, adult adhd medication restrict their analysis to live births, which may underestimate severe teratogenic effects that result in abortion or termination of the pregnancy. The study presented in the journal club addresses these limitations, by examining both data on live and deceased births.
The conclusion: While some studies have shown an association between ADHD medications and the possibility of certain birth defects, others have found no connection and the majority of studies have a neutral or slightly negative impact. As a result an accurate risk-benefit analysis must be done in each situation.
For many women with ADHD, the decision to stop 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 lead to depression and feelings of isolation. The loss of medication can affect the ability to drive safely and to perform work-related tasks which are vital aspects of everyday life for those with ADHD.
She suggests that women who are not sure whether to take the medication or stop due to pregnancy should educate family members, coworkers, and acquaintances about the condition, its effects on daily functioning, and the benefits of continuing the current treatment regimen. It will also help a woman feel supported in her decision. Certain 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 drug could be transferred to the infant.
Risk of Birth Defects
As the use and use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases the concern over the potential adverse effects of the drugs on foetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge regarding this topic. With two massive data sets researchers were able examine more than 4.3 million pregnancies and see whether stimulant medications increased the risk of birth defects. Although the risk overall is low, the researchers found that exposure in the first trimester to ADHD medications was associated with an increased risk of specific heart defects, like ventriculo-septal defects (VSD).
The researchers behind the study found no connection between early use of medication and congenital abnormalities like facial clefting, or club foot. The results are in agreement with previous studies which showed the existence of a slight, 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 during the latter half of pregnancy when many women began to stop taking their medication.
Women who used ADHD medication in the first trimester of their pregnancies were also more likely to have a caesarean section, a low Apgar score following delivery, and a baby that required breathing assistance during birth. The authors of the study could not eliminate bias due to selection because they limited the study to women who did not have any other medical conditions that could have contributed to the findings.
Researchers hope that their research will inform physicians when they see pregnant women. They recommend that, while a discussion of risks and benefits is important, the decision to stop or maintain medication should be based on each woman's needs and the severity of her ADHD symptoms.
The authors also advise that, while stopping the medication is an option, it is not a recommended practice because of the high incidence of depression and other mental health issues among women who are pregnant or recently post-partum. Research has also shown that women who stop taking their medication will have a difficult adjustment to life without them once the baby is born.
Nursing
It can be overwhelming to become a mother. Women suffering from ADHD may face a lot of challenges when they must manage their symptoms, go to doctor appointments, prepare for the birth of a baby and adjust to new routines. As such, many women elect to continue taking their ADHD medications throughout the course of pregnancy.
The risk to a nursing infant is low because the majority of stimulant medications passes through breast milk in low amounts. However, the rate of exposure to medication by the newborn may differ based on dosage, frequency it is administered and the time of day it is administered. In addition, various drugs enter the infant's system through the gastrointestinal tract or breast milk. The effect on the health of a newborn is not completely understood.
Because of the lack of research, some physicians may be inclined to discontinue stimulant medications during the pregnancy of a woman. This is a difficult choice for the patient, who must balance the benefits of keeping her medication against the potential risks to the embryo. As long as there is no more information, doctors should ask all pregnant patients about their history of ADHD and if they plan or are taking to take medication during the perinatal time.
A growing number of studies have revealed that the majority of women are able to safely continue their ADHD medication while they are pregnant and nursing. As a result, an increasing number of patients are choosing to do so and in consultation with their doctor they have discovered that the benefits of maintaining their current medication outweigh any potential risks.
It is crucial for women suffering from ADHD who are considering breastfeeding to seek a specialist psychiatrist's advice prior becoming pregnant. They should review their medications with their physician and discuss the advantages and disadvantages of continuing treatment, including non-pharmacological management strategies. Psychoeducation is also necessary to help pregnant women with ADHD understand the symptoms and underlying disorder. They should also be informed about treatment options and build the coping mechanisms. This should involve a multidisciplinary approach with the GP as well as obstetricians, psychiatry and obstetricians. Pregnancy counseling should include discussion of a treatment plan for the mother as well as the child, monitoring of signs of deterioration, and, if needed adjustments to the medication regimen.