ADHD Medication During Pregnancy and Breastfeeding
The decision to stop or continue ADHD medication during breastfeeding and pregnancy is challenging for women with the condition. Little data exists about how long-term exposure to these drugs may affect the foetus.
A recent study published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological disorders such as impaired hearing or vision, febrile seizures, or IQ impairment. The authors acknowledge that more high quality studies are required.
Risk/Benefit Analysis
Pregnant women who use ADHD medications need to balance the benefits of taking them against the potential risks to the fetus. Doctors don't have the necessary data to make unequivocal recommendations, but they can provide information about the risks and benefits to help pregnant women make informed choices.
A study published in Molecular Psychiatry found that women who took ADHD medications in early pregnancy did not have a significantly higher risk of fetal cardiac malformations or major 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 early pregnancy, and those who did not. Pediatric cardiologists, clinical geneticists and other experts reviewed the cases in order to make sure that the classification was accurate and to minimize any bias.
However, the researchers' study was not without its flaws. The most important issue was that they were not able to differentiate the effects of the medication from the underlying disorder. This makes it difficult to determine whether the small associations observed in the groups that were exposed are due to medication use or confounding by comorbidities. Researchers also did not study the long-term effects for the offspring.
The study revealed that infants whose mother had taken ADHD medication during pregnancy had a slightly greater risk of being admitted to the neonatal care unit (NICU), compared to those whose mothers did not use any medication during pregnancy, or had stopped taking their medication before or during pregnancy. The reason for this was central nervous system disorders, and the increased risk for admission was not found to be affected by the type of stimulant medications were used during pregnancy.
Women who took stimulant ADHD medications during pregnancy also had a higher likelihood of having an emergency caesarean section or having a baby that scored low 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 small risks associated with the use ADHD medications during early pregnancies can be offset by greater benefits for baby and mother of continued treatment for the woman's disorder. Physicians should discuss this with their patients and, if possible, assist them in developing strategies to improve coping skills which can reduce the impact of her disorder on her daily life and relationships.
Interactions with Medication
Many doctors are confronted with the dilemma of whether to continue treatment or stop as more women are diagnosed with ADHD. The majority of these decisions are taken in the absence of solid and reliable evidence either way, so physicians must weigh what they know, the experiences of other doctors, and what the research suggests on the subject as well as their own best judgment for each individual patient.
The issue of risk for infants can be particularly tricky. The research on this issue is based on observations rather than controlled studies, and many of the findings are conflicting. Most 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 this journal club addresses these limitations by looking at data from both live and deceased births.
Conclusion A few studies have revealed an association between ADHD medications and certain birth defects, other studies have not shown such a relationship. The majority of studies show an unintended, or slightly negative, effect. In every case it is imperative to conduct a thorough analysis of the benefits and risks is required.
For many women with ADHD who suffer from ADHD, the decision to stop taking medication is difficult, if not impossible. In fact, in an article recently 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. The loss of medication can affect the ability to safely drive and perform work-related tasks, which are crucial aspects of everyday life for those with ADHD.
She suggests women who are unsure about whether or not to stop medication in light of their pregnancy should consider the possibility of educating friends, family members, and coworkers on the condition, its impact on daily functioning, and on the advantages of continuing the current treatment regimen. It will also help a woman feel supported in her decision. It is important to note that some drugs can pass through the placenta so if the patient decides to discontinue 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.
Birth Defects Risk
As the use and use of ADHD medications to treat the symptoms of attention deficit disorder hyperactivity disorder (ADHD) increases as does the concern about the potential effects of these drugs on fetuses. A recent study published in the journal Molecular Psychiatry adds to the existing knowledge on this subject. With two massive data sets researchers were able to analyze more than 4.3 million pregnancies to determine whether the use of stimulant medications increased the risk of birth defects. Although the risk overall remains low, the scientists found that exposure in the first trimester to ADHD medications was associated with an increase in the risk of specific heart defects, such as ventriculoseptal defect (VSD).
The authors of the study didn't discover any connection between early medication usage and other congenital anomalies such website as facial deformities or club feet. The results are in agreement with previous studies which showed an insignificant, but small increase in cardiac malformations for women who began taking ADHD medication before the time of pregnancy. This risk increased during the latter part of pregnancy when many women began to stop taking their medication.
Women who used ADHD medications in the first trimester of their pregnancies were also more likely to have caesarean sections, a low Apgar score following delivery, and a baby who needed breathing assistance at birth. The authors of the study were not able to remove bias in selection since they limited their study to women who did not have any other medical conditions that might have contributed to the findings.
Researchers hope their research will provide doctors with information when they meet pregnant women. The researchers advise that, while discussing risks and benefits are important, the decision regarding whether or not to stop taking medication should be in light of the severity of each woman's ADHD symptoms and her requirements.
The authors also caution that, while stopping the medication is an alternative, it is not an option to consider due to the high rate of depression and other mental health issues for women who are expecting or recently postpartum. Further, the research suggests that women who choose to stop taking their medications are more likely to experience difficulties adapting to life without them following the baby's arrival.
Nursing
It can be a challenge becoming a mother. Women with ADHD who must work through their symptoms while attending doctor appointments, getting ready for the arrival of their child and adjusting to new household routines can experience severe challenges. Many women decide to continue taking their ADHD medication during pregnancy.
The risk for breastfeeding infant is minimal because the majority of stimulant medication is absorbed through breast milk at a low level. The rate of medication exposure will vary based on the dosage, frequency of administration and the time of the day. Additionally, individual medications enter the body of the baby differently through the gastrointestinal tract and breast milk and the impact of this on a newborn infant is not yet fully understood.
Due to the absence of research, some physicians might be tempted to stop taking stimulant medication during a woman's pregnancy. It's a difficult choice for the woman, who must weigh the benefits of continuing her medication against the potential risks to the fetus. Until more information becomes available, doctors can inquire about pregnant patients whether they have any history of ADHD or if they are planning to take medication during the perinatal stage.
A growing number of studies have proven that most women can safely continue taking their ADHD medication during pregnancy and while breastfeeding. In the end, an increasing number of patients are choosing to do so and in consultation with their physician, they have found that the benefits of maintaining their current medication far outweigh any potential risks.
Women with ADHD who plan to breastfeed should seek the advice of a specialist psychiatrist before becoming pregnant. They should discuss their medication with their doctor as well as the pros and cons of continuing treatment. This includes non-pharmacological methods. Psychoeducation is also needed to help pregnant women with ADHD be aware of the symptoms and the underlying disorder. They should also be educated about treatment options and strengthen the coping mechanisms. This should include a multidisciplinary approach, which includes the GP as well as obstetricians, psychiatry and obstetricians. Counselling for pregnancy should include discussion of a management plan for both the mother and child, as well as monitoring for signs of deterioration, and the need for adjustments to the medication regimen.