ADHD Medication During Pregnancy and Breastfeeding
Women with ADHD face a difficult decision about whether to continue or stop taking ADHD medication during pregnancy and breastfeeding. There are few data on how long-term exposure may affect a fetus.
A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication during utero do not develop neurological developmental disorders such as impaired vision or hearing, febrile seizures, or IQ impairment. The authors acknowledge that further high-quality studies are needed.
Risk/Benefit Analysis
Women who are expecting and taking ADHD medication need to evaluate the benefits of using it versus the dangers for the fetus. Doctors don't have the information needed to provide clear recommendations, but they can provide information on benefits and risks that can help pregnant women make informed decisions.
A study published in Molecular Psychiatry found that women who used ADHD medications during their early pregnancy did not face an higher risk of fetal cardiac malformations or major birth defects that are structural. Researchers used a vast population-based study of case-control to evaluate the incidence of major structural birth defects in infants born to mothers who had taken stimulants during the early stages of pregnancy and those who had not. Pediatric cardiologists, clinical geneticists and other experts looked over the cases to make sure that the classification was accurate and to eliminate any bias.
The research conducted by the researchers was not without limitations. The researchers were not able in the beginning, to separate the effects triggered by the medication from the disorder. This makes it difficult for researchers to establish whether the small differences observed between the groups that were exposed to the use of medication or affected by comorbidities. Additionally the study did not look at the long-term outcomes of offspring.
The study revealed that infants whose mothers took ADHD medication during pregnancy were at a slightly higher risk of admission to the neonatal care unit (NICU) as compared to those whose mothers didn't take any medication during pregnancy or stopped taking their medication before or during pregnancy. The reason for this was central nervous system disorders, and the increased risk of admission was not found to be affected by the type of stimulant medication was used during pregnancy.
Women who were taking stimulant ADHD medications during pregnancy also had a higher risk of having to have an emergency caesarean section or having one whose baby scored low on the Apgar scale (less than 7). These increases appeared to be unrelated to the type of medication taken during pregnancy.
The research suggests that the risk of a small amount with the use of ADHD medications during early pregnancy may be offset by the greater benefits to both mother and child from continued treatment for the woman's disorder. Doctors should discuss with their patients about this issue and as much as possible, assist them develop coping skills that can lessen the impact of her disorder in her daily life and relationships.
Interactions with Medication
As more women than ever before are being diagnosed with ADHD and being treated with medication, the question of whether to keep or discontinue treatment during pregnancy is one that doctors are having to confront. The majority of these decisions are made in the absence of solid and reliable evidence regardless, so doctors have to weigh their experience, the experiences of other doctors, and what research says on the topic, along with their own best judgment for each patient.
Particularly, the issue of potential risks for the baby can be a challenge. A lot of studies on this topic are based on observational data instead of controlled research and their conclusions are often contradictory. Additionally, the majority of studies limit their analysis to live births, which can underestimate severe teratogenic effects that cause abortion or termination of the pregnancy. The study presented in the journal club addresses these shortcomings by analyzing both data on live and deceased births.
The conclusion is that while some studies have found a positive association between ADHD medications and the possibility of certain birth defects, other studies have found no connection, and most studies have a neutral or slight negative effect. In all cases it is imperative to conduct a thorough study of the potential risks and benefits must be performed.
For many women with ADHD who suffer from ADHD, the decision to stop medication is difficult, if not impossible. In fact, in an article recently published in Archives of Women's Mental Health, psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can lead to increased depression, feelings of isolation and family conflict for those suffering from the disorder. A decrease in medication could also affect the ability to drive safely and perform work-related tasks, which are crucial aspects of daily life for those suffering from ADHD.
She recommends women who are uncertain about whether or not to stop medication in light of their pregnancy consider informing family members, friends and colleagues about the condition, its impact on daily functioning, and on the benefits of keeping the current treatment plan. It can also help a woman feel more confident in her decision. Certain medications can pass through the placenta. If a patient decides to not take her ADHD medication while pregnant and breastfeeding, it's important to be aware that the drug could be transferred to the baby.
Birth Defects and Risk of
As the use of ADHD medications to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases, so do concerns over the impact that these medications could have on fetuses. Recent research published in the journal Molecular Psychiatry has added to the body knowledge on this issue. Researchers used two huge data sets to study over 4.3 million pregnancies and determine if stimulant medication use increased birth defects. Although the risk overall is low, the researchers did find that first-trimester exposure to ADHD medications was linked to an increase in the risk of certain heart defects, such as ventriculoseptal defect (VSD).
The researchers behind the study found no association between early use of medication and other congenital anomalies, like facial clefting, or club foot. The results are in line with previous studies revealing a small but significant increase in the risk of cardiac malformations among women who began taking ADHD medications prior to the time of the time of pregnancy. The risk grew in the later part of pregnancy, when a lot of women decide to stop taking their ADHD medication.
Women who took ADHD medications in the first trimester of their pregnancy were also more likely to have caesarean section, low Apgar score after delivery and a baby who 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 did not have any other medical conditions that could be a contributing factor to these findings.
The researchers hope that their research will serve to inform the clinical decisions of doctors who treat pregnant women. The researchers recommend that while discussing the risks and benefits are important, the decision on whether to continue or stop medication should be made based on the severity of each woman's ADHD symptoms and her requirements.
The authors warn that, while stopping the medication is a possibility to think about, it isn't advised due to the high rate depression and other mental disorders for women who are pregnant or who have recently given birth. Additionally, research suggests that women who stop taking their medications will have a tough transitioning to life without them after the baby is born.
Nursing
The responsibilities that come with being a new mother can be overwhelming. Women who suffer from ADHD can face severe challenges when they have to manage their symptoms, attend doctor appointments and prepare for the birth of their child and adjust to new routines. This is why many women choose to continue taking their ADHD medications throughout pregnancy.
The majority of stimulant medicines are absorbed by breast milk in small amounts, therefore the risk to nursing infant is very low. However, the rate of exposure to medication by the newborn may differ based on dosage, how often it is administered, and the time of the day it is administered. In addition, various drugs enter the infant's system via the gastrointestinal tract, or through breast milk. The effect on a newborn's health is not completely comprehended.
Some physicians may discontinue stimulant medication during a woman’s pregnancy due to the absence of research. This is a difficult decision for the mother, who must weigh the benefits of continuing her medication against the risks to the embryo. As long as more information is available, GPs may ask pregnant patients whether they have a background of ADHD or if they are planning to take medication in the perinatal period.
A growing number of studies have proven that the majority of women are able to safely continue taking their ADHD medication during pregnancy and while breastfeeding. As a result, an increasing number of patients choose to do so, and in consultation with their doctor they have found that the benefits of keeping their current medication far exceed any risk.
adhd medication online with ADHD who plan to breastfeed should seek the advice of a specialist psychiatrist before becoming pregnant. They should discuss their medication with their prescriber and discuss the advantages and disadvantages of continuing treatment, including non-pharmacological strategies. Psychoeducation is also required to help pregnant women suffering from ADHD be aware of the symptoms and the underlying disorder. They should also learn about treatment options and strengthen strategies for coping. This should include a multidisciplinary approach, which includes the GP doctors, obstetricians and psychiatrists. Pregnancy counseling should include a discussion of a treatment plan for the mother and child, monitoring of signs of deterioration and, if needed modifications to the medication regimen.