ADHD Medication During Pregnancy and Breastfeeding
Women with ADHD face a difficult decision regarding whether or not to stop taking ADHD medication during pregnancy and breastfeeding. There are few data regarding how exposure over time may affect a pregnant fetus.
A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication during the uterus do not develop neurological developmental disorders like hearing loss or impaired vision, febrile seizures, or IQ impairment. The authors acknowledge the need for higher-quality studies.
Risk/Benefit Analysis
Women who are pregnant and take ADHD medication must weigh the benefits of taking it against the potential risks for the foetus. The doctors don't have the information to give clear advice however they can provide information on 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 face a significantly increased risk of fetal heart malformations or major structural birth defects. Researchers used a vast, population-based case-control study to assess the risk of major structural birth defects in babies born to mothers who had taken stimulants in the early stages of pregnancy and those who had not. Clinical geneticists, pediatric cardiologists and other experts examined the cases to make sure that the classification was correct and to minimize any bias.
The study conducted by the researchers was not without its limitations. Researchers were unable in the beginning to distinguish the effects caused by the medication from the disorder. This limitation makes it difficult for researchers to establish whether the small differences observed between the groups exposed were due to the use of medications or if they were caused by comorbidities. Researchers also did not look at the long-term effects for the offspring.
The study showed that infants whose mother had taken ADHD medication during pregnancy were at a slightly greater risk of being admitted to the neonatal care unit (NICU) in comparison to those whose mothers did not use any medication during pregnancy or had discontinued taking 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 medication used during pregnancy.
Women who were taking stimulant ADHD medication during pregnancy also had an elevated risk of having a caesarean section or having a child with a low Apgar score (less than 7). These increases did appear to be unrelated to the type of medication taken during pregnancy.
Researchers suggest that the minor risk of using ADHD medication during pregnancies in the early stages can be offset by greater benefits to both mother and baby from continuing treatment for the woman’s disorder. Physicians should talk to their patients about this and try to help them improve coping skills which 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 dilemma of whether to keep or stop treatment during pregnancy is a question that more and more physicians face. Often, these decisions are made without any evidence that is clear and definitive in either case, which means that doctors must weigh what they know about their experiences, the experiences of other doctors, and what research suggests on the subject, along with their own best judgment for each patient.
Particularly, the subject of potential risks to the baby can be tricky. The research on this issue is based on observations instead of controlled studies and 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 that is discussed in this journal club addresses these issues by looking at data from both live and deceased births.
The conclusion The conclusion: While certain studies have demonstrated an association between ADHD medications and the risk of certain birth defects, other studies have found no such relationship, and most studies show a neutral or even slight negative effect. In every case, a careful study of the risks and benefits must be performed.
For many women with ADHD who suffer from ADHD, the decision to discontinue medication is difficult, if not impossible. In an article 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 loneliness and family conflict for patients with ADHD. A decrease in medication could also impact the ability to drive safely and complete work-related tasks, which are crucial aspects of normal life for those with ADHD.
She suggests that women who aren't sure whether to continue taking medication or stop due to pregnancy, educate their family members, coworkers and acquaintances about the condition, its impact on daily functioning and the advantages of staying on the current treatment plan. It can also aid in ensuring that the woman feels supported in her struggle with her decision. It is also worth noting that certain medications are able to be absorbed through the placenta so if a woman decides to stop her ADHD medication during pregnancy and breastfeeding, she must be aware of the possibility that traces of the drug can be transferred to the child.
Birth Defects and Risk of
As the use and misuse of ADHD drugs to treat symptoms of attention deficit disorder hyperactivity disorder (ADHD), increases, so does concern about the potential adverse effects of the drugs on foetuses. Recent research published in the journal Molecular Psychiatry has added to the body knowledge on this issue. Researchers used two huge datasets to analyze over 4.3 million pregnancy and determine if the use of stimulant medications increased the risk of birth defects. Researchers discovered that although the risk overall is low, the first trimester ADHD exposure to medication was associated with slightly higher rates of specific heart defects like ventriculoseptal defects.
how to treat adhd without medication in adults of the study found no connection between the use of early medications and other congenital abnormalities, such as facial clefting or club foot. The results are consistent with previous studies that have shown the presence of a small, but significant increase in the risk of heart malformations among women who began taking ADHD medications prior to the time of pregnancy. This risk increased during the latter stages of pregnancy when many women stopped taking their medication.
Women who took ADHD medications in the first trimester of their pregnancy were also more likely to experience a caesarean section, a low Apgar score after delivery and a baby who needed help breathing at birth. The researchers of the study were not able to eliminate bias due to selection because they restricted the study to women with no other medical conditions that could have contributed to the findings.
Researchers hope that their study will help doctors when they see pregnant women. The researchers suggest that, while discussing the risks and benefits are important, the choice about whether to continue or stop medication should be in light of the severity of each woman's ADHD symptoms and the needs of the woman.
The authors caution that, even though stopping the medication is a possibility to look into, it is not advised due to the high rate depression and other mental disorders in women who are expecting or who have recently given birth. Furthermore, research suggests that women who decide to stop taking their medication are more likely to experience a difficult time getting used to life without them following the baby's arrival.
Nursing
The responsibilities of a new mom can be overwhelming. Women with ADHD who must work through their symptoms while attending physician appointments as well as making preparations for the arrival of a child and getting used to new routines at home are often faced with a number of difficulties. Many women choose to continue taking their ADHD medication during pregnancy.
The risk to a breastfeeding infant is minimal because the majority of stimulant medication passes through breast milk at a low level. However, the rate of exposure to medications by the infant can differ based on dosage, how often it is administered and the time of the day the medication is administered. In addition, different drugs enter the infant's system via the gastrointestinal tract or breast milk. The effect on the health of a newborn is not completely comprehended.
Some doctors may decide to stop stimulant medication during a woman's pregnancy due to the absence of research. This is a difficult choice for the patient, who must balance the benefits of continuing her medication against the potential dangers to the foetus. Until more information becomes available, doctors can ask pregnant patients whether they have any background of ADHD or if they are planning to take medication in the perinatal phase.
Numerous studies have proven that women can continue to take their ADHD medication in a safe manner during pregnancy and while breast-feeding. 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 keeping their current medication far outweigh any potential risks.
It is essential for women with ADHD who are thinking of breastfeeding to seek a specialist psychiatrist's advice prior becoming pregnant. They should discuss their medication with their doctor, and the pros and cons of continuing treatment. This includes non-pharmacological methods. Psychoeducation is also needed to help pregnant women suffering from ADHD understand the symptoms and underlying disorder. They should also be informed about treatment options and reinforce coping mechanisms. This should be an approach that is multidisciplinary, including the GP as well as obstetricians, psychiatry and obstetricians. Pregnancy counseling should include discussion of a treatment plan for the mother and the child, monitoring of signs of deterioration, and, if necessary adjustments to the medication regime.