ADHD Medication During Pregnancy and Breastfeeding
The choice of whether to stop or continue ADHD medications during pregnancy and breastfeeding is challenging for women with the condition. There are adhd medication uk regarding how exposure over time may affect a foetus.
A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological problems like hearing loss or vision, febrile seizures, or IQ impairment. The authors acknowledge that further high-quality studies are needed.
Risk/Benefit Analysis
Women who are pregnant and taking ADHD medication should evaluate the benefits of using it against the potential dangers for the foetus. Physicians don't have the data needed to give clear guidelines, but they can provide information regarding risks and benefits that help pregnant women make informed decisions.
A study published in Molecular Psychiatry concluded that women who were taking ADHD medication during early pregnancy were not at a higher risk of fetal malformations, or structural birth defects. Researchers conducted a large sample-based case control study to assess the frequency of major structural defects in infants born to mothers who took stimulants during pregnancy. Clinical geneticists and pediatric cardiologists reviewed the cases to ensure correct case classification and to minimize the possibility of bias.
The research conducted by the researchers was not without its limitations. The most important issue was that they were unable to distinguish the effects of the medication from the underlying disorder. This makes it difficult to determine whether the small differences observed in the exposed groups are due to the use of medication or comorbidities that cause confusion. The researchers also did not study long-term outcomes for offspring.
The study showed that infants whose mothers took ADHD medication during pregnancy had a slightly higher risk of admission to the neonatal care unit (NICU) as compared to those whose mothers did not take any medication during pregnancy or had discontinued taking their medication prior to or during pregnancy. The reason for this was central nervous system-related disorders and the increased risk for admission was not found to be influenced by which stimulant medications were used during pregnancy.
Women who used stimulant ADHD medication during pregnancy were also at an increased risk of having a caesarean section or having a child with an low Apgar score (less than 7). These increases did not seem to be influenced by the kind of medication used during pregnancy.
The researchers suggest that the low risk associated with the use of ADHD medications during early pregnancy may be offset by the higher benefit to both mother and child of continued treatment for the woman's condition. Doctors should discuss with their patients about this and as much as possible, assist them develop coping skills that may reduce the impact of her disorder in her daily functioning and her relationships.
Medication Interactions
Doctors are increasingly confronted with the dilemma of whether to maintain treatment or stop as more women are diagnosed with ADHD. These decisions are usually taken without clear and authoritative evidence. Instead, doctors must take into account their own experience, the experience of other physicians and the research on the topic.
Particularly, the subject of potential risks for the baby can be tricky. The research that has been conducted on this topic is based on observations rather than controlled studies, and many of the findings are in conflict. Furthermore, most studies restrict their analysis to live births, which could underestimate severe teratogenic effects that cause abortion or termination of the pregnancy. The study that is discussed in the journal club addresses these limitations by analyzing information on deceased and live births.
The conclusion: While certain studies have demonstrated that there is a positive correlation between ADHD medications and the possibility of certain birth defects, other studies have found no such relationship, and most studies have a neutral or slightly negative effect. Therefore an accurate risk-benefit analysis is required in every situation.
It can be difficult, if not impossible for women with ADHD to stop taking their medication. In fact, in an article 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 these patients. Furthermore, a loss of medication can affect the ability to perform job-related tasks and drive safely which are essential aspects of daily life for many people suffering from ADHD.
She suggests that women who are unsure whether to continue taking medication or discontinue it due to pregnancy, educate their family members, coworkers, and friends about the condition, the effects on daily functioning, and the benefits of keeping the current treatment plan. It can also help women feel confident about her decision. Certain medications can pass through the placenta. If the patient decides not to take her ADHD medication while pregnant and breastfeeding, it's important to be aware that the drug may be transferred to her baby.
Risk of Birth Defects
As the use and misuse of ADHD drugs to treat symptoms of attention deficit disorder hyperactivity disorder (ADHD) is increasing 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 on this issue. Researchers utilized two massive data sets to study more than 4.3 million pregnancies and determine if the use of stimulant medications increased the risk of birth defects. Researchers discovered that, while the risk overall is low, first-trimester ADHD medication use was associated with slightly higher risk of specific heart defects like ventriculoseptal defect.
The authors of the study could not find any association between the use of early medications and congenital anomalies like facial deformities, or club feet. The results are in the same vein as previous studies that showed a small, but significant increase in cardiac malformations for women who started taking ADHD medication prior to the time of the birth of their child. The risk grew in the latter half of pregnancy, when a lot of women are forced to stop taking their medication.
Women who took ADHD medication during the first trimester were more likely need a caesarean or have an insufficient Apgar after delivery, and have a baby that needed help breathing after birth. However the researchers of the study were unable to eliminate selection bias by restricting the study to women who didn't have any other medical conditions that could have contributed to these findings.
Researchers hope that their research will help doctors when they see pregnant women. They suggest that although discussing the risks and benefits is crucial however, the decision to stop or maintain treatment should be based on each woman's needs and the severity of her ADHD symptoms.
The authors also warn 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 in women who are pregnant or who are recently post-partum. Further, research shows that women who stop taking their medication will have a harder time adjusting to a life without them once the baby is born.
Nursing
It can be a challenge to become a mother. Women who suffer from ADHD who have to manage their symptoms while attending doctor appointments and making preparations for the arrival of a baby and adapting to new routines in the home may face a lot of challenges. Therefore, many women elect to continue taking their ADHD medication throughout the pregnancy.
The risk to a breastfeeding infant is minimal because the majority of stimulant medications passes through breast milk at low levels. However, the rate of exposure to medication by the infant can differ based on dosage, how often it is taken and the time of day the medication is administered. In addition, various medications are introduced into the baby's system via the gastrointestinal tract or through breast milk. The impact on the health of a newborn isn't fully known.
Some physicians may discontinue stimulant medications during a woman's pregnancy due to the lack of research. This is a complicated decision for the patient, who must weigh the benefit of continuing her medication against the potential dangers to the foetus. In the meantime, until more information is available, doctors may inquire about pregnant patients whether they have a background of ADHD or if they are planning to take medication in the perinatal stage.
A increasing number of studies have shown that women can continue their ADHD medication while they are pregnant and nursing. As a result, many patients choose to do so and in consultation with their doctor they have discovered that the benefits of maintaining their current medication far exceed any risk.
Women with ADHD who are planning to nurse should seek the advice of a specialist psychiatrist before becoming pregnant. They should discuss their medication with their doctor and discuss the advantages and disadvantages of continued treatment, including non-pharmacological management strategies. Psychoeducation is also required to help women with ADHD understand their symptoms and underlying disorder Learn about the available treatments and to reinforce existing strategies for managing. This should involve a multidisciplinary approach with the GP doctors, obstetricians and psychiatrists. Pregnancy counseling should include a discussion of a treatment plan for the mother as well as the child, and monitoring for signs of deterioration and, if necessary adjustments to the medication regimen.