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 breastfeeding. There aren't enough data on how exposure to ADHD for a long time could affect a pregnant fetus.
A study recently 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 research is needed.
Risk/Benefit Analysis
Women who are pregnant and taking ADHD medications need to balance the benefits of taking them against potential risks to the fetus. Physicians don't have the information needed to provide clear recommendations but they can provide information regarding the risks and benefits to assist pregnant women in making informed choices.
A study published in Molecular Psychiatry found that women who used ADHD medications during their early pregnancy did not have a significantly higher risk of fetal cardiac malformations or major birth defects that are structural. Researchers conducted a massive population-based case control study to assess the frequency of structural defects that were major in infants born to mothers who used stimulants during pregnancy. Pediatric cardiologists, clinical geneticists and other experts reviewed the cases in order to make sure that the classification was correct and to minimize any bias.
However, the researchers' study was not without its flaws. The researchers were unable to, in the first place to differentiate the effects caused by the medication from the disorder. This limitation makes it difficult to know whether the limited associations observed in the exposed groups result from medication use or the confounding effect of comorbidities. Additionally the researchers did not study the long-term outcomes of offspring.
adhd medication uk found that babies whose mothers had taken ADHD medication during pregnancy had a slightly higher risk of admission to the neonatal care unit (NICU) in comparison to mothers who did not take any medication during pregnancy or discontinued taking their medication prior to or during pregnancy. The reason for this was central nervous system disorders, and the increased risk of admission was not found to be influenced by the stimulant medications were taken during pregnancy.
Women who took stimulant ADHD medications during pregnancy also had a higher risk of having to have caesarean sections or a baby that scored low on the Apgar scale (less than 7). These increases did not appear to be influenced by the type of medication that was used during pregnancy.
Researchers suggest that the minor risks posed by the use of ADHD medications during early pregnancies may be offset by the greater benefits to both mother and baby of continuing treatment for the woman’s disorder. Physicians should talk to their patients about this and as much as possible, assist them develop coping strategies that could reduce the impact of her disorder in her daily functioning and her relationships.
Medication Interactions
As more women than ever are being diagnosed with ADHD and treated with medication, the dilemma of whether to keep or discontinue treatment during pregnancy is one that doctors are having to face. These decisions are usually taken without clear and authoritative evidence. Instead, doctors have to consider their own expertise in conjunction with the experiences of other doctors, and the research that has been conducted on the subject.
The issue of possible risks to the infant can be extremely difficult. The research that has been conducted on this topic is based on observation rather than controlled studies and the results are conflicting. The majority of studies focus on live births, which can underestimate the severity of teratogenic effects which can cause terminations or abortions of pregnancy. The study presented in this journal club addresses these issues by looking at data from both live and deceased births.
Conclusion Some studies have revealed a positive correlation between ADHD medications and certain birth defects, other studies have not shown such a relationship. Most studies show that there is a neutral, or slightly negative, impact. In all cases, a careful evaluation of the benefits and risks must be performed.
It can be difficult, if not impossible for women suffering from ADHD to stop taking their medication. In an article recently published in 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. In addition, a decrease in medication can affect the ability to complete jobs and drive safely, which are important aspects of a normal life for many people suffering from ADHD.
She suggests women who are uncertain about whether or not to discontinue medication due to their pregnancy consider informing family members, friends and colleagues about the condition, its effects on daily functioning, and the benefits of keeping the current treatment regimen. It will also help a woman feel confident about her decision. It is important to remember that certain medications are able to pass through the placenta, so if a woman decides to stop taking her ADHD medication during pregnancy and breastfeeding, she must be aware that traces of the medication could be transferred to the child.
Risk of Birth Defects
As the use and misuse of ADHD medications to treat the symptoms of attention deficit disorder hyperactivity disorder (ADHD) is increasing as does the concern about the potential effects of these drugs on foetuses. A study that was published in the journal Molecular Psychiatry adds to the body of information on this topic. Researchers used two huge data sets to examine over 4.3 million pregnant women and determine if the use of stimulant medications caused birth defects. While the overall risk remains low, the scientists discovered that the first-trimester exposure to ADHD medications was linked to an increased risk of certain heart defects like ventriculo-septal defects (VSD).
The researchers of the study didn't find any association between early medication usage and other congenital anomalies, like facial deformities or club feet. The findings are in line with previous studies that have shown a small but significant increase in the risk of developing cardiac malformations among women who began taking ADHD medications before the time of pregnancy. The risk increased in the latter half of pregnancy, when a lot of women decided to stop taking their medication.
Women who took ADHD medications in the first trimester of their pregnancies were also more likely to experience caesarean section, low Apgar score after delivery and a baby who needed breathing assistance at birth. The authors of the study were not able to eliminate selection bias because they limited the study to women with no other medical conditions that might have contributed to the findings.
The researchers hope that their research will serve to inform the clinical decisions of doctors who treat pregnant women. The researchers suggest that while discussing the risks and benefits are important, the decision on whether to continue or stop taking medication should be in light of the severity of each woman's ADHD symptoms and the needs of the woman.
The authors warn that, although stopping the medication is a possibility to think about, it isn't recommended due to the high rate depression and other mental disorders for women who are pregnant or have recently given birth. Further, research shows that women who stop taking their medications will have a tough adjustment to life without them once the baby is born.
Nursing
The responsibilities of being a new mom can be overwhelming. Women who suffer from ADHD who must work through their symptoms while attending physician appointments as well as making preparations for the arrival of a baby and adjusting to new household routines can experience severe challenges. This is why many women elect to continue taking their ADHD medications throughout the course of pregnancy.
The risk to nursing infant is low because the majority of stimulant medications passes through breast milk in low amounts. The amount of exposure to medications will vary based on the dosage the medication is administered, its frequency and the time of the day. Additionally, medication for adhd enter the infant's system differently through the gastrointestinal tract and breast milk, and the effect of this on a newborn infant is not well understood.
Due to the absence of evidence, some doctors may be inclined to discontinue stimulant drugs during the pregnancy of a woman. It's a difficult choice for the mother, who must weigh the advantages of taking her medication as well as the risks to the foetus. As long as there is no more information, doctors should inquire with all pregnant patients about their history of ADHD and if they are taking or planning to take medication during the perinatal time.
A increasing number of studies have shown that most women can safely continue to take their ADHD medication while they are pregnant and nursing. This has led to more and more patients opt to do this and after consulting with their doctor, they have found that the benefits of continuing their current medication far outweigh any potential risks.
Women who suffer from ADHD who plan to breastfeed should seek advice from a specialist psychiatrist before becoming pregnant. They should discuss their medication with their prescriber and discuss the advantages and disadvantages of continued treatment, including non-pharmacological strategies. Psychoeducation should also be provided to help pregnant people with ADHD understand their symptoms and the underlying disorder, learn about available treatments and to reinforce existing strategies for managing. This should be a multidisciplinary effort including obstetricians, GPs and psychiatry. Counselling for pregnancy should include discussion of a management plan for both mother and child, monitoring for signs of deterioration and, if necessary, adjustments to the medication regimen.