ADHD Medication During Pregnancy and Breastfeeding
Women with ADHD have to make a difficult choice on whether to keep or stop taking ADHD medication during pregnancy and breast-feeding. Little data exists about how long-term exposure to these medications may affect the foetus.
A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication in utero do not develop neurological disorders like impaired vision or hearing, febrile seizures, or IQ impairment. The authors acknowledge that more high-quality studies are needed.
Risk/Benefit Analysis
Pregnant women who take ADHD medications need to balance the benefits of taking them against potential risks to the fetus. The doctors don't have the information to give clear advice, but can provide information on the risks and benefits to help pregnant women make an informed decision.
A study published in Molecular Psychiatry concluded that women who were taking ADHD medication in early pregnancy were not at a higher risk of fetal malformations or structural birth defects. Researchers used a vast population-based study of case-control to assess the risk of major structural birth defects in babies born to mothers who had taken stimulants during early pregnancy, and those who did not. Pediatric cardiologists, clinical geneticists and other experts reviewed the cases in order to ensure that the classification was accurate and to minimize any bias.
The study of the researchers had some limitations. The most important issue was that they were not able to differentiate the effects of the medication from the effects of the disorder that is underlying. This makes it difficult to determine whether the small associations observed in the exposed groups are due to medication use or confounding by comorbidities. The researchers also did not look at the long-term effects for the offspring.
The study showed that infants whose mothers took ADHD medication during pregnancy had a greater risk of being admitted to the neonatal care unit (NICU) as compared to those whose mothers didn't take any medication during pregnancy or had stopped taking their medication before or during pregnancy. This increase was caused by central nervous system disorders. The increased risk of admission was not influenced by the stimulant medications used during pregnancy.
Women who took stimulant ADHD medication during pregnancy were also at an increased chance of having a caesarean section or having a baby with an low Apgar score (less than 7). These increases did not appear 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 the early stages of pregnancy may be offset by the greater benefit to both the mother and child of continued treatment for the woman's disorder. Physicians should discuss this with their patients and, when possible, help them develop strategies to improve their coping abilities that may minimize the impact of her disorder on her daily functioning and relationships.
Medication Interactions
Many doctors are confronted with the dilemma of whether to maintain treatment or stop during pregnancy as more women are diagnosed with ADHD. Often, these decisions are made without any evidence that is clear and definitive either way, so physicians must weigh their knowledge about their experiences, the experiences of other doctors, and what the research suggests about the subject, along with their own best judgment for each individual patient.
The issue of risk to the infant can be particularly tricky. Many of the studies on this subject are based on observational data rather than controlled research, and their conclusions are often contradictory. Additionally, the majority of studies limit their analysis to live births, which can undervalue the serious teratogenic effects that can result in abortion or termination of the pregnancy. The study presented in the journal club addresses these limitations, by examining both data on live and deceased births.
Conclusion A few studies have found a positive correlation between ADHD medications and certain birth defects However, other studies haven't established a link. Most studies show a neutral, or even slightly negative, impact. In all cases, a careful study of the risks and benefits must be performed.
It can be difficult, if not impossible, for women with ADHD to stop taking their medication. In a recent article in the Archives of Women's Mental Health psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can increase depression, feelings of loneliness and family conflict for these patients. Furthermore, a loss of medication can interfere with the ability to complete job-related tasks and drive safely, which are important aspects of daily life for a lot of people with ADHD.
She suggests that women who aren't sure whether to continue taking medication or discontinue it due to pregnancy, educate their family members, coworkers and their friends about the condition, the effects on daily functioning, and the benefits of continuing the current treatment. It can also help women feel supported in her decision. Certain medications can be passed through the placenta. If a woman decides not to take her ADHD medication while breastfeeding, it is important to be aware that the drug could be transferred to the baby.
Risk of Birth Defects
As the use of ADHD medication to treat the symptoms of attention deficit hyperactivity disorder (ADHD) grows there are concerns about what impact the drugs might have on foetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge on this issue. Using two massive data sets researchers were able examine more than 4.3 million pregnancies and determine whether stimulant medication use 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 linked to an increase in the risk of certain heart defects like ventriculo-septal defects (VSD).
The authors of the study didn't discover any link between early medication usage and congenital anomalies like facial deformities, or club feet. The findings are in line with previous studies that have shown an increase, but not significant, in the risk of heart malformations among women who started taking ADHD medications before pregnancy. adhd adults medication increased during the latter half of pregnancy, when a lot of women stopped taking their medication.
Women who took ADHD medication in the first trimester were more likely require a caesarean delivery, have an insufficient Apgar after birth and have a baby who needed help breathing when they were born. The authors of the study were not able to eliminate selection bias because they limited their study to women with no other medical conditions that might have contributed to the findings.
Researchers hope that their study will provide doctors with information when they encounter pregnant women. They advise that while the discussion of the risks and benefits is crucial however, the decision to stop or keep treatment should be based on each woman's requirements and the severity of her ADHD symptoms.
The authors also advise that even though stopping the medication is an option, it is not an option to consider due to the high incidence of depression and other mental health issues in women who are pregnant or who are recently post-partum. Additionally, the research suggests that women who decide to stop taking their medications are more likely to have a difficult time getting used to life without them following the birth of their baby.
Nursing
The responsibilities of a new mother can be overwhelming. Women with ADHD can face severe challenges when they must manage their symptoms, go to doctor appointments and prepare for the birth of their child and adjust to new routines. Therefore, many women decide to continue taking their ADHD medication throughout the pregnancy.
The risk for nursing infant is low because the majority of stimulant medication is absorbed through breast milk at a low level. The rate of medication exposure will differ based on dosage and frequency of administration as well as time of day. Additionally, individual medications enter the body of the baby differently through the gastrointestinal tract as well as breast milk. The impact of this on a newborn is not yet fully known.
Some doctors may decide to stop stimulant medication during a woman's pregnancy due to the absence of research. This is a difficult decision for the patient, who must weigh the benefit of continuing her medication against the potential risks to the embryo. In the meantime, until more information is available, doctors should ask all pregnant patients about their history of ADHD and if they are taking or planning to take medication during the perinatal period.
Numerous studies have proven that women can continue to take their ADHD medication safely while breastfeeding and during pregnancy. In response, a growing number of patients are choosing to do so. They have found through consultation with their doctor, that the benefits of continuing their current medication outweigh potential risks.
Women with ADHD who are planning to nurse should seek advice from an expert psychiatrist prior to becoming pregnant. They should discuss their medication with their prescriber and discuss the pros and cons for continuing treatment. This includes non-pharmacological methods. Psychoeducation is also required to help women with ADHD be aware of their symptoms and the underlying disorder, learn about available treatments and to reinforce existing coping strategies. This should involve a multidisciplinary approach with the GP as well as obstetricians, psychiatry and obstetricians. Pregnancy counseling should consist of a discussion of a treatment plan for the mother and the child, as well as monitoring for signs of deterioration and, if needed modifications to the medication regimen.