ADHD Medication During Pregnancy and Breastfeeding
The decision to stop or continue ADHD medications during pregnancy and breastfeeding is a challenge for women suffering from the condition. 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 issues such as hearing loss or vision, febrile seizures, or IQ impairment. The authors acknowledge that more high quality research is needed.
Risk/Benefit Analysis
Pregnant women who take ADHD medications need to balance the benefits of taking them against potential risks to the foetus. Physicians don't have the information needed to make unequivocal recommendations however they can provide information on the risks and benefits to assist pregnant women in making informed decisions.
A study published in Molecular Psychiatry found that women who used ADHD medications in early pregnancy did not face a significantly increased risk of fetal cardiac malformations or major structural birth defects. Researchers used a vast population-based study of case-control to determine the prevalence of major structural birth defects in infants born to mothers who had taken stimulants in early pregnancy, as well as those who had not. Clinical geneticists and pediatric cardiologists examined the cases to ensure correct classification of the cases and to reduce the possibility of bias.
The study of the researchers was not without limitations. The researchers were unable in the beginning to differentiate the effects triggered by the medication from the disorder. This makes it difficult to know whether the small differences observed in the groups that were exposed result from medication use or the confounding effect of comorbidities. Researchers also did not study long-term outcomes for offspring.
The study showed that infants whose mother took ADHD medication during pregnancy had a higher chance of being admitted to the neonatal care unit (NICU), compared to mothers who did not use any medication during pregnancy, or had discontinued taking their medication prior to or during pregnancy. This was due to central nervous system-related disorders, and the increased risk for admission was not found to be influenced by which stimulant medication was used during pregnancy.
Women who took stimulant ADHD medications during pregnancy also had a higher likelihood of having an emergency caesarean section or having one whose baby scored low on the Apgar scale (less than 7). These increases did appear to be independent of the type of medication used during pregnancy.
Researchers suggest that the minor risk of using ADHD medication during pregnancies in the early stages could be offset by the more beneficial outcomes for both mother and baby of continuing 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
As more women than ever before are being diagnosed with ADHD and being treated with medication, the issue of whether or not to end treatment during pregnancy is one that more and more doctors have to face. The majority of these decisions are taken in the absence of clear and authoritative evidence regardless, so doctors must weigh their knowledge, the experiences of other doctors, and what the research says on the topic as well as their own best judgment for each patient.
In particular, the issue of potential risks to the baby can be tricky. Many studies on this subject are based on observational data instead of controlled research and their findings are often contradictory. In addition, most 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 discussed in the journal club addresses these issues by analyzing the data from deceased and live births.
Conclusion Some studies have found a positive correlation between ADHD medications and certain birth defects However, other studies haven't found a correlation. Most studies have shown an unintended, or slight negative effect. In every case, a careful analysis of the potential risks and benefits is required.
It can be challenging, if not impossible for women suffering from ADHD to stop taking their medication. In fact, in a recent article 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. In addition, a decrease in medication can affect the ability to do job-related tasks and drive safely which are essential aspects of daily life for a lot of people with ADHD.
She suggests that women who are unsure whether to continue taking medication get more info or discontinue it due to pregnancy, educate their family members, coworkers, and friends about the condition, its 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 a patient decides not to take her ADHD medication while breastfeeding, it's important to be aware that the drug may be transferred to her baby.
Birth Defects Risk
As the use and use of ADHD medications to treat the symptoms of attention deficit hyperactivity disorder (ADHD) is increasing as does the concern about the potential effects of these drugs on foetuses. A recent study published in the journal Molecular Psychiatry adds to the existing knowledge about this subject. Utilizing two huge data sets researchers were able to look at more than 4.3 million pregnancies and see whether the use of stimulant medications 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 a slightly higher rate of specific heart defects, such as ventriculo-septal defect (VSD).
The authors of the study could not find any association between early use of medication and congenital anomalies such as facial deformities or club feet. The results are in agreement with previous studies that showed a small, but significant increase in cardiac malformations for women who started taking ADHD medication prior to the time of pregnancy. This risk increased during the latter part of pregnancy, when a lot of women begin to discontinue their medication.
Women who took ADHD medications during the first trimester of their pregnancy were also more likely to have a caesarean section, a low Apgar score after delivery and a baby who required breathing assistance at birth. However the researchers of the study were unable to eliminate bias due to selection by restricting the study to women who did not have other medical issues that could be a contributing factor to these findings.
The researchers hope their study will serve to inform the clinical decisions of physicians who treat pregnant women. The researchers recommend that while discussing the risks and benefits are important, the choice regarding whether or not to stop medication should be in light of the severity of each woman's ADHD symptoms and the needs of the woman.
The authors also warn that, while stopping the medication is an option, it is not an option that is recommended due to the high prevalence of depression and other mental health problems for women who are expecting or who are recently postpartum. Furthermore, research suggests that women who decide to stop taking their medication are more likely to experience a difficult time adapting to life without them following the birth of their baby.
Nursing
The responsibilities of a new mother can be overwhelming. Women suffering from ADHD can face severe challenges when they have to manage their symptoms, go to doctor appointments and prepare for the birth of their child and adjust to new routines. Many women choose to continue taking their ADHD medication during pregnancy.
The risk to nursing infant is low because the majority of stimulant medication passes through breast milk at a low level. The rate of exposure to medication can vary depending upon the dosage, frequency of administration and time of day. In addition, various drugs enter the infant's system via the gastrointestinal tract, or through breast milk. The impact of these medications on a newborn's health is not completely understood.
Some doctors may stop taking stimulant medications during a woman's pregnancy due to the lack of research. This is a complicated decision for the patient, who must balance the benefits of continuing her medication against the possible risks to the fetus. As long as more information is available, doctors can ask pregnant patients whether they have any background of ADHD or if they plan to take medication in the perinatal stage.
Many studies have shown that women can continue to take their ADHD medication safely while breastfeeding and during pregnancy. In response, a rising number of patients are opting to do so. They have concluded, in consultation with their doctor, that the benefits of continuing their current medication far outweigh any risk.
Women who suffer from ADHD who are planning to breastfeed should seek the advice of an expert psychiatrist prior to becoming pregnant. They should review their medications with their doctor and discuss the advantages and disadvantages of continued treatment, including non-pharmacological management strategies. Psychoeducation should also be offered to help pregnant people with ADHD recognize their symptoms and the root cause Learn about the available treatment options and strengthen existing coping strategies. This should include a multidisciplinary approach, which includes the GP, obstetricians and psychiatry. Pregnancy counseling should consist of a discussion of a treatment plan for the mother as well as the child, monitoring of signs of deterioration, and, if needed adjustments to the medication regime.