20 Trailblazers Lead The Way In ADHD Medication Pregnancy
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 breastfeeding. Little data exists about how long-term exposure to these drugs could affect the fetus.
A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication during the uterus do not develop neurological developmental conditions like hearing loss or impaired vision seizures, 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 must weigh the benefits of taking them against the potential risks to the foetus. Physicians do not have the necessary data to give clear guidelines but they can provide information about the risks and benefits to assist pregnant women in making informed decisions.
A study published in Molecular Psychiatry found that women who were taking ADHD medications during early pregnancy did not face an increased risk of fetal cardiac malformations or major birth defects that are structural. Researchers conducted a large population-based study of case control to compare the incidence of structural defects that were major in infants who were born to mothers who took stimulants during pregnancy. Pediatric cardiologists and clinical geneticists examined the cases to ensure accurate case classification and to limit the chance of bias.
The research conducted by the researchers had some limitations. In particular, they were unable to separate the effects of the medication from the disorder that is underlying. That limitation makes it difficult to determine whether the small differences observed in the groups that were exposed are due to medication use or comorbidities that cause confusion. In addition the study did not look at long-term offspring outcomes.
The study did show that babies whose mothers had taken ADHD medication during pregnancy were at slightly greater risk of being admitted to the neonatal intensive care unit (NICU) than those who were born without any medication or stopped their medications before or during pregnancy. This was due to central nervous system disorders. The higher risk of admission was not influenced by the stimulant medication that was used during pregnancy.
Women who were taking stimulant ADHD medications during pregnancy also had a higher likelihood of having an emergency caesarean section or having a baby that scored low on the Apgar scale (less than 7). These increases appear to be independent of the type of medication taken during pregnancy.
Researchers suggest that the small risk of using ADHD medications in early pregnancies can be offset by greater benefits for mother and baby from continuing treatment for the woman’s disorder. Physicians should speak with their patients about this and as much as possible, assist them improve coping skills which could reduce the effects of her disorder on her daily functioning and her relationships.
Medication Interactions
Many doctors are faced with the decision of whether to continue treatment or stop it during pregnancy as more women are diagnosed with ADHD. The majority of these decisions are made without any evidence that is clear and definitive either way, so physicians must weigh their knowledge from their own experiences, those of other doctors, and what the research suggests on the subject and their own best judgment for each individual patient.
The issue of risk to infants is difficult to determine. Many studies on this topic are based on observational data rather than controlled research, and their conclusions are often contradictory. 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 presented in this journal club addresses these issues by looking at data from both live and deceased births.
Conclusion A few studies have revealed an association between ADHD medications and certain birth defects, other studies have not found a correlation. Most studies have shown that there is a neutral, or slightly negative, effect. In every case it is imperative to conduct a thorough study of the risks and benefits must be performed.
For women suffering from ADHD and ADD, the decision to stop taking medication is difficult, if not impossible. In a recent article in the Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can lead to depression and feelings of isolation. A loss of medication may affect the ability to drive safely and to perform work-related tasks which are vital aspects of everyday life for those with ADHD.
She suggests that women who are unsure whether to take the medication or stop it due to their pregnancy, educate their family members, coworkers and friends about the condition, its effects on daily functioning, and the advantages of staying on the current treatment plan. It can also help women feel confident about her decision. It is also worth noting that certain medications can pass through the placenta therefore, if a patient decides to discontinue her ADHD medication during pregnancy and breastfeeding, she must be aware of the possibility that traces of the drug could be transferred to the child.
Risk of Birth Defects
As the use and abuse of ADHD medications to treat the symptoms of attention deficit disorder hyperactivity disorder (ADHD), increases, so does concern about the potential effects of these drugs on foetuses. A study that was published in the journal Molecular Psychiatry adds to the existing knowledge on this subject. Utilizing two huge data sets researchers were able to look at more than 4.3 million pregnancies to determine whether stimulant medications increased the risk of birth defects. Although the risk overall remains low, the researchers found that exposure in the first trimester to ADHD medications was associated with an increased risk of certain heart defects, like ventriculo-septal defects (VSD).
The researchers of the study did 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 the existence of a slight, but significant increase in cardiac malformations for women who began taking ADHD medication prior to pregnancy. This risk increased during the latter stages of pregnancy when many women began to stop taking their medication.
Women who took ADHD medication during the first trimester were more likely require a caesarean birth or have a low Apgar after birth and had a baby that required breathing assistance at birth. The researchers of the study were not able to remove bias in selection since they restricted the study to women without other medical conditions that might have contributed to the findings.
The researchers hope their research will serve to inform the clinical decisions of physicians who treat pregnant women. They recommend that, while discussing the risks and benefits is crucial but the decision to stop or continue medication should be based on the woman's needs and the severity of her adhd medication list uk (more resources) symptoms.
The authors caution that, even though stopping the medication is an option to consider, it is not advised because of the high incidence of depression and mental health issues among women who are pregnant or who have recently given birth. Further, the research suggests that women who decide to stop taking their medications are more likely to have difficulties adapting to life without them after the birth of their baby.
Nursing
The responsibilities of a new mom can be overwhelming. Women who suffer from ADHD who have to deal with their symptoms while attending physician appointments as well as getting ready for the arrival of a baby and adjusting to new household routines are often faced with a number of difficulties. Therefore, many women decide to continue taking their ADHD medications throughout the course of pregnancy.
The risk to breastfeeding infant is not too high since the majority of stimulant medications passes through breast milk at low levels. The rate of medication exposure will vary based on the dosage the medication is administered, its frequency and the time of the day. Additionally, individual medications enter the infant's system differently through the gastrointestinal tract as well as breast milk and the impact of this on a newborn isn't fully known.
Because of the lack of research, some physicians may be inclined to discontinue stimulant medication during the course of pregnancy. This is a difficult decision for the patient, who must weigh the benefit of continuing her medication with the potential dangers to the fetus. In the meantime, until more information is available, doctors should inquire with all pregnant patients about their experience with ADHD and whether they are taking or planning to take medication during the perinatal period.
Numerous studies have demonstrated that women can continue to take their ADHD medication safely during pregnancy and while breast-feeding. As a result, many patients choose to do so and, after consulting with their doctor, they have found that the benefits of keeping their current medication outweigh any potential risks.
It is crucial for women suffering from ADHD who are thinking of breastfeeding to seek a specialist psychiatrist's advice prior to becoming pregnant. They should discuss their medication with their doctor and discuss the pros and cons of continuing treatment. This includes non-pharmacological methods. Psychoeducation is also necessary to help pregnant women with adhd sleep medication be aware of the symptoms and underlying disorder. They should also be informed about treatment options and build the coping with adhd without medication mechanisms. This should be a multidisciplinary process with the GPs, obstetricians and psychiatry. Pregnancy counseling should include a discussion of a treatment plan for the mother and the child, and monitoring for signs of deterioration and, if necessary adjustments to the medication regime.