ADHD Medication During Pregnancy and Breastfeeding
The choice of whether to stop or continue ADHD medications during breastfeeding and pregnancy is challenging for women with the condition. There are few data regarding how exposure over time may affect the foetus.
A recent study 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 more high-quality studies are needed.
Risk/Benefit Analysis
Pregnant women who use ADHD medications need to balance the advantages of using them against the risks to the fetus. Doctors don't have the information needed to make unequivocal recommendations but they can provide information regarding risks and benefits that aid pregnant women in making informed decisions.
A study published in Molecular Psychiatry concluded that women who were taking ADHD medication in early pregnancy were not at a greater risk of fetal malformations or structural birth defects. Researchers conducted a large population-based study of case-control to evaluate the incidence of major structural birth defects in babies born to mothers who had taken stimulants during the early stages of pregnancy, as well as those who had not. Clinical geneticists, pediatric cardiologists and other experts examined the cases to confirm 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 separate the effects caused by the medication from the disorder. This limitation makes it difficult for researchers to determine if the small differences observed between the groups that were exposed to medication use, or if they were caused by comorbidities. The researchers also did not look at long-term outcomes for the offspring.
The study did find that infants whose mothers had taken ADHD medication during pregnancy were at a more risk of being admitted to the neonatal intensive care unit (NICU) than those who whose mothers did not take any medication or had stopped their medications before or during pregnancy. The reason for this was central nervous system disorders, and the higher risk of admission was not found to be influenced by the stimulant medications were used during pregnancy.
Women who used stimulant ADHD medication during pregnancy were also at an increased chance of having a caesarean birth or having a baby born with an low Apgar score (less than 7). These increases did appear to be unrelated to the type of medication taken during pregnancy.
Researchers suggest that the minor risks associated with the use ADHD medications in early pregnancies can be offset by greater benefits to both mother and baby of continuing treatment for the woman's condition. Physicians should discuss the issue with their patients and, where they are able, assist them in developing strategies for improving their coping skills that may minimize the effects of her disorder on her daily life and relationships.
Interactions with Medication
Many doctors are confronted with the dilemma of whether to continue treatment or stop as more women are diagnosed with ADHD. The majority of these decisions are made without any evidence that is clear and definitive in either case, which means that doctors have to weigh their experience from their own experiences, those of other doctors, and what research suggests about the subject as well as their best judgment for each individual patient.
Particularly, the subject of potential risks to 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 conflicting. Most studies restrict their analysis to live-births, which could underestimate the severity of teratogenic effects that can lead to terminations or abortions of pregnancy. The study that is discussed in the journal club addresses these limitations by analyzing both information on deceased and live births.
The conclusion is that while some studies have shown a positive association between ADHD medications and the risk of certain birth defects, others have found no connection and the majority of studies have a neutral or slightly negative effect. In every case an in-depth study of the potential risks and benefits must be performed.
It can be challenging, if not impossible, for women with ADHD to stop taking their medication. In a recent article published in Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can increase depression and feelings of isolation. The loss of medication for inattentive adhd and anxiety can also impact the ability to safely drive and complete work-related tasks, which are crucial aspects of daily life for those suffering from ADHD.
She suggests that women who aren't sure whether to continue taking medication or stop it due to their pregnancy educate family members, coworkers and their friends about the condition, the effects on daily functioning, and the benefits of keeping the current treatment regimen. It can also make the woman feel more comfortable in her struggle with her decision. It is also worth noting that some drugs can pass through the placenta, therefore, if a patient decides to stop taking her ADHD medication during pregnancy and breastfeeding, she should be aware of the possibility that traces of the drug could be transferred to the child.
Birth Defects and Risk of
As the use of ADHD medications to treat symptoms of attention deficit hyperactivity disorder (ADHD) grows as do concerns over the impact that these medications could have on foetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge regarding this issue. 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. While the overall risk remains low, the scientists found that exposure in the first trimester to adhd medication names medicines was associated with an increased risk of specific heart defects, like ventriculo-septal defects (VSD).
The authors of the study did not find any association between the use of early medications and other congenital anomalies like facial deformities or club feet. The results are consistent with previous studies revealing an increase, but not significant, in the risk of heart malformations in women who started taking ADHD medications prior to the time of pregnancy. The risk grew in the latter half of pregnancy, as many women begin to discontinue their managing adhd without medication adults medication.
Women who were taking ADHD medication during the first trimester were more likely need a caesarean, have a low Apgar after delivery, and have a baby who needed breathing assistance after birth. However the authors of the study were unable to eliminate bias due to selection by limiting the study to women who did not have other medical issues that could be a contributing factor to these findings.
The researchers hope that their research will help inform the clinical decisions of physicians who encounter pregnant women. They advise that while a discussion of the benefits and risks is important but 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 even though stopping the medication is an option, it is not an option that is recommended due to the high rate of depression and other mental health issues among women who are pregnant or who are recently postpartum. Furthermore, research suggests that women who choose to stop taking their medication are more likely to experience difficulties adjusting to life without them after the baby's arrival.
Nursing
It can be a challenge to become a mother. Women who suffer from ADHD are often faced with a number of difficulties when they have to manage their symptoms, attend doctor appointments and prepare for the birth of a baby and adjust to a new routine. As such, many women choose to continue taking their adhd medication list medications throughout the course of pregnancy.
The majority of stimulant medicines are absorbed through breast milk in very small amounts, therefore the risk to the breastfeeding infant is minimal. The rate of exposure to medication will vary based on the dosage, frequency of administration and the time of day. Additionally, different medications enter the baby’s system through the gastrointestinal tract or breast milk. The impact on the health of a newborn is not fully known.
Because of the lack of evidence, some doctors may recommend stopping 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 risks to the fetus. Until more information is available, doctors should ask all pregnant patients about their experience with ADHD and whether they are taking or planning to take medication during the perinatal time.
A growing number of studies have proven that women can continue to take their ADHD medication while they are pregnant and nursing. In response, a rising number of patients are opting to do so. They have concluded through consultation with their doctors, that the benefits of retaining their current medication outweigh risk.
Women who suffer from ADHD who are planning to nurse should seek the advice of an expert psychiatrist prior to becoming pregnant. They should discuss the medication they are taking with their physician, and the pros and cons of continuing treatment. This includes non-pharmacological strategies. Psychoeducation should also be provided to help pregnant people with ADHD be aware of their symptoms and the underlying disorder and learn about treatment options and strengthen existing coping strategies. This should be a multidisciplinary process including obstetricians, GPs and psychiatrists. Counselling for pregnancy should include discussion of a management plan for both the mother as well as the child, and monitoring for signs of deterioration, and, if necessary, adjustments to the medication regimen.