ADHD Medication During Pregnancy and Breastfeeding
Women suffering from ADHD have to make a difficult choice regarding whether or not to stop taking ADHD medication during pregnancy and breast-feeding. There are few data on how exposure to safest adhd medication for adults for a long time could affect a pregnant fetus.
A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication in utero do not develop neurological conditions like impaired vision or hearing seizures, febrile seizures or IQ impairment. The authors acknowledge that more high-quality studies are required.
Risk/Benefit Analysis
Women who are expecting and taking ADHD medication need to evaluate the benefits of using it against the potential risks for the baby. Physicians don't have the data to make unambiguous recommendations however they can provide information about risks and benefits to assist pregnant women to make informed decisions.
A study published in Molecular Psychiatry found that women who took intuniv adhd medication medications during early pregnancy did not have a significantly increased risk of fetal cardiac malformations or major structural birth defects. Researchers conducted a large 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 the early stages of pregnancy and those who had not. Pediatric cardiologists and clinical geneticists examined the cases to ensure accurate classification of the cases and to reduce the possibility of bias.
However, the study was not without its flaws. Most important, they were unable to distinguish the effects of the medication from those of the underlying disorder. This limitation makes it difficult for researchers to determine whether the few associations observed between the exposed groups were due to the use of medication, or if they were confounded by co-morbidities. over the counter adhd medication for adults researchers did not study long-term outcomes for offspring.
The study did show that infants whose mothers took ADHD medication during pregnancy were at slightly greater risk of being admitted to the neonatal intensive care unit (NICU) than infants who were born without any medication or had cut back on their medications 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 medications were taken during pregnancy.
Women who took stimulant ADHD medications during pregnancy also had a higher chance of having to have an emergency caesarean section or having the baby was not scoring well 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 small risks associated with the use ADHD medication during pregnancies in the early stages may be offset by the greater benefits for mother and baby from continuing treatment for the woman's disorder. Physicians should speak with their patients about this issue and as much as possible, assist them develop coping strategies that could reduce the effects of her disorder on her daily functioning and her relationships.
Medication Interactions
More and more doctors are confronted with the dilemma of whether to keep treatment or stop it during pregnancy as more women are diagnosed with ADHD. Often, these decisions are taken in the absence of any evidence that is clear and definitive in either case, which means that doctors must weigh their knowledge, the experiences of other doctors, and what research says on the topic, along with their best judgment for each individual patient.
Particularly, the subject of potential risks to the infant can be difficult. The research on this issue is based on observations instead of controlled studies and a lot of the results are contradictory. The majority of studies focus on live births, which may underestimate the teratogenic impact which can cause abortions or terminations of pregnancy. The study that is discussed in the journal club addresses these shortcomings, by examining both information on deceased and live births.
Conclusion A few studies have revealed a positive correlation between ADHD medications and certain birth defects However, other studies haven't shown such a relationship. Most studies show a neutral, or even somewhat negative, impact. In the end an accurate risk-benefit analysis is required in every instance.
It can be challenging, if not impossible, for women suffering from ADHD to stop taking their medication. In fact, in an article published 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 these patients. Additionally, the loss of medication can interfere with the ability to perform jobs and drive safely which are essential aspects of a normal life for many people suffering from ADHD.
She suggests that women who are not sure whether to continue taking medication or stop it due to their pregnancy should educate family members, coworkers, and their friends about the condition, its impact on daily functioning and the benefits of continuing the current treatment. It will also help a woman feel more confident in her decision. Some medications can pass through the placenta. If the patient decides to not take her ADHD medication while breastfeeding, it is important to be aware that the medication could be passed on to her baby.
Birth Defects and Risk of
As the use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) grows there are concerns about what impact the drugs might have on fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge regarding this issue. Researchers used two huge data sets to examine more than 4.3 million pregnancy and determine whether stimulant medications increased the risk of birth defects. While the overall risk is low, the researchers found that exposure in the first trimester to ADHD medications was linked to an increased risk of specific heart defects, like ventriculo-septal defects (VSD).
The researchers of the study could not find any association between the use of early medications and other congenital anomalies, such as facial deformities or club feet. The results are in agreement with previous studies that have shown an insignificant, but small increase in the number of cardiac malformations among women who started taking ADHD medication before the time of pregnancy. This risk increased in the latter half of pregnancy, when a lot of women are forced to stop taking their ADHD medication.
Women who took adhd inattentive type medication medication in the first trimester were more likely to require a caesarean delivery, have an insufficient Apgar after delivery, and had a baby that required breathing assistance when they were born. The researchers of the study were unable to remove bias in selection since they limited the study to women with no other medical conditions that could have contributed to the findings.
The researchers hope their study will serve to inform the clinical decisions of physicians who see pregnant women. They suggest that although a discussion of the risks and benefits is crucial however, the decision to stop or continue treatment should be based on the woman's needs and the severity of her ADHD symptoms.
The authors warn that, although stopping the medication is a possibility to consider, it is not advised due to the high rate depression and other mental problems in women who are expecting or who have recently given birth. Furthermore, research suggests that women who choose to stop taking their medications are more likely to have a difficult time adjusting to life without them after the birth of their baby.
Nursing
The responsibilities of being a new mom can be overwhelming. Women with ADHD who must work through their symptoms while attending doctor appointments and making preparations for the arrival of a child and adjusting to new household routines may face a lot of challenges. Many women decide to continue taking their ADHD medication during pregnancy.
The risk to breastfeeding infant is minimal because the majority of stimulant medications passes through breast milk at low levels. The rate of exposure to medication can vary depending upon the dosage the medication is administered, its frequency and time of day. In addition, individual medications enter the infant's system differently through the gastrointestinal tract as well as breast milk, and the effect of this on a newborn is not well known.
Because of the lack of research, some physicians may be inclined to discontinue stimulant drugs during the pregnancy of a woman. It's a difficult choice for the woman, who must weigh the benefits of continuing her medication against the risks to the embryo. In the meantime, until more information is available, doctors may inquire about pregnant patients whether they have an history of ADHD or if they are planning to take medication during the perinatal phase.
Many studies have shown that women can continue taking their ADHD medication in a safe manner while breastfeeding and during pregnancy. In the end, more and more patients are choosing to do so, and in consultation with their physician, they have discovered that the benefits of continuing their current medication outweigh any risks.
Women who suffer from ADHD who are planning to nurse should seek the advice of a specialist psychiatrist prior to becoming pregnant. They should discuss the medication they are taking with their physician and discuss the pros and cons for continuing treatment. This includes non-pharmacological methods. Psychoeducation should also be provided to help pregnant women suffering from generic adhd medications be aware of their symptoms and the underlying disorder, learn about available treatments and to reinforce existing strategies for coping. This should be an approach that is multidisciplinary, including the GP, obstetricians and psychiatry. Counselling for pregnancy should include the discussion of a treatment plan for both the mother and child, monitoring for signs of deterioration, and when necessary, making adjustments to the medication regimen.