ADHD Medication During Pregnancy and Breastfeeding
Women with ADHD must make a difficult decision regarding whether or not to stop taking ADHD medication during pregnancy and breast-feeding. There is a lack of information about how long-term exposure to these drugs may affect the foetus.
A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication during the uterus don't develop neurological conditions like hearing or vision impairment, febrile seizures, or IQ impairment. The authors acknowledge the need for more high-quality research.
Risk/Benefit Analysis
Pregnant women who take ADHD medications must weigh the benefits of using them against the risks to the foetus. Doctors don't have enough data to give clear advice, but can provide information on the risks and benefits to assist pregnant women to make informed decisions.
A study published in Molecular Psychiatry concluded that women who took ADHD medication during early pregnancy were not at a greater risk of fetal malformations or structural birth defects. Researchers used a large sample-based case control study to compare the incidence of major structural defects in infants who were born to mothers who took stimulants during pregnancy. Pediatric cardiologists and clinical geneticists reviewed the cases to ensure correct case classification and to minimize the chance of bias.
However, the researchers' study had its limitations. Most important, they were unable to separate the effects of the medication from the effects of the disorder at hand. This makes it difficult for researchers to determine whether the small associations observed among the groups exposed were due to the use of medications or caused by co-morbidities. Researchers also did not look at long-term outcomes for the offspring.
The study revealed that infants whose mother took ADHD medication during pregnancy had a higher risk of admission to the neonatal care unit (NICU) in comparison to those whose mothers did not use any medication during pregnancy or had stopped taking their medication before or during pregnancy. This was due to central nervous system-related disorders, and the increased risk of admission was not found to be affected by the type of stimulant medication was used during pregnancy.
Women who took stimulant ADHD medication during pregnancy also had an elevated chance of having a caesarean section or having a baby with an low Apgar score (less than 7). These increases appeared to be independent of the type of medication taken during pregnancy.
The research suggests that the small risk associated with the use of ADHD medications during early pregnancy could be offset by the higher benefit to both mother and child of continued treatment for the woman's condition. Physicians should discuss the issue with their patients and, when possible, assist them in developing strategies to improve their coping abilities that can lessen the negative impact of her condition on her daily life and relationships.
Medication Interactions
More and more doctors are confronted with the dilemma of whether to keep treatment or stop as more women are diagnosed with ADHD. The majority of these decisions are made in the absence of any evidence that is clear and definitive regardless, so doctors must weigh their knowledge, the experiences of other doctors, and what the research suggests about the subject and their own best judgment for each patient.
Particularly, the issue of potential risks to the baby can be tricky. Many studies on this issue are based on observational data instead of controlled research and their findings are often contradictory. most common adhd medication uk studies restrict their analysis to live-births, which could underestimate the teratogenic impact which can cause abortions or terminations of pregnancy. The study that is discussed in this journal club addresses these issues by looking at data from both live and deceased births.
The conclusion: While certain studies have demonstrated an association between ADHD medications and the possibility of certain birth defects, other studies have not found any evidence of a link, and most studies demonstrate a neutral or slightly negative effect. In all cases an in-depth analysis of the potential risks and benefits must be performed.
For many women with ADHD and ADD, the decision to discontinue medication is difficult if not impossible. In fact, in a recent article in the 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 patients with ADHD. Furthermore, a loss of medication can interfere with the ability to perform job-related tasks and drive safely that are crucial aspects of a normal life for many people with ADHD.
She recommends women who are uncertain about whether or not to stop taking medication because of their pregnancy, consider educating family members, friends and colleagues about the condition, its impact on daily life, and the advantages of staying on the current treatment regimen. It can also aid in ensuring that the woman feels supported when she is struggling with her decision. It is also worth noting that certain medications can pass through the placenta so if the patient decides to stop taking her adhd uk medication medication during pregnancy and breastfeeding, she should be aware that the effects of the drug can be transferred to the child.
Risk of Birth Defects
As the use and misuse of inattentive adhd medication uk medications to treat the symptoms of attention deficit disorder hyperactivity disorder (ADHD) increases, so does adhd medication work concern about the possible effects of the drugs on foetuses. A study that was published in the journal Molecular Psychiatry adds to the existing information on this topic. Researchers used two huge data sets to study more than 4.3 million pregnancies and determine if the use of stimulant medications increased birth defects. Researchers found that while the overall risk is low, the first trimester ADHD exposure to medication was associated with slightly higher risk of certain heart defects, like ventriculoseptal defects.
The authors of the study did not discover any link between early medication usage and other congenital anomalies like facial deformities, or club feet. The results are consistent with previous studies that have shown an increase, but not significant, in the risk of cardiac malformations in women who started taking ADHD medications prior to pregnancy. This risk increased during the latter stages of pregnancy, when a lot of women began to stop taking their medication.
Women who used getting adhd medication uk medication in the first trimester of their pregnancies were also more likely to experience caesarean sections, a low Apgar score following delivery, and a baby that required breathing assistance at birth. The researchers of the study were not able to eliminate bias due to selection because they restricted the study to women without 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. The researchers recommend that, while discussing risks and benefits are crucial, the decision about whether to continue or stop medication should be in light of the severity of each woman's ADHD symptoms and her requirements.
The authors caution that, while stopping the medication is an option to look into, it is not recommended due to the high rate depression and other mental disorders in women who are expecting or have recently given birth. Research has also shown that women who stop taking their medications will have a difficult transitioning to life without them once the baby is born.
Nursing
It can be overwhelming to become a mom. Women with ADHD can adhd medication help with memory face severe challenges when they must deal with their symptoms, go to doctor appointments and prepare for the birth of a child and adjust to new routines. As such, many women elect 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 medication passes through breast milk in low amounts. The rate of medication exposure will vary based on the dosage and frequency of administration as well as the time of day. Additionally, different medications enter the baby’s system via the gastrointestinal tract or through breast milk. The impact of these medications on a newborn's health is not fully comprehended.
Due to the absence of research, some physicians may recommend stopping stimulant medication during the course of pregnancy. This is a difficult choice for the patient, who must balance the benefits of continuing her medication against the potential risks to the foetus. Until more information is available, doctors should ask all pregnant patients about their experience with ADHD and if they are taking or planning to take medication during the perinatal period.
A increasing number of studies have proven that the majority of women are able to safely continue taking their ADHD medication while they are pregnant and nursing. This has led to more and more patients choose to do so, and in consultation with their doctor they have discovered that the benefits of maintaining their current medication outweigh any potential risks.
Women who suffer from ADHD who plan to breastfeed should seek the advice of a specialist psychiatrist before becoming pregnant. They should discuss their medication with their prescriber and discuss the pros and cons of continued treatment, including non-pharmacological management strategies. Psychoeducation is also required to help pregnant women suffering from ADHD be aware of their symptoms and the underlying disorder, learn about available treatment options and reinforce existing strategies for managing. This should be a multidisciplinary process including obstetricians, GPs and psychiatry. Pregnancy counseling should consist of a discussion of a treatment plan for the mother as well as the child, as well as monitoring for signs of deterioration and, if necessary modifications to the medication regimen.