ADHD Medication During Pregnancy and Breastfeeding
The decision to stop or continue ADHD medications during pregnancy and breastfeeding is challenging for women with the condition. There isn't much information on how long-term exposure to these drugs may 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 disorders like impaired vision or hearing seizures, febrile seizures, or IQ impairment. The authors acknowledge the need for higher-quality research.
Risk/Benefit Analysis
Women who are pregnant and taking different adhd medications medications must weigh the benefits of taking them against the potential risks to the fetus. 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 concluded that women who took strongest adhd medication medication during their early pregnancy were not at higher risk of fetal malformations or structural birth defects. Researchers conducted a massive population-based case control study to examine the prevalence of structural defects that were major in infants who were born to mothers who took stimulants during pregnancy. Clinical geneticists and pediatric cardiologists reviewed the cases to ensure correct case classification and to minimize the chance of bias.
The study conducted by the researchers was not without limitations. The most important issue was that they were unable to distinguish the effects of the medication from the effects of the underlying disorder. This makes it difficult to know whether the limited associations observed in the groups that were exposed are due to medication use or the confounding effect of comorbidities. In addition, the researchers did not study the long-term outcomes of offspring.
The study revealed that infants whose mother took ADHD medication during pregnancy were at a slightly higher risk of admission to the neonatal care unit (NICU), compared 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 did not appear to be affected by the type of stimulant medication was used during pregnancy.
Women who were taking stimulant ADHD medications during pregnancy also had a higher likelihood of having to have caesarean sections or the baby was not scoring well on the Apgar scale (less than 7). These increases appear to be unrelated to the type of medication taken during pregnancy.
Researchers suggest that the minor risk of using strongest adhd medication medication during pregnancies in the early stages can be offset by greater benefits to both baby and mother of continued treatment for the woman's disorder. Physicians should discuss the issue with their patients and, when possible, help them develop strategies to improve coping skills that may minimize the impact of her disorder on her daily functioning and relationships.
Interactions dealing with adhd without medication Medication
As more women than ever before are being diagnosed with ADHD and being treated with medication, the question of whether to continue or discontinue treatment during pregnancy is a question that more and more physicians confront. These decisions are often made without clear and authoritative evidence. Instead, physicians must weigh their own knowledge, the experience of other physicians and the research on the subject.
Particularly, the issue of potential risks for the infant can be difficult. Many studies on this subject are based on observational data instead of controlled research and their conclusions are often contradictory. The majority of studies limit their analysis where to get prescribed adhd medication live-births, which could underestimate the teratogenic impact leading to terminations or abortions of pregnancy. The study discussed in this journal club addresses these limitations by examining data on both live and deceased births.
Conclusion: While some studies have shown a positive correlation between ADHD medications and certain birth defects, other studies have not shown such a relationship. The majority of studies show a neutral, or even somewhat negative, effect. Therefore, a careful risk/benefit assessment must be conducted in every situation.
It can be challenging, if not impossible for women suffering from ADHD to stop taking their medication. In an article recently published in Archives of Women's Mental Health psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can cause depression, feelings of loneliness, and family conflict for these patients. In addition, a decrease in medication can affect the ability to do job-related tasks and drive safely that are crucial aspects of a normal life for many people with ADHD.
She suggests that women who are unsure whether to continue taking medication or stop it due to their pregnancy educate family members, colleagues, and their friends about the condition, its effects on daily functioning, and the advantages of staying on the current treatment plan. It can also make the woman feel more comfortable as she struggles with her decision. Certain medications can be passed through the placenta. If the patient decides to stop taking her ADHD medication while pregnant and breastfeeding, it is crucial to be aware that the drug could be transferred to the infant.
Birth Defects and Risk of
As the use of ADHD medication to treat the symptoms of attention deficit hyperactivity disorder (ADHD) grows, so do concerns over the impact that these drugs might have on fetuses. Recent research published in the journal Molecular Psychiatry has added to the body knowledge on this issue. With two massive data sets researchers were able look at more than 4.3 million pregnancies and see whether stimulant medications increased the risk of birth defects. While the overall risk remains low, the researchers found that exposure in the first trimester to ADHD medications was linked to a slightly higher rate of specific heart defects, like ventriculo-septal defects (VSD).
The authors of the study didn't discover any link 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 the time of pregnancy. This risk increased during the latter part of pregnancy when many women stopped taking their medication.
Women who took ADHD medication in the first trimester were more likely to need a caesarean and also have an insufficient Apgar after delivery, and had a baby that required 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 any other medical issues that could have contributed to the findings.
The researchers hope their study will serve to inform the clinical decisions of physicians who treat pregnant women. They suggest that although discussing risks and benefits is important however, the decision to stop or maintain treatment should be based on the woman's needs and the severity of her ADHD symptoms.
The authors caution that, although stopping the medication is a possibility to consider, it is not recommended due to the high prevalence of depression and mental health issues 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 experience a difficult time adapting to life without them after the baby's arrival.
Nursing
It can be overwhelming to become a mom. Women who suffer from ADHD may face a lot of challenges when they have to manage their symptoms, go to doctor appointments, prepare for the birth of their child and adjust to a new routine. Many women choose to continue taking their ADHD medication during pregnancy.
The majority of stimulant medications are absorbed by breast milk in small quantities, so the risk to the nursing infant is very low. The amount of exposure to medications will differ based on dosage, frequency of administration and the time of day. In addition, various drugs enter the infant's system through the gastrointestinal tract or breast milk. The impact on a newborn's health is not completely known.
Some physicians may discontinue stimulant medication during a woman’s pregnancy due to the lack of research. It is a difficult decision for the woman, who must weigh the advantages of her medication against the risk to the embryo. In the meantime, until more information is available, doctors should inquire with all pregnant patients about their history of ADHD and whether they plan or are taking to take medication during the perinatal time.
Many studies have shown that women can continue taking their ADHD medication in a safe manner during pregnancy and breast-feeding. In response, a growing number of patients are opting to continue their medication. They have concluded through consultation with their physicians that the benefits of keeping their current medication outweigh any risk.
It is crucial for women suffering from ADHD who are considering breastfeeding to seek out a specialist psychiatrist's guidance prior to becoming pregnant. They should review their medications with their physician and discuss the advantages and disadvantages of continuing treatment, including non-pharmacological management strategies. Psychoeducation should also be offered to help pregnant people with managing adhd without medication recognize their symptoms and the root cause, learn about available treatment options and strengthen existing strategies for coping. This should involve an approach that is multidisciplinary, including the GP as well as obstetricians, psychiatry and obstetricians. Pregnancy counseling should include a discussion of a treatment plan for the mother as well as the child, monitoring of indicators of deterioration, and, if necessary modifications to the medication regimen.