ADHD Medication During Pregnancy and Breastfeeding
Women suffering from ADHD have to make a difficult choice about whether to continue or stop taking ADHD medication during pregnancy and breastfeeding. There is a lack of information about how long-term exposure to these medications may affect the fetus.
A study recently published in Molecular Psychiatry demonstrates that children exposed to adhd and medication medication during pregnancy do not develop neurological issues like hearing loss or vision, febrile seizures or IQ impairment. The authors acknowledge the need for higher-quality studies.
Risk/Benefit Analysis
Pregnant women who use ADHD medications need to balance the benefits of taking them against the potential risks to the fetus. The doctors don't have the information to make unambiguous recommendations however they can provide information on the risks and benefits to help pregnant women make an informed decision.
A study published in Molecular Psychiatry found that women who used ADHD medications during their early pregnancy did not have a significantly increased risk of fetal heart malformations or major structural birth defects. The researchers used a large, population-based case-control study to assess the risk of major structural birth defects in babies born to mothers who had taken stimulants during the early stages of pregnancy, and those who did not. Clinical geneticists and pediatric cardiologists reviewed the cases to ensure an accurate classification of the cases and to reduce the chance of bias.
The study of the researchers was not without limitations. Most important, they were not able to differentiate the effects of the medication from the effects of the disorder that is underlying. This makes it difficult for researchers to establish whether the few associations observed between the groups that were exposed to the use of medication or affected by comorbidities. The researchers also did not examine long-term outcomes for the offspring.
The study did reveal that infants whose mothers had taken ADHD medications during pregnancy were at a higher risk of being admitted to the neonatal intensive care unit (NICU) than those who were born without any medication or had stopped their medications before or during pregnancy. The reason for this was central nervous system disorders, and the increased risk for admission did not appear to be influenced by which stimulant medications were used during pregnancy.
Women who were taking stimulant ADHD medications during pregnancy also had a higher risk of having caesarean sections or a baby that scored low on the Apgar scale (less than 7). These increases didn't appear to be influenced by the kind of medication used during pregnancy.
The researchers suggest that the low risk associated with the use of ADHD medications during the early stages of pregnancy may be offset by the greater benefit to both mother and child from continued treatment for the woman's disorder. Physicians should talk to their patients about this and as much as possible, assist them develop coping strategies that may reduce the effects of her disorder on her daily functioning and her relationships.
Medication Interactions
As more women than ever are being diagnosed with ADHD and treated with medication, the question of whether to continue or discontinue treatment during pregnancy is a question that more and more doctors face. These decisions are frequently made without clear and reliable evidence. Instead, physicians must take into account their own experience in conjunction with the experiences of other doctors and the research that has been conducted on the subject.
The issue of potential risks to the infant can be particularly tricky. Many studies on this subject are based on observational data rather than controlled research, and their findings are often contradictory. Furthermore, most studies restrict their analysis to live births, which may underestimate severe teratogenic effects that cause abortion or termination of the pregnancy. The study discussed in the journal club addresses these issues by analyzing data on live and deceased births.
The conclusion The conclusion: While some studies have shown a positive association between ADHD medications and the possibility of certain birth defects, other studies have found no such relationship, and most studies have a neutral or slight negative effect. As a result, a careful risk/benefit assessment is required in every case.
For a lot of women with ADHD and ADD, the decision to discontinue medication can be 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 cause depression and feelings of being isolated. In addition, a decrease in medication can affect the ability to complete job-related tasks and drive safely, which are important aspects of a normal life for a lot of people with ADHD.
She suggests that women who are not sure whether to take the medication or stop due to pregnancy educate family members, coworkers and acquaintances about the condition, the effects on daily functioning, and the advantages of staying on the current treatment. In addition, educating them can help the woman feel supported in her struggle with her decision. Some medications can pass through the placenta. If a woman decides to stop taking her ADHD medication while pregnant and breastfeeding, it is crucial to be aware that the medication could be transferred to the infant.
Risk of Birth Defects
As the use and misuse of ADHD drugs to treat symptoms of attention deficit disorder hyperactivity disorder (ADHD) is increasing the concern over the possible effects of the drugs on the fetuses. A study that was published in the journal Molecular Psychiatry adds to the body of knowledge about this subject. Using two massive data sets researchers were able to analyze more than 4.3 million pregnancies to determine whether the use of stimulant medications increased the risk of birth defects. Researchers discovered that, while the risk overall is low, first-trimester ADHD medication exposure was associated with slightly higher rates of certain heart defects, like ventriculoseptal defects.
The researchers behind the study found no link between the use of early medications and congenital abnormalities like facial clefting, or club foot. The findings are in line with previous studies that have shown the presence of a small, but significant increase in the risk of heart malformations among women who started taking ADHD medications prior to the time of pregnancy. The risk grew in the later part of pregnancy, when many women begin to discontinue their ADHD medications.
Women who took ADHD medications in the first trimester of their pregnancy were also more likely to have a caesarean section, a low Apgar score following delivery, and a baby who required breathing assistance at birth. The authors of the study were not able to eliminate selection bias because they limited the study to women who did not have any other medical conditions that could have contributed to the findings.
The researchers hope that their research will aid in the clinical decisions of physicians who see pregnant women. The researchers recommend that, while discussing the risks and benefits are important, the decision regarding whether or not to stop taking medication should be in light of the severity of each woman's ADHD symptoms and the needs of the woman.
The authors also advise that while discontinuing the medications is an alternative, it is not an option that is recommended due to the high rate of depression and other mental health problems in women who are pregnant or who are recently post-partum. Furthermore, research suggests that women who choose to stop their medications are more likely to experience a difficult time adjusting to life without them after the baby's arrival.
Nursing
It can be overwhelming becoming a mother. Women suffering from ADHD are often faced with a number of difficulties when they must manage their symptoms, attend doctor appointments, prepare for the birth of a child and adjust to new routines. Many women choose to continue taking their ADHD medication during pregnancy.
The risk for breastfeeding infant is minimal because the majority of stimulant medication is absorbed through breast milk at low levels. However, the amount of exposure to medication by the infant can differ based on dosage, how often it is taken and the time of the day it is administered. In addition, different medications enter the baby’s system through the gastrointestinal tract or through breast milk. The effect on the health of a newborn is not completely known.
Some physicians may discontinue stimulant medication during a woman's pregnancy due to the lack of research. It's a difficult choice for the woman, who must weigh the benefits of continuing her best medication for inattentive adhd against the risks to the fetus. In the meantime, until more information is available, doctors should inquire with all pregnant patients about their history of best adhd medication for someone with anxiety 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 while breastfeeding and during pregnancy. As a result, many patients choose to do so and, in consultation with their physician, they have discovered that the benefits of continuing their current medication far outweigh any potential risks.
Women with ADHD who are planning to breastfeed should seek advice from a specialist psychiatrist prior to becoming pregnant. They should review their medications with their prescriber and discuss the advantages and disadvantages of continuing treatment, including non-pharmacological management strategies. Psychoeducation should also be provided to help women with ADHD be aware of their symptoms and the root cause and learn about treatments and to reinforce existing strategies for coping. This should involve a multidisciplinary approach with the GP as well as obstetricians, psychiatry and obstetricians. The pregnancy counselling should consist of the discussion of a plan for management for both the mother as well as the child, monitoring for signs of deterioration and the need for adjustments to the medication regimen.