ADHD Medication During Pregnancy and Breastfeeding
The decision to stop or keep ADHD medication during pregnancy and breastfeeding is a difficult decision for women suffering from the condition. There isn't much information on how long-term exposure to these medications could affect the foetus.
A recent study published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological disorders such as hearing loss or vision, febrile seizures, or IQ impairment. The authors acknowledge the need for more high-quality research.
Risk/Benefit Analysis
Women who are expecting and taking ADHD medication must weigh the benefits of taking it against the possible risks to the foetus. Physicians do not have the data needed to give clear guidelines, but they can provide information regarding benefits and risks that can assist pregnant women in making informed decisions.
A study published in Molecular Psychiatry concluded that women who were taking ADHD medication during early pregnancy were not at a greater risk of fetal malformations, or structural birth defects. Researchers conducted a large population-based case control study to assess the frequency of structural defects that were major in infants who were born to mothers who were taking stimulants during pregnancy. Pediatric cardiologists, clinical geneticists and other experts looked over the cases to make sure that the classification was accurate and to eliminate any bias.
The study of the researchers had some limitations. Most important, they were not able to differentiate the effects of the medication from those of the disorder at hand. This limitation makes it difficult for researchers to determine whether the few associations observed between the exposed groups were due to medication use, or if they were affected by co-morbidities. Additionally the researchers did not study the long-term outcomes of offspring.
The study showed that infants whose mothers had taken ADHD medication during pregnancy had a greater risk of being admitted to the neonatal care unit (NICU) in comparison to those whose mothers did not take any medication during pregnancy, or had discontinued taking their medication prior to or during pregnancy. The reason for this was central nervous system disorders. The higher risk of admission was not affected by the stimulant medications used during pregnancy.
Women who were taking stimulant ADHD medications during pregnancy also had a higher risk of having to have an emergency caesarean section or having the baby was not scoring well on the Apgar scale (less than 7). These risks did not seem to be influenced by the kind of medication used during pregnancy.
The research suggests that the small risk associated with the use of ADHD medications during early pregnancy may be offset by the greater benefit to both mother and child of continuing treatment for the woman's condition. Physicians should speak with their patients about this and, if possible, help them improve coping skills which can lessen the effects of her disorder on her daily life and relationships.
Medication Interactions
As more women than ever are being diagnosed with ADHD and treated with medication, the question of whether to continue or stop treatment during pregnancy is a question that doctors are having to face. Often, these decisions are taken in the absence of solid and reliable evidence in either case, which means that doctors must weigh what they know, the experiences of other doctors, and what research says on the topic, along with their own judgments for each patient.
Particularly, the subject of possible risks to the baby can be tricky. The research on this subject is based on observation rather than controlled studies, and many of the findings are contradictory. Furthermore, most studies restrict their analysis to live births, which could underestimate severe teratogenic effects that lead to abortion or termination of the pregnancy. The study 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 that there is a positive correlation between ADHD medications and the possibility of certain birth defects, others have found no such relationship and the majority of studies have a neutral or slight negative effect. In each case an in-depth evaluation of the potential risks and benefits is required.
For women suffering from ADHD and ADD, the decision to stop taking medication is difficult if not impossible. In a recent article in Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can lead to depression and feelings of isolation. The loss of medication can also impact the ability to safely drive and perform work-related tasks, which are essential aspects of everyday life for people with uk adhd medication ADHD.
She recommends women who are uncertain about whether or not to stop medication in light of their pregnancy, consider informing family members, friends and colleagues about the condition, its impact on daily life, and the benefits of keeping the current treatment plan. In addition, educating them can aid in ensuring that the woman feels supported in her struggle with her decision. It is also worth noting that some drugs can be absorbed through the placenta therefore, if a patient decides to stop taking her ADHD medication during pregnancy and breastfeeding, she must be aware that the effects of the medication could be transferred to the child.
Birth Defects and Risk of
As the use and use of ADHD medications to treat the symptoms of attention deficit disorder hyperactivity disorder (ADHD) increases, so does concern about the potential effects of these drugs on the fetuses. Recent research published in the journal Molecular Psychiatry has added to the body knowledge on this issue. Utilizing two huge data sets researchers were able to look at more than 4.3 million pregnancies and see whether stimulant medication use increased the risk of birth defects. While the overall risk remains low, the scientists did find that first-trimester exposure to ADHD medications was associated with an increase in the risk of certain heart defects, such as ventriculoseptal defect (VSD).
The authors of the study did not discover any link between the use of early medications and other congenital anomalies, like facial deformities, or club feet. The findings are in line with previous studies revealing a small but significant increase in the risk of heart malformations among women who began taking ADHD medications prior to the birth of their child. This risk increased during the latter part of pregnancy, when many women are forced to stop taking their medication.
Women who took ADHD medications in the first trimester of pregnancy were also more likely to undergo a caesarean section, a low Apgar score after delivery and a baby who needed breathing assistance at birth. The researchers of the study were unable to eliminate selection bias because they limited their study to women who did not have any other medical conditions that might have contributed to the findings.
Researchers hope that their study will provide doctors with information when they see pregnant women. The researchers recommend that, while discussing the risks and benefits are important, the decision regarding whether or not to stop medication should be made based on the severity of each woman's ADHD symptoms and her requirements.
The authors also advise that while discontinuing the medications is an option, it isn't a recommended practice because of the high rate of depression and other mental health problems for women who are expecting or who are recently postpartum. Furthermore, research suggests that women who decide to stop taking their medications 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 who must work through their symptoms while attending doctor appointments, making preparations for the arrival of their child and getting used to new routines at home may face a lot of challenges. Many women opt to continue taking their ADHD medication during pregnancy.
The majority of stimulant medicines pass through breast milk in very small amounts, therefore the risk to breastfeeding infant is minimal. The amount of exposure to medications can vary depending upon the dosage the medication is administered, its frequency and the time of the day. In addition, individual medications enter the body of the baby differently through the gastrointestinal tract and breast milk, and the effect of this on a newborn infant is not well known.
Because of the lack of evidence, some doctors may be inclined to discontinue stimulant medication during the course of pregnancy. It is a difficult decision for the woman, who must weigh the benefits of her medication against the risks to the foetus. In the meantime, until more information is available, doctors may inquire about pregnant patients whether they have any history of ADHD or if they plan to take medication in the perinatal phase.
Numerous studies have proven that women can continue to take their ADHD medication safely during pregnancy and while breast-feeding. In response, a growing number of patients are opting to do so. They have concluded, in consultation with their doctors, that the benefits of retaining their current medication far outweigh any possible risks.
Women who suffer from ADHD who are planning to nurse should seek advice from a specialist psychiatrist before becoming pregnant. They should discuss their medication with their prescriber and discuss the pros and cons of continuing treatment. This includes non-pharmacological strategies. Psychoeducation is also required to help pregnant women with ADHD be aware of the symptoms and the underlying disorder. They should also be informed about treatment options and strengthen coping mechanisms. This should involve an approach that is multidisciplinary, including the GP doctors, obstetricians and psychiatrists. Pregnancy counseling should consist of a discussion of a treatment plan for the mother and the child, as well as monitoring for signs of deterioration, and, if necessary, adjustments to the medication regime.