ADHD Medication During Pregnancy and Breastfeeding
The decision to stop or continue ADHD medication during pregnancy and breastfeeding is a difficult decision for women suffering from the condition. There are few data regarding how exposure over time may affect the foetus.
A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological problems like hearing loss or vision, febrile seizures, or IQ impairment. The authors acknowledge the need for higher-quality research.
Risk/Benefit Analysis
Women who are pregnant and take ADHD medication should consider the benefits of taking it against the possible dangers for the foetus. Physicians do not have the necessary data to provide clear recommendations however they can provide information about 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 did not have a higher risk of fetal malformations, or structural birth defects. Researchers used a large population-based study of case control to assess the frequency of structural defects that were major in infants who were born to mothers who took stimulants during pregnancy. Pediatric cardiologists, clinical geneticists and other experts looked over the cases to ensure that the classification was correct and to minimize any bias.
The research conducted by the researchers was not without its limitations. In particular, they were not able to differentiate the effects of the medication from those of the underlying disorder. This makes it difficult for researchers to determine if the few associations observed between the exposed groups were due to the use of medications or affected by comorbidities. Additionally the researchers did not study the long-term effects of offspring on their parents.
The study did reveal that babies whose mothers had taken ADHD medications during pregnancy were at a slightly greater risk of being admitted to the neonatal intensive care unit (NICU) than infants whose mothers had not taken any medication or stopped their medications before 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 medication was used during pregnancy.
Women who used stimulant ADHD medication during pregnancy were also at an elevated risk of having a caesarean delivery or having a baby born with an low Apgar score (less than 7). These increases did appear to be independent of the type of medication taken during pregnancy.
Researchers suggest that the small risks posed by the use of ADHD medications in early pregnancies could be offset by the more beneficial outcomes for both baby and mother of continued treatment for the woman’s disorder. Physicians should talk to their patients about this and try to help them develop coping strategies that can lessen the impact of her disorder in her daily life and relationships.
Medication Interactions
As more women than ever are being diagnosed with ADHD and treated with medication, the dilemma of whether or not to discontinue treatment during pregnancy is one that more and more physicians face. These decisions are often taken without clear and authoritative evidence. Instead, doctors have to weigh their own knowledge in conjunction with the experiences of other doctors and the research on the subject.
Particularly, the subject of potential 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 conflicting. The majority of studies restrict their analysis to live-births, which could underestimate the severity of teratogenic effects that can lead to terminations or abortions of pregnancy. The study presented in this journal club addresses these shortcomings by examining data on both live and deceased births.
The conclusion is that while some studies have found an association between ADHD medications and the possibility of certain birth defects, other studies have found no such relationship and the majority of studies show a neutral or even slightly negative impact. In the end, a careful risk/benefit assessment is required in every case.
For a lot of women with ADHD who suffer from ADHD, the decision to stop taking medication is difficult, if not impossible. In a recent article published in the 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 being isolated. In addition, a decrease in medication can affect the ability to perform job-related tasks and drive safely which are essential aspects of a normal life for many people suffering from ADHD.
She recommends women who are uncertain about whether to keep or stop medication in light of their pregnancy, consider educating family members, friends and colleagues about the condition, its impact on daily functioning, and the advantages of staying on the current treatment regimen. Educating them can also make the woman feel more comfortable in her struggle with her decision. It is important to remember that some drugs can pass through the placenta, so if the patient decides to stop her ADHD medication during pregnancy and breastfeeding, she should be aware that traces of the drug could be transferred to the infant.
Risk of Birth Defects
As the use and misuse of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) is increasing as does the concern about the possible effects of the drugs on fetuses. A recent study published in the journal Molecular Psychiatry adds to the body of knowledge on this subject. With two massive data sets researchers were able analyze more than 4.3 million pregnancies and determine whether stimulant medication use increased the risk of birth defects. Although the risk overall is low, the researchers found that exposure in the first trimester to ADHD medications was associated with an increased risk of certain heart defects, like ventriculo-septal defects (VSD).
The researchers of the study could not discover any connection between early use of medication and other congenital anomalies, such as facial deformities or club feet. The findings are in line with previous studies showing a small but significant increase in the risk of developing cardiac malformations among women who began taking ADHD medications before pregnancy. The risk increased in the latter half of pregnancy, when a lot of women decided to stop taking their medication.
Women who took ADHD medication during the first trimester were more likely require a caesarean delivery or have a low Apgar after delivery, and had a baby that required help breathing after birth. However the authors of the study were unable to eliminate selection bias by restricting the study to women who didn't have any other medical conditions that could have contributed to the findings.
The researchers hope their research will serve to inform the clinical decisions of physicians who treat pregnant women. The researchers suggest that while discussing risks and benefits are important, the choice on whether to continue or stop taking medication should be according to the severity of each woman's ADHD symptoms and the needs of the woman.
The authors warn that, although stopping the medication is a possibility to think about, it isn't recommended due to the high rate depression and other mental problems among women who are pregnant or recently gave birth. Furthermore, research suggests that women who choose to stop taking their medication are more likely to experience a difficult time adjusting to life without them after the baby's arrival.
Nursing
It can be a stressful experience to become a mother. Women with ADHD can face severe challenges when they have to manage their symptoms, attend doctor appointments, prepare for the birth of their child and adjust to a new routine. Therefore, many women elect to continue taking their ADHD medications throughout the course of pregnancy.
The risk to a breastfeeding infant is not too high since the majority of stimulant medication is absorbed through breast milk at low levels. However, the frequency of exposure to medication by the newborn may differ based on the dosage, frequency it is administered and the time of day the medication is administered. In most effective adhd medication for adults , individual medications enter the body of the baby differently through the gastrointestinal tract and breast milk. The impact of this on a newborn is not yet fully known.
Some doctors may decide to stop stimulant medication during a woman’s pregnancy due to the lack of research. This is a difficult decision for the woman who must weigh the advantages of her medication against the potential risks to the fetus. Until more information becomes available, GPs can inquire about pregnant patients whether they have an background of ADHD or if they intend to take medication during the perinatal period.
A growing number of studies have revealed that most women can safely continue to take their ADHD medication during pregnancy and while breastfeeding. In response, a rising number of patients are choosing to do this. They have concluded through consultation with their physicians, that the benefits of retaining their current medication outweigh risk.
Women who suffer from ADHD who are planning to breastfeed should seek advice from a specialist psychiatrist before becoming pregnant. They should discuss their medication with their prescriber and discuss the advantages and disadvantages of continuing treatment, including non-pharmacological management strategies. Psychoeducation is also needed to help pregnant women with ADHD recognize the signs and underlying disorder. They should also be informed about treatment options and build strategies for coping. This should be a multidisciplinary approach, which includes the GP doctors, obstetricians and psychiatrists. Pregnancy counseling should consist of a discussion of a treatment plan for the mother and the child, and monitoring for signs of deterioration and, if necessary modifications to the medication regime.