ADHD Medication During Pregnancy and Breastfeeding
The decision to stop or continue ADHD medication during pregnancy and breastfeeding is challenging for women with the condition. There are few data regarding how exposure over time may affect the foetus.
A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication in utero do not develop neurological developmental disorders such as impaired vision or hearing, febrile seizures, or IQ impairment. The authors acknowledge the need for more high-quality studies.
Risk/Benefit Analysis
Women who are pregnant and taking ADHD medication should weigh the benefits of taking it against the possible dangers for the foetus. Physicians don't have the necessary data to make unequivocal recommendations but they can provide information on risks and benefits that aid pregnant women in making informed decisions.
A study published in Molecular Psychiatry found that women who were taking ADHD medications during their early pregnancy did not face a significantly higher risk of fetal cardiac malformations or major birth defects that are structural. The researchers used a large, population-based case-control study to evaluate the incidence of major structural birth defects in babies born to mothers who took stimulants during early pregnancy and those who had not. Pediatric cardiologists, clinical geneticists and other experts examined the cases to make sure that the classification was correct and to minimize any bias.
However, the researchers' study was not without its flaws. In particular, they were unable to separate the effects of the medication from the disorder that is underlying. This limitation makes it difficult for researchers to determine if the few associations observed between the groups that were exposed to the use of medications or confounded by comorbidities. Additionally the study did not look at long-term offspring outcomes.
The study revealed that infants whose mothers had taken ADHD medication during pregnancy had a higher chance of being admitted to the neonatal care unit (NICU), compared to mothers who didn't take any medication during pregnancy or stopped taking their medication before or during pregnancy. The reason for this was central nervous system disorders. The higher risk of admission was not influenced by the stimulant medication used during pregnancy.
Women who used stimulant ADHD medication during pregnancy also had an increased risk of having a caesarean section 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 used during pregnancy.
The research suggests that the risk of a small amount with the use of ADHD medications during the early stages of pregnancy may be offset by the higher benefit to both the mother and child of continuing treatment for the woman's disorder. Physicians should speak with their patients about this issue and try to help them develop coping skills that may reduce the effects of her disorder on her daily life and relationships.
Medication Interactions
As more women than ever are diagnosed with ADHD and being treated with medication, the issue of whether or not to discontinue treatment during pregnancy is a question that more and more doctors have to face. These decisions are usually made without clear and authoritative evidence. Instead, doctors must take into account their own experience and experience, as well as the experiences of other doctors and the research on the subject.
Particularly, the issue of possible risks to the baby can be tricky. Many studies on this topic are based on observational data instead of controlled research and their findings are often contradictory. In addition, most studies limit their analysis to live births, which can underestimate the severity of teratogenic effects that could result in abortion or termination of the pregnancy. The study presented in the journal club addresses these shortcomings, by examining both data on live and deceased births.
Conclusion A few studies have revealed a positive correlation between ADHD medications and certain birth defects however, other studies haven't established a link. The majority of studies show an unintended, or slightly negative, impact. In all cases it is imperative to conduct a thorough evaluation of the potential risks and benefits is required.
For a lot of women with ADHD, the decision to discontinue medication is 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. Furthermore, a loss of medication can interfere with the ability to complete job-related tasks and drive safely, which are important aspects of daily life for many people with ADHD.
She recommends women who are unsure about whether or not to stop medication in light of their pregnancy should consider the possibility of educating friends, family members, and coworkers on the condition, its effects on daily functioning, and the benefits of keeping the current treatment plan. Educating them can also aid in ensuring that the woman feels supported when she is struggling with her decision. It is important to remember that certain medications can be absorbed through the placenta therefore, if a patient decides to stop taking her ADHD medication during pregnancy and breastfeeding, she should be aware that traces of the drug could be transferred to the infant.
Risk check here of Birth Defects
As the use and use of ADHD medications to treat the symptoms of attention deficit disorder hyperactivity disorder (ADHD), increases as does the concern about the possible effects of the drugs on foetuses. A study that was published in the journal Molecular Psychiatry adds to the existing knowledge about this subject. Using two massive 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. Although the risk overall is low, the researchers discovered that the first-trimester exposure to ADHD medications was associated with an increased risk of certain heart defects such as ventriculoseptal defect (VSD).
The authors of the study didn't find any association between early medication usage and congenital anomalies like facial deformities or club feet. The results are in line with previous studies revealing an increase, but not significant, in the risk of cardiac malformations among women who started taking ADHD medications prior to the time of the birth of their child. The risk was higher during the latter part of pregnancy, as many women are forced to stop taking their medication.
Women who took ADHD medication in the first trimester were more likely require a caesarean delivery, have an insufficient Apgar after birth and have a baby who needed breathing assistance after birth. The researchers of the study were not able to eliminate bias due to selection because they limited their study to women without other medical conditions that could have contributed to the findings.
Researchers hope that their study will inform physicians when they see pregnant women. The researchers suggest that while discussing benefits and risks are important, the decision regarding whether or not to stop taking medication should be according to the severity of each woman's ADHD symptoms and her needs.
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 problems for women who are pregnant or recently gave birth. Furthermore, research suggests that women who decide to stop taking their medications are more likely to experience difficulties getting used to life without them following the birth of their baby.
Nursing
The responsibilities of being a new mom can be overwhelming. Women with ADHD who must work through their symptoms while attending doctor appointments as well as getting ready for the arrival of a child and adjusting to new household routines are often faced with a number of difficulties. Many women choose to continue taking their ADHD medication during pregnancy.
The majority of stimulant drugs pass through breast milk in low quantities, so the risk to nursing infant is very low. However, the frequency of medication exposure to the newborn may differ based on the dosage, frequency it is taken and the time of day it is administered. Additionally, different medications enter the body of the baby differently through the gastrointestinal tract and breast milk. The impact of this on a newborn is not well known.
Because of the lack of research, some doctors might be tempted to stop taking stimulant medication during a woman's pregnancy. It's a difficult choice for the mother, who must weigh the benefits of her medication against the potential risks to the embryo. In the meantime, until more information is available, doctors can inquire about pregnant patients whether they have an background of ADHD or if they are planning to take medication during the perinatal period.
Many studies have shown that women can continue taking their ADHD medication safely during pregnancy and while breast-feeding. In response, a growing number of patients are opting to continue their medication. They have discovered, in consultation with their doctor, that the benefits of retaining their current medication outweigh any risk.
It is crucial for women suffering from ADHD who are contemplating breastfeeding to seek a specialist psychiatrist's advice prior to becoming pregnant. They should review their medications with their prescriber and discuss the pros and cons of continued treatment, including non-pharmacological management strategies. Psychoeducation should also be offered to help pregnant women suffering from ADHD recognize their symptoms and the underlying disorder Learn about the available treatment options and strengthen existing strategies for coping. This should be a multidisciplinary approach together with obstetricians, GPs and psychiatrists. The pregnancy counselling should consist of the discussion of a plan for management for both the mother and child, and monitoring for signs of deterioration and the need for adjustments to the medication regimen.