ADHD Medication During Pregnancy and Breastfeeding
Women suffering from ADHD face a difficult decision 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 drugs can affect the foetus.
A recent study published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological problems such as hearing loss or vision, febrile seizures, or IQ impairment. The authors acknowledge that more high quality studies are needed.
Risk/Benefit Analysis
Women who are pregnant and taking ADHD medication need to weigh the benefits of taking it against the possible risks for the foetus. Physicians don't have the data needed to provide clear recommendations, but they can provide information regarding risks and benefits that aid pregnant women in making informed decisions.
A study published in Molecular Psychiatry found that women who used ADHD medications during their early pregnancy did not have an increased risk of fetal cardiac malformations or major birth defects that are structural. Researchers conducted a massive population-based case control study to assess the frequency of structural defects that were major in infants born to mothers who used stimulants during pregnancy. Pediatric cardiologists, clinical geneticists and other experts looked over the cases to confirm that the classification was correct and to eliminate any bias.
However, the researchers' study was not without its flaws. Researchers were unable in the beginning to differentiate the effects of the medication from the disorder. This limitation makes it difficult to know whether the small associations observed in the exposed groups are due to medication use or confounding by comorbidities. Additionally the researchers did not examine the long-term effects of offspring on their parents.
The study did show that babies whose mothers had taken ADHD medications during pregnancy were at slightly higher risk of being admitted to the neonatal intensive care unit (NICU) than those who were born without any medication or cut back on their medications prior to or during pregnancy. This increase was due to central nervous system disorders, and the increased risk of admission did not appear to be influenced by which stimulant medication was used during pregnancy.
Women who were taking stimulant ADHD medication during pregnancy also had an elevated chance of having a caesarean section or having a child with an low Apgar score (less than 7). These increases appeared to be unrelated to the type of medication used during pregnancy.
The research suggests that the small risk associated with the use of ADHD medications during the early stages of pregnancy may be offset by the greater benefit for both mother and child of continuing treatment for the woman's disorder. Physicians should discuss the issue with their patients and, when possible, assist them in developing strategies to improve their coping abilities that may minimize the impact of her disorder on her daily functioning and relationships.
Interactions with Medication
Many doctors are faced with the decision of whether to maintain treatment or stop as more women are diagnosed with ADHD. The majority of these decisions are made in the absence of clear and authoritative evidence in either case, which means that doctors have to weigh their experience from their own experiences, those of other doctors, and what the research suggests about the subject and their own best judgment for each individual patient.
The issue of possible risks for infants can be particularly tricky. Many of the studies on this topic are based on observational data instead of controlled research and their conclusions are often contradictory. Furthermore, most studies restrict their analysis to live births, which could undervalue the serious teratogenic effects that can result in abortion or termination of the pregnancy. The study that is discussed in this journal club addresses these shortcomings by examining data on both live and deceased births.
Conclusion Some studies have found an association between ADHD medications and certain birth defects, other studies have not shown such a relationship. The majority of studies show an unintended, or slightly negative, effect. In medications for adhd in adults an in-depth analysis of the benefits and risks must be performed.
For women suffering from 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 isolation. A decrease in medication could affect the ability to safely drive and complete work-related tasks, which are essential aspects of normal life for those suffering from ADHD.
She suggests that women who are unsure about whether to keep or discontinue medication due to their pregnancy should consider informing family members, friends, and coworkers on the condition, its impact on daily life, and the benefits of keeping the current treatment plan. It can also help women feel confident about her decision. Certain medications can pass through the placenta. If a patient decides to not take her ADHD medication while pregnant and breastfeeding, it's important to be aware that the medication could be passed on to her baby.
Risk of Birth Defects
As the use of ADHD medication to treat the symptoms of attention deficit hyperactivity disorder (ADHD) increases as do concerns about the effects that the drugs could have on foetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge regarding this issue. Researchers used two massive data sets to study over 4.3 million pregnant women and determine if the use of stimulant medications increased the risk of birth defects. While the overall risk remains low, the scientists discovered that the first-trimester exposure to ADHD medications was associated with a slightly higher rate of certain heart defects, such as ventriculo-septal defect (VSD).
The authors of the study did not find any association between early use of medication and other congenital anomalies, such as facial deformities or club feet. The results are consistent 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. This risk increased during the latter part of pregnancy, when a lot of women began to stop taking their medication.
Women who used ADHD medications during the first trimester of pregnancy were also more likely to have caesarean sections, a low Apgar score following delivery, and a baby that required breathing assistance at birth. The authors of the study were not able to eliminate bias due to selection because they limited their study to women without other medical conditions that might have contributed to the findings.
Researchers hope that their study will help doctors when they meet pregnant women. They recommend that, while a discussion of the risks and benefits is crucial however, the decision to stop or continue treatment should be based on each woman's requirements and the severity of her ADHD symptoms.
The authors also caution that, while stopping the medication is an alternative, it is not an option that is recommended due to the high incidence of depression and other mental health issues in women who are pregnant or post-partum. Additionally, research suggests that women who stop taking their medication will have a difficult adjustment to life without them once the baby is born.
Nursing
The responsibilities of being a new mother can be overwhelming. Women with ADHD who have to manage their symptoms while attending physician appointments as well as preparing for the arrival of a baby and adjusting to new household routines are often faced with a number of difficulties. This is why many women choose to continue taking their ADHD medication throughout the pregnancy.
The majority of stimulant medicines pass through breast milk in low amounts, so the risk for nursing infant is very low. The rate of medication exposure will vary based on the dosage, frequency of administration and the time of day. In addition, various medications enter the baby’s system through the gastrointestinal tract, or through breast milk. The impact on the health of a newborn isn't fully understood.
Because of the lack of research, some doctors might be tempted to stop taking stimulant medications during the course of pregnancy. It's a difficult choice for the mother, who must weigh the advantages of taking her medication as well as the risks to the embryo. Until more information is available, GPs should ask all pregnant patients about their experience with ADHD and whether they plan or are taking to take medication during the perinatal period.
A growing number of studies have proven that the majority of women are able to safely continue to take their ADHD medication during pregnancy and while breastfeeding. In response, a growing number of patients are choosing to do so. They have discovered after consulting with their physicians that the benefits of retaining their current medication outweigh any risk.
Women with ADHD who plan to breastfeed should seek advice from a specialist psychiatrist before becoming pregnant. They should discuss their medication with their prescriber as well as the pros and cons for continuing treatment. This includes non-pharmacological strategies. Psychoeducation is also needed to help pregnant women with ADHD recognize the signs and underlying disorder. They should also be educated about treatment options and build coping mechanisms. This should involve a multidisciplinary approach with the GP, obstetricians and psychiatry. Pregnancy counseling should include discussion of a treatment plan for the mother as well as the child, as well as monitoring for indicators of deterioration, and, if necessary modifications to the medication regimen.