ADHD Medication During Pregnancy and Breastfeeding
Women with ADHD must make a difficult decision on whether to keep or stop taking ADHD medication during pregnancy and breastfeeding. There aren't enough data on how long-term exposure may affect a 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 hearing loss or impaired vision, febrile seizures, or IQ impairment. The authors acknowledge the need for more high-quality research.
Risk/Benefit Analysis
Women who are pregnant and take ADHD medication need to evaluate the benefits of using it against the possible risks for the baby. The doctors don't have the information to provide clear recommendations, but can provide information on risks and benefits to assist pregnant women to make an informed decision.
A study published in Molecular Psychiatry found that women who used ADHD medications during early pregnancy did not face a significantly higher risk of fetal cardiac malformations or major birth defects that are structural. Researchers used a large population-based study of case control to compare the incidence of structural defects that were major in infants who were born to mothers who took stimulants during pregnancy. Clinical geneticists, pediatric cardiologists and other experts reviewed the cases in order to ensure that the classification was accurate and to minimize any bias.
However, the study was not without its flaws. The most important issue was that they were unable to separate the effects of the medication from those of the disorder at hand. This makes it difficult to determine whether the small associations observed in the groups that were exposed are due to the use of medication or confounding by comorbidities. Researchers also did not look at long-term outcomes for the offspring.
The study did reveal that infants whose mothers had taken ADHD medications during pregnancy were at a slightly more risk of being admitted to the neonatal intensive care unit (NICU) than those who were born without any medication or had taken off their medication prior to or during pregnancy. This increase was caused by central nervous system disorders. The higher risk of admission was not influenced by the stimulant medication that was used during pregnancy.
Women who took stimulant ADHD medication during pregnancy were also at an elevated chance of having a caesarean section or having a baby born with an low Apgar score (less than 7). These increases didn't appear to be affected by the kind of medication used during pregnancy.
Researchers suggest that the minor risk of using ADHD medications in early pregnancies may be offset by the more beneficial outcomes for both mother and baby from continuing treatment for the woman's disorder. Physicians should discuss this with their patients and, where possible, help them develop strategies to improve coping skills that may minimize the impact of her disorder on her daily functioning 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 stop treatment during pregnancy is a question that doctors are having to face. Often, these decisions are made in the absence of solid and reliable evidence regardless, so doctors must weigh their knowledge from their own experiences, those of other doctors, and what research suggests on the subject and their best judgment for each individual patient.
Particularly, the issue of potential risks to the baby can be tricky. The research on this issue is based on observation rather than controlled studies, and the results are contradictory. Furthermore, most studies restrict their analysis to live births, which may undervalue the serious teratogenic effects that can result in abortion or termination of the pregnancy. The study presented in the journal club addresses these issues, by examining both the data from deceased and live births.
The conclusion is that while some studies have found an association between ADHD medications and the risk of certain birth defects, other studies have not found any evidence of a link and the majority of studies demonstrate a neutral or slightly negative effect. In each case, a careful analysis of the potential risks and benefits must be performed.
For a lot of women with ADHD, the decision to stop medication is difficult if not impossible. In an article recently published in the Archives of Women's Mental Health psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can cause depression, feelings of isolation, and family conflict for patients with ADHD. A decrease in medication could also impact the ability to safely drive and to perform work-related tasks which are vital aspects of daily life for people with ADHD.
She recommends women who are uncertain about whether to continue or stop medication in light of their pregnancy should consider informing family members, friends, and coworkers on the condition, its impact on daily functioning, and on the advantages of continuing the current treatment plan. It can also help the woman feel supported as she struggles with her decision. Certain 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 drug may be transferred to her infant.
Risk of Birth Defects
As the use of ADHD medications to treat symptoms of attention deficit hyperactivity disorder (ADHD) grows there are concerns about the effects that the medications could have on the fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge on this topic. With two massive data sets, researchers were able to examine 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 discovered that the first-trimester exposure to ADHD medicines was associated with an increased risk of certain heart defects such as ventriculoseptal defect (VSD).
The authors of the study found no connection between the use of early medications and other congenital anomalies, such as facial clefting or club foot. The results are in line with previous studies that have shown an increase, but not significant, in the risk of cardiac malformations in women who started taking ADHD medications before pregnancy. This risk increased during the latter part of pregnancy, when a lot of women decided to stop taking their medication.
Women who used ADHD medication in the first trimester of their pregnancies were also more likely to have caesarean sections, a low Apgar score after delivery and a baby who needed help breathing at birth. However the authors of the study were unable to eliminate selection bias by limiting the study to women who didn't have any other medical issues that could have contributed to the findings.
The researchers hope their study will aid in the clinical decisions of doctors who treat pregnant women. They advise that while a discussion of risks and benefits is important, the decision to stop or maintain treatment must be based on each woman's requirements and the severity of her ADHD symptoms.
The authors also warn that even though stopping the medication is an alternative, it is not a recommended practice because of the high incidence of depression and other mental health issues among women who are pregnant or who are recently postpartum. 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
It can be a challenge to become a mom. Women with ADHD may face a lot of challenges when they must manage their symptoms, go to doctor appointments and prepare for the birth of a baby and adjust to a new routine. This is why many women choose to continue taking their ADHD medications throughout pregnancy.
The risk to nursing infant is low because the majority of stimulant medication passes through breast milk in low amounts. However, the amount of exposure to medications by the infant can differ based on the dosage, frequency it is taken and the time of the day it is administered. In addition, individual medications enter the infant's system differently through the gastrointestinal tract as well as breast milk and the impact of this on a newborn infant is not well understood.
Due to the absence of research, some physicians may recommend stopping stimulant medications during the course of pregnancy. This is a difficult decision for the patient, who must weigh the benefits of continuing her medication with the potential dangers to the fetus. In the meantime, until more information is available, GPs should ask all pregnant patients about their experience with ADHD 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 without risk while breastfeeding and during pregnancy. As a result, many patients are choosing to do so, and after consulting with their doctor, they have found that the benefits of maintaining their current medication far outweigh any potential risks.
Women who suffer from 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 of continuing treatment. This includes non-pharmacological strategies. Psychoeducation is also necessary to help pregnant women suffering from ADHD understand the symptoms and underlying disorder. Suggested Looking at should also learn about treatment options and strengthen strategies for coping. This should include an approach that is multidisciplinary, including the GP as well as obstetricians, psychiatry and obstetricians. Pregnancy counselling should include the discussion of a treatment plan for both the mother and child, and monitoring for signs of deterioration, and the need for adjustments to the medication regimen.