ADHD Medication During Pregnancy and Breastfeeding
Women with ADHD have to make a difficult choice regarding whether or not to stop taking ADHD medication during pregnancy and breast-feeding. There are few data regarding how exposure over time may affect the pregnant fetus.
adult add medication published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological issues such as impaired hearing or vision, febrile seizures or IQ impairment. The authors acknowledge that further high-quality studies are required.
Risk/Benefit Analysis
Pregnant women who take ADHD medications must weigh the advantages of using them against the risks to the foetus. Physicians don't have the necessary data to make unequivocal recommendations but they can provide information regarding benefits and risks that can help pregnant women make informed choices.
A study published in Molecular Psychiatry concluded that women who took ADHD medication in early pregnancy did not have a higher risk of fetal malformations, or structural birth defects. Researchers conducted a large population-based case control study to compare the incidence of structural defects that were major in infants born to mothers who were taking stimulants during pregnancy. Clinical geneticists and pediatric cardiologists reviewed the cases to ensure accurate case classification and to minimize the possibility of bias.
However, the study had its limitations. Researchers were unable in the beginning to distinguish the effects caused by the medication from the disorder. This limitation makes it difficult for researchers to determine whether the small associations observed among the exposed groups were due to medication use or if they were confounded by the presence of comorbidities. The researchers also did not study long-term outcomes for the offspring.
The study showed that babies whose mothers had taken ADHD medication during pregnancy had a greater risk of being admitted to the neonatal care unit (NICU) as compared to mothers who did not take any medication during pregnancy or stopped taking their medication before or during pregnancy. This was due to central nervous system disorders, and the increased risk of admission did not appear to be affected by the type of stimulant medication was used during pregnancy.
Women who took stimulant ADHD medication during pregnancy also had an elevated risk of having a caesarean section or having a baby with an low Apgar score (less than 7). These increases appear to be independent of the type of medication used during pregnancy.
The researchers suggest that the low risk associated with the use of ADHD medications during early pregnancy could be offset by the greater benefits to both mother and child of continuing treatment for the woman's disorder. Doctors should discuss with their patients about this and, if possible, help them develop coping strategies that could reduce the effects of her disorder on her daily life and relationships.
Medication Interactions
Doctors are increasingly faced with the decision of whether to keep treatment or stop it during pregnancy as more women are diagnosed with ADHD. These decisions are often made without clear and reliable evidence. Instead, physicians must take into account their own experience, the experience of other doctors and the research on the topic.
In particular, the issue of possible risks to the infant can be difficult. The research on this subject is based on observations instead of controlled studies and the results are contradictory. The majority of studies limit their analysis to live births, which can underestimate the teratogenic impact which can cause terminations or abortions of pregnancy. The study that is discussed in the journal club addresses these issues by analyzing data on live and deceased births.
Conclusion Some studies have revealed a positive correlation between ADHD medications and certain birth defects however, other studies haven't established a link. Most studies show an unintended, or slight negative effect. In the end, a careful risk/benefit analysis is required in every situation.
It can be challenging, if not impossible, for women suffering from ADHD to stop taking their medication. In an article published in Archives of Women's Mental Health psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can lead to increased depression, feelings of isolation and family conflict for these patients. In addition, a decrease in medication may affect the ability to complete jobs and drive safely which are essential aspects of a normal life for many people with ADHD.
She suggests that women who aren't sure whether to continue taking the medication or discontinue it due to pregnancy should educate family members, coworkers and friends about the condition, the effects on daily functioning, and the advantages of staying on the current treatment. In addition, educating them can aid in ensuring that the woman feels supported in her struggle with her decision. It is important to note that certain drugs can pass through the placenta, so if the patient decides to stop taking her ADHD medication during pregnancy and breastfeeding, she should be aware that traces of the drug can be transferred to the infant.
Risk of Birth Defects
As the use of ADHD medications to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases as do concerns about what impact the drugs might have on foetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge regarding this topic. With two massive data sets researchers were able examine more than 4.3 million pregnancies to determine whether the use of stimulant medications increased the risk of birth defects. Researchers found that while the overall risk is low, the first trimester ADHD exposure to medication was associated with slightly higher risk of certain heart defects, like ventriculoseptal defect.
The authors of the study could not discover any link between early use of medication and other congenital anomalies, like facial deformities, or club feet. The findings are in line with previous studies that have shown an increase, but not significant, in the risk of developing cardiac 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 a large number of women stopped taking their medication.
Women who used ADHD medications in the first trimester of their pregnancies were also more likely to have caesarean sections, a low Apgar score after delivery and a baby that required help breathing at birth. The researchers of the study were unable to eliminate selection bias 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 encounter pregnant women. The researchers advise that while discussing the risks and benefits are crucial, the decision about whether to continue or stop taking medication should be in light of the severity of each woman's ADHD symptoms and her requirements.
The authors also caution that even though stopping the medication is an option, it is not an option to consider due to the high prevalence of depression and other mental health issues for women who are expecting or recently post-partum. Further, the research suggests that women who choose to stop their medications are more likely to have difficulties adjusting to life without them following the birth of their baby.
Nursing
It can be overwhelming becoming a mother. Women with ADHD who must work through their symptoms while attending doctor appointments and preparing for the arrival of their child and adjusting to new household routines can experience severe challenges. Therefore, many women choose to continue taking their ADHD medication throughout the pregnancy.
The majority of stimulant medications are absorbed by breast milk in small amounts, so the risk to breastfeeding infant is minimal. The rate of exposure to medication can vary depending upon the dosage the medication is administered, its frequency and the time of day. Additionally, different medications enter the body of the baby differently through the gastrointestinal tract as well as breast milk and the impact of this on a newborn is not well known.
Because of the lack of evidence, some doctors may recommend stopping stimulant medications during the course of pregnancy. It's a difficult choice for the woman, who must weigh the benefits of continuing her medication against the risk to the embryo. 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.
A increasing number of studies have shown that most women can safely continue their ADHD medication while they are pregnant and nursing. In response, a rising number of patients are choosing to do this. They have concluded after consulting with their physicians, that the benefits of continuing their current medication outweigh any possible risks.
Women with ADHD who are planning to breastfeed should seek advice from a specialist psychiatrist prior to becoming pregnant. They should review their medications with their prescriber and discuss the pros and cons of continued treatment, including non-pharmacological strategies. Psychoeducation is also required to help women with ADHD be aware of their symptoms and underlying disorder, learn about available treatment options and reinforce existing strategies for managing. This should be a multidisciplinary approach together with obstetricians, GPs and psychiatry. adhd medications uk should consist of a discussion of a treatment plan for the mother and child, monitoring of indicators of deterioration, and, if necessary modifications to the medication regime.