ADHD Medication During Pregnancy and Breastfeeding
Women suffering from ADHD have to make a difficult choice regarding whether or not to stop taking ADHD medication during pregnancy and breastfeeding. There isn't much information on how long-term exposure to these medications could affect the fetus.
A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus do not develop neurological disorders like impaired vision or hearing, febrile seizures, or IQ impairment. The authors acknowledge that further high-quality research is needed.
Risk/Benefit Analysis
Pregnant women who take ADHD medications must weigh the advantages of taking them against potential risks to the fetus. Doctors don't have enough data to make unambiguous recommendations however they can provide information on the risks and benefits to assist pregnant women to make an informed decision.
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. The researchers used a large population-based study of case-control to assess the risk of major structural birth defects in infants born to mothers who had taken stimulants during early pregnancy, and those who did not. Pediatric cardiologists, clinical geneticists and other experts looked over the cases to make sure that the classification was correct and to eliminate any bias.
The research conducted by the researchers was not without limitations. Researchers were unable in the beginning to differentiate the effects caused by the medication from the disorder. That limitation makes it difficult to determine whether the limited associations observed in the groups that were exposed are due to medication use or confounding by comorbidities. In addition the study did not look at the long-term effects of offspring on their parents.
The study revealed that infants whose mother had taken ADHD medication during pregnancy had a slightly higher risk of admission to the neonatal care unit (NICU), compared to those whose mothers didn't take any medication during pregnancy or had quit taking the medication prior to or during pregnancy. This was due to central nervous system disorders. The higher risk of admission was not influenced by the stimulant medication used during pregnancy.
Women who took stimulant ADHD medications during pregnancy also had a higher chance of having a caesarean section or a baby that scored low on the Apgar scale (less than 7). These increases did appear to be unrelated to the type of medication used during pregnancy.
The researchers suggest that the low risk associated with the use of ADHD medications during the early stages of pregnancy could be offset by the higher benefit to both mother and child from continued treatment for the woman's disorder. Doctors should discuss with their patients about this issue and try to help them develop coping skills that could reduce the impact of her disorder in her daily functioning and her relationships.
Medication Interactions
Doctors are increasingly faced with the decision of whether to continue treatment or stop as more women are diagnosed with ADHD. These decisions are often taken without clear and authoritative evidence. Instead, physicians must consider their own expertise in conjunction with the experiences of other physicians and the research on the subject.
The issue of potential risks to the infant can be particularly tricky. Many of the studies on this subject are based on observations instead of controlled research and their conclusions are often contradictory. The majority of studies limit their analysis to live births, which can underestimate the teratogenic impact that can lead to abortions or terminations of pregnancy. The study that is discussed in this journal club addresses these issues by analyzing data on live and deceased births.
Conclusion Some studies have revealed an association between ADHD medications and certain birth defects however, other studies haven't shown such a relationship. The majority of studies show a neutral, or even slightly negative, impact. In each case an in-depth evaluation of the risks and benefits is required.
It can be difficult, if not impossible, for women with ADHD to stop taking their medication. 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 cause depression and feelings of being isolated. A loss of medication may affect the ability to drive safely and to perform work-related tasks which are essential aspects of normal life for people with ADHD.
She suggests women who are unsure about whether to keep or discontinue medication due to their pregnancy, consider the possibility of educating friends, family members and colleagues about the condition, its effects on daily life, and the advantages of staying on the current treatment regimen. It will also help a woman feel more confident in 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 must be aware that the effects of the drug can be transferred to the child.
Birth Defects Risk
As the use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases, so do concerns about what impact the medications could have on foetuses. Recent research published in the journal Molecular Psychiatry has added to the body knowledge on this subject. Researchers used two massive datasets to analyze more than 4.3 million pregnant women and determine whether stimulant medications increased birth defects. While the overall risk remains low, the scientists discovered that the first-trimester exposure to ADHD medications was associated with an increase in the risk of certain heart defects, such as ventriculo-septal defect (VSD).
The researchers of the study found no connection between the use of early medications and other congenital abnormalities, such as facial clefting or club foot. The findings are in line with previous studies revealing the presence of a small, but significant increase in the risk of cardiac malformations among women who began taking ADHD medications prior to the time of the time of pregnancy. The risk increased in the latter half of pregnancy when many women began to stop taking their medication.
Women who used ADHD medication in the first trimester of their pregnancies were also more likely to undergo a caesarean section, a low Apgar score following delivery, and a baby that required breathing assistance during birth. However, the authors of the study were unable to eliminate bias due to selection by limiting the study to women who did not have any other medical conditions that could have contributed to the findings.
The researchers hope their research will aid in the clinical decisions of doctors who see pregnant women. The researchers advise that while discussing risks and benefits are important, the decision regarding whether or not to stop medication should be according to the severity of each woman's ADHD symptoms and the needs of the woman.
The authors warn that, while stopping the medication is an option to look into, it is not recommended because of the high incidence of depression and other mental problems among women who are pregnant or who have recently given birth. Further, sources suggests that women who choose to stop taking their medication are more likely to experience a difficult time adjusting to life without them following the baby's arrival.
Nursing
The responsibilities of being a new mother can be overwhelming. Women who suffer from ADHD who must work through their symptoms while attending physician appointments and preparing for the arrival of their child and adjusting to new household routines may face a lot of challenges. Many women choose to continue taking their ADHD medication during pregnancy.
The majority of stimulant medications pass through breast milk in very small quantities, so the risk to breastfeeding infant is minimal. The rate of exposure to medication can vary depending upon the dosage and frequency of administration as well as time of day. Additionally, individual medications enter the infant's system differently through the gastrointestinal tract as well as breast milk. The impact of this on a newborn is not yet fully known.
Because of the lack of research, some doctors may be inclined to discontinue stimulant medication during a woman's pregnancy. It is a difficult decision for the woman, who must weigh the benefits of her medication against the potential risks to the fetus. Until more information becomes available, GPs can inquire about pregnant patients if they have a history of ADHD or if they are planning to take medication in the perinatal stage.
A growing number of studies have shown that women can continue taking their ADHD medication during pregnancy and breastfeeding. As a result, many patients opt to do this and, in consultation with their doctor they have found that the benefits of maintaining their current medication outweigh any potential risks.
It's important for women with ADHD who are contemplating breastfeeding to seek out a specialist psychiatrist's guidance prior to becoming pregnant. They should discuss the medication they are taking with their physician, and the pros and cons of continuing treatment. This includes non-pharmacological methods. Psychoeducation is also required to help pregnant women suffering from ADHD be aware of their symptoms and the root cause Learn about the available treatment options and strengthen existing strategies for managing. This should be a multidisciplinary approach, which includes the GP doctors, obstetricians and psychiatrists. Pregnancy counselling should include the discussion of a plan for management for both mother and child, and monitoring for signs of deterioration, and, if necessary, adjustments to the medication regimen.