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 breastfeeding. There are few data on how exposure to ADHD for a long time could affect the pregnant fetus.
A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological issues such as hearing loss or vision, febrile seizures, or IQ impairment. The authors acknowledge the need for higher-quality research.
Risk/Benefit Analysis
Women who are pregnant and take ADHD medication should consider the benefits of taking it against the potential risks for the foetus. Physicians don't have the data to provide clear recommendations but they can provide information on risks and benefits to aid pregnant women in making an informed decision.
A study published in Molecular Psychiatry found that women who took ADHD medications during their early pregnancy did not face an increased risk of fetal heart malformations or major structural birth defects. Researchers used a vast, population-based case-control study to assess the risk of major structural birth defects in babies born to mothers who had taken stimulants in early pregnancy and those who had not. Clinical geneticists, pediatric cardiologists and other experts looked over the cases to confirm that the classification was accurate and to reduce any bias.
The study of the researchers was not without its limitations. The most important issue was that they were not able to differentiate the effects of the medication from the disorder at hand. This makes it difficult for researchers to establish whether the small differences observed between the exposed groups were due to the use of medications or if they were affected by co-morbidities. In addition, the researchers did not examine the long-term outcomes of offspring.
The study did find that infants whose mothers took ADHD medication during pregnancy were at a slightly higher risk of being admitted to the neonatal intensive care unit (NICU) than those who whose mothers did not take any medication or had taken off their medication prior to or during pregnancy. The reason for this was central nervous system disorders. The higher risk of admission was not affected by the stimulant medication that was used during pregnancy.
Women who took stimulant ADHD medications during pregnancy also had a higher risk of having to have a caesarean section or the baby was not scoring well on the Apgar scale (less than 7). These risks did not appear to be influenced by the kind of medication used during pregnancy.
The researchers suggest that the small risk associated with the use of ADHD medications during the early stages of pregnancy could be offset by the greater benefit for both mother and child of continued treatment for the woman's disorder. Physicians should talk to their patients about this and as much as possible, assist them develop coping strategies that could 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 dilemma of whether to keep or stop treatment during pregnancy is a question that more and more physicians confront. These decisions are frequently made without clear and reliable evidence. Instead, adhd medication online must weigh their own knowledge and experience, as well as the experiences of other physicians and the research that has been conducted on the subject.
The issue of risk to infants is particularly tricky. A lot of studies on this issue are based on observational evidence rather than controlled research and their conclusions are often contradictory. The majority of studies restrict their analysis to live-births, which could 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 examining data on both live and deceased births.
The conclusion: While some studies have shown an association between ADHD medications and the possibility of certain birth defects, other studies have found no connection and the majority of studies have a neutral or slightly negative effect. In every case, a careful evaluation of the benefits and risks should be conducted.
For a lot of women with ADHD who suffer from ADHD, the decision to discontinue medication can be difficult, if not impossible. In an article published in Archives of Women's Mental Health, psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can increase depression, feelings of loneliness, and family conflict for these patients. The loss of medication can affect the ability to drive safely and complete work-related tasks, which are vital aspects of daily life for those suffering from ADHD.
She suggests that women who aren't sure whether to continue taking medication or stop due to pregnancy should educate family members, coworkers and acquaintances about the condition, the effects on daily functioning, and the advantages of staying on the current treatment. It can also aid in ensuring that the woman feels supported when she is struggling with her decision. Certain medications can pass through the placenta. If a woman decides to not take her ADHD medication while pregnant and breastfeeding, it is important to be aware that the drug could be transferred to the baby.
Birth Defects and Risk of
As the use of ADHD medication to treat the symptoms of attention deficit hyperactivity disorder (ADHD) grows as do concerns about what impact the drugs might have on fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge on this issue. Researchers used two huge data sets to study over 4.3 million pregnancy and determine whether stimulant medications increased birth defects. While the overall risk remains low, the scientists did find that first-trimester exposure to ADHD medicines was associated with an increase in the risk of certain heart defects like ventriculo-septal defects (VSD).
The researchers behind the study found no association between the use of early medications and congenital abnormalities such as facial clefting or club foot. The results are in line with previous studies showing the presence of a small, but significant increase in the risk of heart malformations in women who started taking ADHD medications before the birth of their child. The risk increased in the latter part of pregnancy when many women decided to stop taking their medication.
Women who took ADHD medication in the first trimester were more likely need a caesarean and also have an insufficient Apgar after birth and have a baby that needed breathing assistance when they were born. However the authors of the study were not able to eliminate bias due to selection by restricting the study to women who didn't have other medical issues that could be a contributing factor to these findings.
Researchers hope their research will provide doctors with information when they meet pregnant women. The researchers advise that, while discussing the risks and benefits are important, the choice on whether to continue or stop medication should be made based on the severity of each woman's ADHD symptoms and her requirements.
The authors warn that, even though stopping the medication is a possibility to think about, it isn't recommended because of the high incidence of depression and other mental problems among women who are pregnant or have recently given birth. Further, the research suggests that women who decide to stop taking their medication are more likely to experience a difficult time getting used to life without them after the birth of their baby.
Nursing
The responsibilities that come with being a new mom can be overwhelming. Women with ADHD who must work through their symptoms while attending physician appointments as well as preparing for the arrival of a child and adapting to new routines in the home may face a lot of challenges. Many women decide to continue taking their ADHD medication during pregnancy.
The majority of stimulant medications are absorbed by breast milk in low amounts, therefore the risk to breastfeeding infant is minimal. However, the frequency of medication exposure to the infant can differ based on dosage, how often it is taken and the time of day it is administered. In addition, different medications are introduced into the baby's system through the gastrointestinal tract or through breast milk. The impact on the health of a newborn is not completely known.
Some doctors may stop taking stimulant medication during a woman's pregnancy due to the lack of research. It is a difficult decision for the woman, who must weigh the benefits of her medication against the risk to the embryo. In the meantime, until more information is available, GPs should ask all pregnant patients about their experience with ADHD and if they are planning or taking to take medication during the perinatal time.
Numerous studies have demonstrated that women can continue taking their ADHD medication in a safe manner while breastfeeding and during pregnancy. In response, a rising number of patients are choosing to do this. They have concluded after consulting with their doctors, that the benefits of continuing their current medication far outweigh any possible risks.
It's important for women with ADHD who are thinking of breastfeeding to seek a specialist psychiatrist's guidance prior to becoming pregnant. They should discuss their medication 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 recognize their symptoms and underlying disorder, learn about available treatment options and reinforce existing strategies for managing. This should be a multidisciplinary approach, which includes the GP doctors, obstetricians and psychiatrists. Pregnancy counseling should include a discussion of a treatment plan for the mother as well as the child, and monitoring for signs of deterioration, and, if needed modifications to the medication regime.