ADHD Medication During Pregnancy and Breastfeeding
Women with ADHD face a difficult decision on whether to keep or stop taking ADHD medication during pregnancy and breast-feeding. There is a lack of information about how long-term exposure to these medications can affect the fetus.
A recent study 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 more high-quality research.
Risk/Benefit Analysis
Women who are pregnant and taking ADHD medication should evaluate the benefits of using it against the potential risks to the foetus. Physicians do not have the necessary data to make unequivocal recommendations, but they can provide information on the risks and benefits to assist 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 higher risk of fetal cardiac malformations or major structural birth defects. Researchers used a large sample-based case control study to assess the frequency of major structural defects in infants born to mothers who used stimulants during pregnancy. Clinical geneticists and pediatric cardiologists reviewed the cases to ensure correct classification of the cases and to reduce the chance of bias.
The study of the researchers was not without its limitations. Researchers were unable to, in the first place, to separate the effects caused by the medication from the disorder. This limitation makes it difficult for researchers to determine if the small associations observed among the exposed groups were due to the use of medications or if they were affected by co-morbidities. In addition the researchers did not study long-term offspring outcomes.
The study revealed that babies whose mothers took ADHD medication during pregnancy were at a slightly greater risk of being admitted to the neonatal care unit (NICU) as compared to those whose mothers did not take any medication during pregnancy, or had quit taking the medication prior to or during pregnancy. This increase was due to central nervous system-related disorders, and the increased risk for admission was not found to be influenced by the stimulant medication was used during pregnancy.
Women who used stimulant ADHD medication during pregnancy were also at an elevated risk of having a caesarean section or having a child with a low Apgar score (less than 7). These risks did not seem to be influenced by the type of medication that was used during pregnancy.
The researchers suggest that the small risk associated with the use of ADHD medications during early pregnancy may be offset by the greater benefits to both mother and child of continued treatment for the woman's disorder. Physicians should talk to their patients about this issue and as much as possible, assist them improve coping skills which could reduce the effects of her disorder on her daily life and relationships.
Medication Interactions
More and more doctors are confronted with the dilemma of whether to continue treatment or stop it during pregnancy as more women are diagnosed with ADHD. These decisions are often taken without clear and authoritative evidence. Instead, physicians must take into account their own experience, the experience of other physicians and the research on the subject.
The issue of potential risks for infants can be particularly tricky. The research on this issue is based on observation rather than controlled studies and a lot of the results are contradictory. The majority of studies restrict their analysis to live births, which can underestimate the teratogenic impact that can lead to terminations or abortions of pregnancy. The study presented in this journal club addresses these limitations by looking at data from both live and deceased births.
The conclusion is that while certain studies have demonstrated a positive association between ADHD medications and the possibility of certain birth defects, others have found no such relationship and the majority of studies have a neutral or slight negative effect. In the end, a careful risk/benefit analysis must be conducted in every situation.
It isn't easy, but not impossible for women suffering from ADHD to stop taking their medication. In a recent article in the Archives of Women's Mental Health psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can cause depression, feelings of loneliness, and family conflict for those suffering from the disorder. A decrease in medication could also impact the ability to drive safely and complete work-related tasks, which are essential aspects of normal life for people with ADHD.
She recommends women who are uncertain about whether or not to stop medication in light of their pregnancy, consider informing family members, friends and colleagues about the condition, its effects on daily functioning, and on the advantages of staying on the current treatment plan. It can also help a woman feel more confident in her decision. It is important to remember that some medications can pass through the placenta so if a woman decides to stop taking her ADHD medication during pregnancy and breastfeeding, she must be aware that the effects of the medication could be transferred to the infant.
Risk of Birth Defects
As the use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) grows, so do 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 subject. Using two massive data sets, researchers were able to examine more than 4.3 million pregnancies to determine whether the use of stimulant medications increased the risk of birth defects. Although adhd and depression medication is low, the researchers did find that first-trimester exposure to ADHD medicines was associated with an increased risk of certain heart defects like ventriculo-septal defects (VSD).
The researchers behind the study found no connection between early medication use and congenital abnormalities like facial clefting, or club foot. The results are in the same vein as previous studies which showed the existence of a slight, but significant increase in cardiac malformations for women who began taking ADHD medication prior to the time of pregnancy. This risk increased during the latter stages of pregnancy when a large number of women stopped taking their medication.
Women who took ADHD medication in the first trimester of their pregnancies were also more likely to experience caesarean section, low Apgar score after delivery and a baby who required breathing assistance during birth. However the researchers of the study were unable to eliminate selection bias by restricting the study to women who did not have other medical issues that could have contributed to the findings.
Researchers hope their research will inform physicians when they meet pregnant women. The researchers recommend that, while discussing the risks and benefits are important, the decision about whether to continue or stop medication should be according to the severity of each woman's ADHD symptoms and her needs.
The authors warn that, even though stopping the medication is an option to look into, it is not advised because of the high incidence of depression and other mental problems among women who are pregnant or who have recently given birth. Further, research shows that women who stop taking their medication will have a tough transitioning to life without them once the baby is born.
Nursing
It can be a challenge becoming a mother. Women who suffer from ADHD who have to deal with their symptoms while attending physician appointments as well as making preparations for the arrival of a child and getting used to new routines at home may face a lot of challenges. This is why many women elect to continue taking their ADHD medication throughout the pregnancy.
The majority of stimulant medications are absorbed by breast milk in very small quantities, so the risk to the infant who is breastfeeding is low. The rate of medication exposure can vary depending upon the dosage the medication is administered, its frequency and the time of the day. Additionally, different drugs enter the infant's system via the gastrointestinal tract or breast milk. The impact of these medications on a newborn's health is not fully comprehended.
Because of the lack of evidence, some doctors might be tempted to stop taking stimulant medications during a woman's pregnancy. It's a difficult choice for the woman who must weigh the advantages of continuing her medication against the potential risks to the foetus. Until more information is available, GPs should ask all pregnant patients about their history of ADHD and if they are planning or taking to take medication during the perinatal time.
Many studies have shown that women can continue taking their ADHD medication without risk during pregnancy and breast-feeding. In the end, many patients opt to do this, and in consultation with their doctor they have discovered that the benefits of continuing their current medication far outweigh any risks.
It is crucial for women suffering from ADHD who are thinking of breastfeeding to seek a specialist psychiatrist's advice prior to becoming pregnant. They should discuss their medication with their doctor as well as the pros and cons for continuing treatment. This includes non-pharmacological strategies. Psychoeducation is also necessary to help pregnant women suffering from ADHD be aware of the symptoms and underlying disorder. They should also learn about treatment options and build strategies for coping. This should be a multidisciplinary approach together with obstetricians, GPs, and psychiatrists. Pregnancy counseling should consist of a discussion of a treatment plan for the mother and the child, monitoring of signs of deterioration and, if necessary modifications to the medication regime.