ADHD Medication During Pregnancy and Breastfeeding
Women with ADHD face a difficult decision about whether to continue or 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 recent study published in Molecular Psychiatry shows that children exposed to ADHD medication during the uterus don't develop neurological disorders such as hearing or vision impairment, febrile seizures, or IQ impairment. The authors acknowledge that further high-quality studies are 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 provide clear recommendations however they can provide information on the risks and benefits to help pregnant women make informed choices.
A study published in Molecular Psychiatry found that women who took ADHD medications during early pregnancy did not face a significantly increased risk of fetal heart malformations or major structural birth defects. The researchers used a large population-based case-control study to determine the prevalence of major structural birth defects in babies born to mothers who had taken stimulants during the early stages of pregnancy and those who had not. Pediatric cardiologists, clinical geneticists and other experts reviewed the cases in order to confirm that the classification was accurate and to eliminate any bias.
The research conducted by the researchers was not without its limitations. In particular, they were not able to differentiate the effects of the medication from the effects of the disorder that is underlying. This limitation makes it difficult for researchers to establish whether the small associations observed among the groups that were exposed to medication use or confounded by co-morbidities. Researchers also did not examine long-term outcomes for the offspring.
The study did find that infants whose mothers took ADHD medication during pregnancy were at a slightly more risk of being admitted to the neonatal intensive care unit (NICU) than those who whose mothers did not take any medication or cut back on their medications 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 likelihood of having to have an emergency caesarean section or having the baby was not scoring well on the Apgar scale (less than 7). These increases did not seem to be influenced by the type of medication that was used during pregnancy.
The researchers suggest that the risk of a small amount with the use of ADHD medications during the early stages of pregnancy could be offset by the higher benefit to both the mother and child from continued treatment for the woman's disorder. Physicians should talk to their patients about this and try to help them improve coping skills which can lessen the effects of her disorder on her daily functioning and her relationships.
Interactions with Medication
As more women than ever are being diagnosed with ADHD and treated with medication, the question of whether to keep or end treatment during pregnancy is one that more and more physicians have to face. Most of the time, these decisions are made without solid and reliable evidence either way, so physicians have to weigh their experience from their own experiences, those of other doctors, and what the research suggests about the subject as well as their best judgment for each individual patient.
The issue of possible risks for infants can be particularly tricky. Many of the studies on this topic are based on observations instead of controlled research and their findings are often contradictory. The majority of studies restrict their analysis to live births, which may underestimate the teratogenic impact which can cause abortions or terminations of pregnancy. The study presented in this journal club addresses these issues by analyzing data on live and deceased births.
The conclusion The conclusion: While some studies have found a positive association between ADHD medications and the risk of certain birth defects, others have not found any evidence of a link and the majority of studies demonstrate a neutral or slight negative effect. In all cases it is imperative to conduct a thorough analysis of the risks and benefits should be conducted.
It can be difficult, if not impossible, for women suffering from ADHD to stop taking their medication. In a recent article in the Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can increase depression and feelings of isolation. Furthermore, a loss of medication can interfere with the ability to do jobs and drive safely that are crucial aspects of daily life for a lot of people with ADHD.
She suggests women who are unsure about whether to keep or stop medication in light of their pregnancy, consider educating family members, friends and colleagues about the condition, its effects on daily functioning, and on the advantages of staying on the current treatment regimen. In addition, educating them can help the woman feel supported when she is struggling with her decision. It is important to remember 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 of the possibility that traces of the drug could be transferred to the child.
Birth Defects and Risk of
As the use and misuse of ADHD medication to treat symptoms of attention deficit hyperactivity disorder (ADHD), increases as does the concern about the possible effects of the drugs on fetuses. Recent research published in the journal Molecular Psychiatry has added to the body knowledge on this subject. Utilizing two website huge data sets, researchers were able to analyze more than 4.3 million pregnancies and see whether stimulant medication use increased the risk of birth defects. While the overall risk is low, the researchers did find that first-trimester exposure to ADHD medications was linked to a slightly higher rate of certain heart defects such as ventriculo-septal defect (VSD).
The researchers of the study could not find any association between early medication usage and other congenital anomalies such as facial deformities or club feet. The results are in line with previous studies that have shown the presence of a small, but significant increase in the risk of developing cardiac malformations among women who started taking ADHD medications prior to the time of pregnancy. This risk increased during the latter part of pregnancy, when a lot of women stopped taking their medication.
Women who took ADHD medication in the first trimester of their pregnancy were also more likely to experience caesarean section, low Apgar score after delivery and a baby who needed help breathing at birth. The researchers of the study could not eliminate selection bias because they limited their study to women without other medical conditions that could have contributed to the findings.
Researchers hope their research will inform physicians when they meet pregnant women. The researchers suggest that, while discussing benefits and risks are important, the decision about whether to continue or stop medication should be based on the severity of each woman's ADHD symptoms and the needs of the woman.
The authors caution that, although stopping the medication is an option to think about, it isn't recommended because of the high incidence of depression and other mental problems among women who are pregnant or who have recently given birth. Additionally, the research suggests that women who decide to stop taking their medications are more likely to have a difficult time adapting to life without them after the baby's arrival.
Nursing
It can be overwhelming to become a mom. Women with ADHD are often faced with a number of difficulties when they must manage their symptoms, attend doctor appointments and prepare for the birth of a child and adjust to a new routine. This is why many women elect to continue taking their ADHD medications throughout the course of pregnancy.
The risk to breastfeeding infant is minimal because the majority of stimulant medications passes through breast milk at a low level. However, the rate of exposure to medications by the newborn can vary depending on the dosage, frequency it is taken and the time of day the medication is administered. In addition, various medications are introduced into the baby's system via the gastrointestinal tract or breast milk. The impact on a newborn's health is not completely understood.
Some physicians may discontinue stimulant medication during a woman’s pregnancy due to the absence of research. This is a difficult choice for the patient, who must weigh the benefits of keeping her medication against the potential risks to the foetus. In the meantime, until more information is available, doctors should ask all pregnant patients about their history of ADHD and whether they are planning or taking to take medication during the perinatal time.
A increasing number of studies have revealed that most women can safely continue to take their ADHD medication while they are pregnant and nursing. In response, a growing number of patients are choosing to do this. They have found through consultation with their physicians that the benefits of retaining their current medication outweigh potential risks.
Women with ADHD who are planning to nurse should seek advice from a specialist psychiatrist before becoming pregnant. They should discuss their medication with their prescriber and discuss the advantages and disadvantages of continued treatment, including non-pharmacological management strategies. Psychoeducation should also be provided to help pregnant people with ADHD be aware of their symptoms and the underlying disorder, learn about available treatment options and reinforce existing coping strategies. This should be a multidisciplinary effort with the GPs, obstetricians and psychiatrists. Pregnancy counselling should include discussion of a management plan for both the mother and child, monitoring for signs of deterioration and, if necessary, adjustments to the medication regimen.