ADHD Medication During Pregnancy and Breastfeeding
The decision to stop or keep ADHD medications during pregnancy and breastfeeding is challenging for women with the condition. 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 do not develop neurological developmental conditions like hearing loss or impaired vision seizures, febrile seizures or IQ impairment. The authors acknowledge that more high quality studies are needed.
Risk/Benefit Analysis
Women who are expecting and taking ADHD medication must consider the benefits of taking it versus the dangers for the foetus. Physicians don't have the data needed to make unequivocal recommendations, but they can provide information about benefits and risks that can help pregnant women make informed choices.
A study published in Molecular Psychiatry concluded that women who were taking ADHD medication during their early pregnancy were not at greater risk of fetal malformations or structural birth defects. The researchers used a large population-based case-control study to assess the risk of major structural birth defects in infants born to mothers who had taken stimulants in the early stages of pregnancy and those who had not. Clinical geneticists, pediatric cardiologists and other experts reviewed the cases in order to ensure that the classification was accurate and to minimize any bias.
The research conducted by the researchers had some limitations. Most important, they were not able to differentiate the effects of the medication from those of the disorder that is underlying. This limitation makes it difficult to know whether the limited associations observed in the exposed groups are due to medication use or comorbidities that cause confusion. Additionally, the researchers did not examine long-term offspring outcomes.
The study did reveal 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 infants whose mothers had not taken any medication or had cut back on their medications prior to or during pregnancy. The reason for this was central nervous system disorders. The increased risk of admission was not affected by the stimulant medications used during pregnancy.
Women who were taking stimulant ADHD medication during pregnancy also had an increased risk of having a caesarean delivery or having a baby born with an low Apgar score (less than 7). These increases didn't seem to be influenced by the type of medication that was used during pregnancy.
The researchers suggest that the low risk associated with the use of ADHD medications during the early stages of pregnancy may be offset by the greater benefits for both mother and child from continued treatment for the woman's condition. Physicians should discuss this with their patients and, when possible, help them develop strategies for improving their coping skills that may minimize the negative impact of her condition on her daily life and relationships.
Medication Interactions
As more women than ever are diagnosed with ADHD and treated with medication, the dilemma of whether or not to end treatment during pregnancy is a question that doctors are having to have to face. The majority of these decisions are taken in the absence of solid and reliable evidence regardless, so doctors have to weigh their experience, the experiences of other doctors, and what the research suggests on the subject and their own judgments for each patient.
The issue of potential risks to infants is difficult to determine. Many of the studies on this issue are based on observational evidence rather than controlled research and their findings are often contradictory. In addition, most studies limit their analysis to live births, which can underestimate the severity of teratogenic effects that could cause abortion or termination of the pregnancy. The study presented in the journal club addresses these issues, by examining both information on deceased and live births.
The conclusion: While some studies have shown that there is a positive correlation between ADHD medications and the risk of certain birth defects, others have found no such relationship, and most studies show a neutral or even slight negative effect. As a result an accurate risk-benefit analysis must be done in each instance.
For a lot of women with ADHD and ADD, the decision to discontinue medication is difficult, if not impossible. In a recent piece published in Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can cause depression and feelings of loneliness. A loss of medication may affect the ability to drive safely and to perform work-related tasks which are crucial aspects of daily life for those suffering from ADHD.
She suggests that women who are unsure whether to take the medication or stop it due to their pregnancy should educate family members, colleagues, and acquaintances about the condition, the impact on daily functioning and the benefits of keeping the current treatment regimen. It will also help a woman feel supported in her decision. Certain medications can pass through the placenta. If a patient decides to stop taking her ADHD medication while breastfeeding, it's important to be aware that the drug may be transferred to her baby.
Birth Defects and Risk of
As the use and abuse of ADHD medications to treat the symptoms of attention deficit disorder hyperactivity disorder (ADHD) increases the concern over the possible effects of the drugs on fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge on this topic. With two massive data sets researchers were able to analyze more than 4.3 million pregnancies and determine whether stimulant medications increased the risk of birth defects. Researchers discovered that although the overall risk is low, first-trimester ADHD exposure to medication was associated with slightly higher risk of certain heart defects, such as ventriculoseptal defect.
The authors of the study found no association between early use of medication and congenital abnormalities such as facial clefting or club foot. The results are consistent with previous studies revealing a small but significant increase in the risk of cardiac malformations among women who started taking ADHD medications before pregnancy. The risk grew in the latter half of pregnancy, as many women are forced to stop taking their medication.
Women who took ADHD medication during the first trimester were more likely need a caesarean or have an insufficient Apgar after delivery, and had a baby that required breathing assistance after birth. The researchers of the study were unable to eliminate bias due to selection because they restricted the study to women without other medical conditions that could have contributed to the findings.
Researchers hope their research will inform physicians when they see pregnant women. They suggest that although the discussion of risks and benefits is important however, the decision to stop or keep treatment should be based on each woman's needs and the severity of her ADHD symptoms.
The authors caution that, while stopping the medication is an option to look into, it is not advised because of the high incidence of depression and mental health here issues for women who are pregnant or who have recently given birth. Additionally, research suggests that women who stop taking their medications will have a harder adjustment to life without them after the baby is born.
Nursing
It can be overwhelming to become a mom. Women with ADHD who have to deal with their symptoms while attending doctor appointments as well as preparing for the arrival of their child and adapting to new routines in the home may face a lot of challenges. Many women choose to continue taking their ADHD medication during pregnancy.
The risk to a breastfeeding infant is not too high since the majority of stimulant medication is absorbed through breast milk at a low level. However, the frequency of exposure to medication by the infant can differ based on dosage, how often it is administered, and the time of the day it is administered. Additionally, individual 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 fully known.
Because of the lack of research, some physicians may recommend stopping stimulant medications during the pregnancy of a woman. It's a difficult choice for the woman, who must weigh the benefits of taking her medication as well as the risks to the foetus. As long as more information is available, GPs can ask pregnant patients whether they have any history of ADHD or if they plan to take medication during the perinatal stage.
Numerous studies have demonstrated that women can continue to take their ADHD medication without risk during pregnancy and while breast-feeding. This has led to an increasing number of patients opt to do this and in consultation with their physician, they have found that the benefits of keeping their current medication far exceed any risk.
It's important for women with ADHD who are considering breastfeeding to seek out a specialist psychiatrist's advice prior to becoming pregnant. They should discuss the medication they are taking with their physician and discuss the pros and cons for continuing treatment. This includes non-pharmacological methods. Psychoeducation is also needed to help pregnant women with ADHD be aware of the symptoms and the underlying disorder. They should also be informed about treatment options and strengthen strategies for coping. This should involve an approach that is multidisciplinary, including the GP doctors, obstetricians and psychiatrists. Pregnancy counselling should include the discussion of a plan for management for both the mother as well as the child, monitoring for signs of deterioration, and when necessary, making adjustments to the medication regimen.