ADHD Medication During Pregnancy and Breastfeeding
Women suffering from ADHD have to make a difficult choice on whether to keep or stop taking ADHD medication during pregnancy and breastfeeding. There are few data on how long-term exposure may affect a pregnant fetus.
A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus do not develop neurological disorders such as hearing loss or impaired vision, febrile seizures, or IQ impairment. The authors acknowledge the need for more high-quality research.
Risk/Benefit Analysis
Pregnant women who take ADHD medications need to balance the benefits of taking them against the potential risks to the foetus. The doctors don't have the information to give clear advice but they can provide information about 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 during early pregnancy did not have a higher risk of fetal malformations, or structural birth defects. Researchers conducted a large sample-based case control study to compare the incidence of structural defects that were major in infants born to mothers who took stimulants during pregnancy. Clinical geneticists, pediatric cardiologists and other experts reviewed the cases in order to confirm that the classification was correct and to reduce any bias.
The study of the researchers was not without its limitations. Researchers were unable, in the first place to differentiate the effects triggered by the medication from the disorder. This limitation makes it difficult to know whether the small differences observed in the exposed groups are due to the use of medication or the confounding effect of comorbidities. Researchers also did not look at long-term outcomes for offspring.
The study found that infants whose mothers took ADHD medication during pregnancy were at a slightly higher risk of admission to the neonatal care unit (NICU) as compared to mothers who 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, and the increased risk for admission did not appear to be affected by the type of stimulant medication was used during pregnancy.
buy adhd medication uk who took stimulant ADHD medications during pregnancy also had a higher risk of having a caesarean section or the baby was not scoring well on the Apgar scale (less than 7). These increases appear to be unrelated to the type of medication used during pregnancy.
Researchers suggest that the minor risk of using ADHD medications during early pregnancies could be offset by the greater benefits for mother and baby of continuing treatment for the woman's disorder. Physicians should talk to their patients about this issue and try to help them develop coping skills 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 question of whether to keep or end treatment during pregnancy is a question that more and more doctors face. Often, these decisions are made without clear and authoritative evidence in either case, which means that doctors must weigh what they know from their own experiences, those of other doctors, and what the research suggests on the subject and their own best judgment for each individual patient.
Particularly, the issue of possible risks to the baby can be a challenge. The research on this issue is based on observation rather than controlled studies, and many of the findings are in conflict. The majority of studies restrict their analysis to live-births, which could underestimate the severity of teratogenic effects that can lead to abortions or terminations of pregnancy. The study that is discussed in this journal club addresses these limitations by looking at data from both live and deceased births.
Conclusion: While some studies have revealed an association between ADHD medications and certain birth defects, other studies have not shown such a relationship. The majority of studies show that there is a neutral, or somewhat negative, impact. As a result, a careful risk/benefit analysis is required in every instance.
It can be difficult, if not impossible for women with ADHD to stop taking their medication. In a recent piece published in the Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can lead to depression and feelings of isolation. Additionally, the loss of medication can affect the ability to do work-related tasks and safely drive which are essential aspects of a normal life for a lot of people with ADHD.
She suggests that women who are unsure whether to take the medication or stop due to pregnancy should educate family members, coworkers, and acquaintances about the condition, its impact on daily functioning and the advantages of staying on the current treatment plan. It can also help women feel supported in her decision. Some medications can pass through the placenta. If the patient decides to not take her ADHD medication while breastfeeding, it's important to be aware that the medication could be transferred to the baby.
Risk of Birth Defects
As the use and misuse of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD), increases the concern over the potential adverse effects of the drugs on foetuses. Recent research published in the journal Molecular Psychiatry has added to the body knowledge on this subject. Utilizing two huge data sets researchers were able analyze more than 4.3 million pregnancies to determine whether the use of stimulant medications increased the risk of birth defects. Researchers discovered that, while the risk overall is low, the first trimester ADHD exposure to medication was associated with slightly higher rates of specific heart defects like ventriculoseptal defect.
The authors of the study found no link between early medication use and congenital abnormalities such as facial clefting or club foot. The results are in the same vein as previous studies which showed an insignificant, but small increase in cardiac malformations for women who started taking ADHD medication before the time of pregnancy. The risk increased in the latter part of pregnancy when many women began to stop taking their medication.
Women who used ADHD medications in the first trimester of their pregnancy were also more likely to experience caesarean sections, a low Apgar score after delivery and a baby who required help breathing at birth. However the authors of the study were not able to eliminate selection bias by restricting the study to women who did not have any other medical issues that could have contributed to these findings.
The researchers hope that their research will help inform the clinical decisions of doctors who treat pregnant women. The researchers recommend that, while discussing risks and benefits are crucial, the decision regarding whether or not to stop taking medication should be according to the severity of each woman's ADHD symptoms and her requirements.
The authors also caution that even though stopping the medication is an option, it is not a recommended practice because of the high incidence of depression and other mental health problems for women who are expecting or recently postpartum. Further, research shows that women who stop taking their medications will have a difficult transitioning to life without them once the baby is born.
Nursing
It can be a stressful experience to become a mother. Women suffering from ADHD may face a lot of challenges when they have to manage their symptoms, go to doctor appointments, prepare for the birth of a child and adjust to new routines. Many women choose to continue taking their ADHD medication during pregnancy.
The majority of stimulant medications pass through breast milk in small amounts, therefore the risk to nursing infant is very low. However, the frequency of medication exposure to the infant can differ based on the dosage, frequency it is administered, and the time of the day it is administered. Additionally, different medications enter the infant's system differently through the gastrointestinal tract as well as breast milk. The impact of this on a newborn infant is not yet fully understood.
Because of the lack of evidence, some doctors may be inclined to discontinue stimulant medications during a woman's pregnancy. This is a difficult decision for the patient, who must weigh the benefits of keeping her medication against the potential dangers to the embryo. As long as there is no more information, doctors should ask all pregnant patients about their history of ADHD and whether they are taking or planning to take medication during the perinatal time.
Many studies have shown that women can continue to take their ADHD medication safely while breastfeeding and during pregnancy. In response, an increasing number of patients are choosing to continue their medication. They have concluded through consultation with their doctors that the benefits of retaining their current medication outweigh any potential risks.
Women who suffer from ADHD who are planning to breastfeed should seek advice from an expert psychiatrist prior to becoming pregnant. They should discuss their medication with their prescriber, and the pros and cons for continuing treatment. This includes non-pharmacological strategies. Psychoeducation is also required to help pregnant women suffering from ADHD be aware of the symptoms and underlying disorder. They should also be informed about treatment options and strengthen strategies for coping. This should include a multidisciplinary approach, which includes the GP doctors, obstetricians 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, adjustments to the medication regimen.