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. Little data exists about how long-term exposure to these drugs may affect the fetus.
A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus don't develop neurological developmental disorders such as impaired vision or hearing, 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 medications must weigh the benefits of taking them against potential risks to the foetus. Physicians do not have the information needed to provide clear recommendations, but they can provide information about the risks and benefits to help pregnant women make informed decisions.
A study published in Molecular Psychiatry found that women who used ADHD medications during their early pregnancy did not face a significantly higher risk of fetal cardiac malformations or major birth defects that are structural. Researchers used a vast population-based study of case-control to assess the risk of major structural birth defects in babies born to mothers who took stimulants during the early stages of pregnancy, as well as those who had not. Clinical geneticists and pediatric cardiologists reviewed the cases to ensure accurate classification of the cases and to reduce the possibility of bias.
However, the study had its limitations. Most important, they were unable to separate the effects of the medication from those of the disorder at hand. This limitation makes it difficult for researchers to determine if the few associations observed between the groups exposed were due to the use of medication or caused by comorbidities. Researchers also did not look at long-term outcomes for offspring.
The study did find that babies whose mothers had taken ADHD medications during pregnancy were at a slightly more risk of being admitted to the neonatal intensive care unit (NICU) than infants who whose mothers did not take any medication or had stopped their medications before or during pregnancy. The reason for this was central nervous system disorders. The higher risk of admission was not influenced by the stimulant medications used during pregnancy.
Women who used stimulant ADHD medication during pregnancy also had an increased chance of having a caesarean delivery or having a baby born with an low Apgar score (less than 7). These increases did not appear to be affected by the kind of medication used during pregnancy.
Researchers suggest that the small risk of using ADHD medication during pregnancies in the early stages could be offset by the greater benefits for baby and mother of continued treatment for the woman's condition. Physicians should discuss the issue with their patients and, when they are able, assist them in developing strategies to improve coping skills which can reduce the impact of her disorder on her daily functioning and relationships.
Interactions with Medication
As more women than ever are being diagnosed with ADHD and treated with medication, the dilemma of whether to keep or stop treatment during pregnancy is one that doctors are having to have to face. Often, these decisions are made in the absence of any evidence that is clear and definitive regardless, so doctors must weigh their knowledge, the experiences of other doctors, and what research suggests on the subject and their own judgments for each individual patient.
The issue of potential risks to infants is extremely difficult. Many of the studies on this topic are based on observational evidence instead of controlled research and their conclusions are often contradictory. The majority of studies restrict their analysis to live births, which may underestimate the severity of teratogenic effects which can cause terminations or abortions of pregnancy. The study discussed in this journal club addresses these limitations by analyzing data on live and deceased births.
Conclusion: While some studies have found a positive correlation between ADHD medications and certain birth defects, other studies have not shown such a relationship. Most studies have shown an unintended, or somewhat negative, effect. Therefore, a careful risk/benefit analysis is required in every situation.
For many women with ADHD, the decision to stop medication is difficult, if not impossible. In an article recently 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 patients with ADHD. 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 not sure whether to continue taking the medication or stop due to pregnancy educate family members, coworkers and acquaintances about the condition, the impact on daily functioning and the benefits of continuing the current treatment plan. It can also help a woman feel confident about her decision. It is important to note that some medications can be absorbed through the placenta so if the patient decides to discontinue her ADHD medication during pregnancy and breastfeeding, she must be aware that traces of the drug can be passed on to the baby.
Birth Defects and Risk of
As the use of ADHD medications to treat symptoms of attention deficit hyperactivity disorder (ADHD) grows there are concerns over the impact that these medications could have on foetuses. A recent study published in the journal Molecular Psychiatry click here adds to the body of information on this topic. Using two massive data sets, researchers were able to look at more than 4.3 million pregnancies and determine whether stimulant medications increased the risk of birth defects. Researchers discovered that, while the overall risk is low, first-trimester ADHD exposure to medication was associated with slightly higher risk of specific heart defects such as ventriculoseptal defect.
The researchers behind the study found no link between early medication use and other congenital anomalies, like facial clefting, or club foot. The results are in line with previous studies that have shown an increase, but not significant, in the risk of cardiac malformations among women who began taking ADHD medications prior to the birth of their child. This risk increased during the latter half of pregnancy when a large number of women stopped taking their medication.
Women who were taking ADHD medication during the first trimester were more likely to need a caesarean, have a low Apgar after delivery, and have a baby who needed breathing assistance at birth. The researchers of the study were unable to remove bias in selection since they restricted the study to women with no other medical conditions that could have contributed to the findings.
The researchers hope that their research will aid in the clinical decisions of doctors who see pregnant women. The researchers advise that while discussing the risks and benefits are crucial, the decision on whether to continue or stop medication should be according to the severity of each woman's ADHD symptoms and the needs of the woman.
The authors also caution that while discontinuing the medications is an alternative, it is not an option that is recommended due to the high prevalence of depression and other mental health issues for women who are expecting or recently post-partum. Further, the research suggests that women who decide to stop taking their medications are more likely to have difficulties adapting to life without them following the birth of their baby.
Nursing
The responsibilities that come with being a new mom can be overwhelming. Women who suffer from ADHD who have to deal with their symptoms while attending physician appointments and getting ready for the arrival of a child and getting used to new routines at home are often faced with a number of difficulties. This is why many women elect to continue taking their ADHD medications throughout pregnancy.
The risk for breastfeeding infant is not too high since the majority of stimulant medications passes through breast milk at low levels. The rate of exposure to medication can vary depending upon the dosage and frequency of administration as well as the time of the day. Additionally, individual medications enter the infant's system differently through the gastrointestinal tract and breast milk, and the effect of this on a newborn is not fully understood.
Because of the lack of research, some physicians may recommend stopping stimulant drugs during the pregnancy of a woman. This is a difficult choice for the patient, who must balance the benefits of continuing her medication against the possible dangers to the foetus. Until more information becomes available, doctors can ask pregnant patients whether they have a history of ADHD or if they plan to take medication during the perinatal phase.
Numerous studies have demonstrated that women can continue to take their ADHD medication in a safe manner during pregnancy and while breast-feeding. In response, a rising number of patients are choosing to continue their medication. They have concluded through consultation with their physicians, that the benefits of retaining their current medication far outweigh any possible risks.
It is crucial for women suffering from ADHD who are contemplating breastfeeding to seek a specialist psychiatrist's advice prior becoming pregnant. They should discuss their medication with their prescriber and discuss the advantages and disadvantages of continuing treatment, including non-pharmacological strategies. Psychoeducation is also required to help women with ADHD understand their symptoms and the root cause, learn about available treatments and to reinforce existing strategies for managing. This should involve a multidisciplinary approach with the GP doctors, obstetricians and psychiatrists. Pregnancy counseling should include a discussion of a treatment plan for the mother and the child, as well as monitoring for signs of deterioration, and, if needed modifications to the medication regime.