ADHD Medication During Pregnancy and Breastfeeding
The decision to stop or continue ADHD medications during breastfeeding and pregnancy is a difficult decision for women suffering from the condition. There aren't many studies on how long-term exposure may affect a fetus.
A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication during utero do not develop neurological developmental disorders like hearing or vision impairment seizures, febrile seizures or IQ impairment. The authors acknowledge the need for higher-quality studies.
Risk/Benefit Analysis
Pregnant women who use ADHD medications need to balance the advantages of using them against the risks to the fetus. Doctors don't have enough data to provide clear recommendations, but can provide information about risks and benefits to assist pregnant women to make informed decisions.
A study published in Molecular Psychiatry concluded that women who took ADHD medication in early pregnancy were not at a greater risk of fetal malformations or structural birth defects. Researchers used a large sample-based case control study to assess the frequency of structural defects that were major in infants who were born to mothers who used stimulants during pregnancy. Clinical geneticists and pediatric cardiologists reviewed the cases to ensure accurate case classification and to minimize the possibility of bias.
However, the researchers' study was not without its flaws. The researchers were not able, in the first place to differentiate the effects caused by the medication from the disorder. This makes it difficult for researchers to establish whether the small associations observed among the groups exposed were due to the use of medications or affected by comorbidities. Researchers also did not examine the long-term effects for the offspring.
The study did show that infants whose mothers took ADHD medications during pregnancy were at slightly more risk of being admitted to the neonatal intensive care unit (NICU) than infants who were born without any medication or cut back on their medications prior to or during pregnancy. The reason for this was central nervous system-related disorders, and the increased risk of admission was not found to be influenced by which stimulant medication was used during pregnancy.
Women who were taking stimulant ADHD medications during pregnancy also had a higher risk 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 kind of medication used during pregnancy.
The research suggests that the low risk associated with the use of ADHD medications during the early stages of pregnancy may be offset by the greater benefits to both mother and child of continued treatment for the woman's condition. Physicians should discuss this with their patients and, where they are able, assist them in developing strategies to improve coping skills which can reduce the negative impact of her condition on her daily life and relationships.
Medication Interactions
More and more doctors are confronted with the dilemma of whether to maintain treatment or stop as more women are diagnosed with ADHD. Most of the time, these decisions are made in the absence of any evidence that is clear and definitive in either case, which means that doctors must weigh what they know, the experiences of other doctors, and what the research says on the topic and their own best judgment for each individual patient.
Particularly, the issue of potential risks to the infant can be difficult. Many of the studies on this issue are based on observational evidence rather than controlled research, and their conclusions are often contradictory. In addition, most studies limit their analysis to live births, which may undervalue the serious teratogenic effects that can cause abortion or termination of the pregnancy. The study presented in this journal club addresses these shortcomings 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 connection and the majority of studies have a neutral or slight negative effect. In all cases it is imperative to conduct a thorough study of the risks and benefits is required.
For a lot of women with ADHD who suffer from ADHD, the decision to stop medication can be difficult, if not impossible. In adhd medication adults www.iampsychiatry.uk 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 loneliness. Furthermore, a loss of medication may affect the ability to do work-related tasks and safely drive that are crucial aspects of a normal life for a lot of people with ADHD.
She suggests women who are unsure about whether to keep or stop taking medication because of their pregnancy consider informing family members, friends, and coworkers on the condition, its impact on daily life, and the advantages of staying on the current treatment regimen. It can also help the woman feel supported when she is struggling with her decision. Certain medications can pass through the placenta. If the patient decides to stop taking her ADHD medication while pregnant and breastfeeding, it is important to be aware that the drug could be transferred to the infant.
Birth Defects and Risk of
As the use and use of ADHD drugs to treat symptoms of attention deficit disorder hyperactivity disorder (ADHD) is increasing as does the concern about the potential adverse effects of the drugs on foetuses. A recent study published in the journal Molecular Psychiatry adds to the body of knowledge on this subject. Utilizing two huge data sets, researchers were able to examine more than 4.3 million pregnancies and determine whether stimulant medication use increased the risk of birth defects. Although the risk overall remains low, the scientists found that exposure in the first trimester to ADHD medicines was associated with a slightly higher rate of certain heart defects such as ventriculo-septal defect (VSD).
The researchers of the study could not discover any connection between early medication usage and other congenital anomalies such as facial deformities or club feet. The results are in agreement with previous studies which showed a small, but significant increase in cardiac malformations for women who started taking ADHD medication prior to the time of the birth of their child. This risk increased during the latter stages of pregnancy when many women stopped taking their medication.
Women who were taking ADHD medication in the first trimester were more likely require a caesarean birth, have an insufficient Apgar after delivery and have a baby who needed help breathing after 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.
Researchers hope that their research will inform physicians when they meet pregnant women. They recommend that, while the discussion of the benefits and risks is important, the decision to stop or maintain treatment should be based on the woman's needs and the severity of her ADHD symptoms.
The authors warn that, while stopping the medication is a possibility to consider, it is not recommended because of the high incidence of depression and other mental disorders for women who are pregnant or recently gave birth. Additionally, the research suggests that women who choose to stop their medications are more likely to have a difficult time getting used to life without them following the birth of their baby.
Nursing
It can be a challenge to become a mother. Women suffering from ADHD can face severe challenges when they must deal with their symptoms, attend doctor appointments and prepare for the birth of a child and adjust to new routines. This is why many women elect to continue taking their ADHD medications throughout the course of pregnancy.
The majority of stimulant medications are absorbed through breast milk in low amounts, therefore the risk to the nursing infant is very low. However, the rate of exposure to medications by the infant can differ based on the dosage, frequency it is taken and the time of day the medication is administered. Additionally, different drugs enter the infant's system via the gastrointestinal tract or breast milk. The effect on the health of a newborn isn't fully comprehended.
Some doctors may stop taking stimulant medication during a woman's pregnancy due to the lack of research. It's a difficult choice for the mother, who must weigh the benefits of taking her medication as well as the risks to the embryo. As long as there is no more information, doctors should inquire with all pregnant patients about their experience with ADHD and whether they are taking or planning to take medication during the perinatal period.
Numerous studies have proven that women can continue taking their ADHD medication without risk during pregnancy and while breast-feeding. In response, an increasing number of patients are choosing to continue their medication. They have concluded, in consultation with their physicians, that the benefits of keeping their current medication outweigh possible risks.
Women with ADHD who plan to breastfeed should seek advice from a specialist psychiatrist prior to becoming pregnant. They should review their medications with their prescriber and discuss the advantages and disadvantages of continuing treatment, including non-pharmacological management strategies. Psychoeducation is also necessary to help pregnant women with ADHD understand the symptoms and underlying disorder. They should also be educated about treatment options and strengthen strategies for coping. This should include a multidisciplinary approach, which includes the GP, obstetricians and psychiatry. Pregnancy counseling should include discussion of a treatment plan for the mother as well as the child, monitoring of signs of deterioration, and, if needed, adjustments to the medication regimen.