ADHD Medication During Pregnancy and Breastfeeding
Women with ADHD must make a difficult decision regarding whether or not to stop taking ADHD medication during pregnancy and breastfeeding. There aren't enough data on how long-term exposure may affect the foetus.
A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological problems like hearing loss or vision, febrile seizures or IQ impairment. The authors acknowledge the need for higher-quality research.
Risk/Benefit Analysis
Women who are pregnant and taking ADHD medication need to weigh the benefits of taking it against the possible risks to the foetus. Doctors don't have the information needed to give clear guidelines however they can provide information regarding the risks and benefits to aid pregnant women in making informed decisions.
A study published in Molecular Psychiatry found that women who took ADHD medications in early pregnancy did not have an increased risk of fetal heart malformations or major birth defects that are structural. 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. Pediatric cardiologists and clinical geneticists examined the cases to ensure correct case classification and to minimize the chance of bias.
However, the study had its limitations. The researchers were not able, in the first place to distinguish the effects of the medication from the disorder. This makes it difficult to determine whether the small associations observed in the exposed groups result from medication use or comorbidities that cause confusion. In addition the study did not look at the long-term effects of offspring on their parents.
The study did find that infants whose mothers took ADHD medications during pregnancy were at a higher risk of being admitted to the neonatal intensive care unit (NICU) than those whose mothers had not taken any medication or had stopped their medications before or during pregnancy. This increase was due to central nervous system-related disorders and the increased risk for admission did not appear to be affected by the type of stimulant medications were taken during pregnancy.
Women who were taking stimulant ADHD medications during pregnancy also had a higher risk of having a caesarean section or one whose baby scored low on the Apgar scale (less than 7). These risks did not seem to be influenced by the type of medication that was used during pregnancy.
Researchers suggest that the small risks associated with the use ADHD medications in early pregnancies may be offset by the greater benefits for mother and baby from continuing treatment for the woman's condition. Physicians should talk to their patients about this and try to help them develop coping skills that could reduce the effects of her disorder on her daily functioning and her relationships.
Interactions with Medication
More and more doctors are confronted with the dilemma of whether to keep treatment or stop as more women are diagnosed with ADHD. Often, these decisions are taken in the absence of solid and reliable evidence regardless, so doctors must weigh what they know, the experiences of other doctors, and what the research says on the topic, along with their own best judgment for each patient.
The issue of potential risks for infants can be difficult to determine. Many of the studies on this topic are based on observations instead of controlled research and their conclusions are often contradictory. Furthermore, most studies restrict their analysis to live births, which could underestimate severe teratogenic effects that lead to abortion or termination of the pregnancy. The study presented in the journal club addresses these limitations, by examining both data on live and deceased births.
The conclusion The conclusion: While certain studies have demonstrated that there is a positive correlation between ADHD medications and the risk of certain birth defects, others have not found any evidence of a link, and most studies show a neutral or even slightly negative effect. In each case, a careful study of the risks and benefits is required.
For a lot of women with ADHD, the decision to discontinue medication can be 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. In addition, a decrease in medication can affect the ability to do work-related tasks and safely drive that are crucial aspects of a normal life for many people with ADHD.
She suggests that women who aren't sure whether to continue taking medication or discontinue it due to pregnancy, educate their family members, coworkers, and friends about the condition, the impact on daily functioning and the benefits of continuing the current treatment plan. In addition, educating them can make the woman feel more comfortable in her struggle with her decision. It is important to note that certain drugs can pass through the placenta so if the patient decides to stop her ADHD medication during pregnancy and breastfeeding, she should be aware that traces of the drug could be transferred to the infant.
Birth Defects Risk
As the use and abuse of ADHD drugs to treat symptoms of attention deficit disorder hyperactivity disorder (ADHD) is increasing the concern over the potential effects of these drugs on the fetuses. A recent study published in the journal Molecular Psychiatry adds to the body of knowledge about this subject. With two massive data sets researchers were able to look at more than 4.3 million pregnancies and see whether stimulant medications increased the risk of birth defects. Researchers found that while the overall risk is low, the first trimester ADHD medication exposure was associated with slightly higher risk of specific heart defects like ventriculoseptal defect.
The authors of the study found no association between early medication use and other congenital abnormalities, such as facial clefting or club foot. The results are in the same vein as previous studies that showed the existence of a slight, but significant increase in cardiac malformations for women who began taking ADHD medication before the time of pregnancy. The risk grew in the later part of pregnancy, as many women decide to stop taking their ADHD medications.
Women who were taking ADHD medication during the first trimester were more likely need a caesarean or have a low Apgar after birth and had a baby that required help breathing when they were born. However the researchers of the study were not able to eliminate bias due to selection by restricting the study to women who did not have other medical issues 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 recommend that, while discussing risks and benefits are crucial, the decision on whether to continue or stop medication should be based on the severity of each woman's ADHD symptoms and her needs.
The authors also warn that even though stopping the medication is an option, it is not an option that is recommended due to the high incidence of depression and other mental health issues for women who are expecting or who are recently postpartum. Research has also shown that women who stop taking their medication will have a difficult adjustment to life without them after the baby is born.
Nursing
It can be a stressful experience becoming a mother. Women who suffer from ADHD who must work through their symptoms while attending physician appointments, preparing for the arrival of a child and adjusting to new household routines are often faced with a number of difficulties. This is why many women decide to continue taking their ADHD medications throughout the course of pregnancy.
The risk to a nursing infant is low because the majority of stimulant medications passes through breast milk in low amounts. The rate of exposure to medication will vary based on the dosage the medication is administered, its frequency and the time of the day. In addition, 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 well known.
Some doctors may decide to stop stimulant medications during a woman's pregnancy due to the absence of research. It is a difficult decision for the woman who must weigh the benefits of her medication against the risk to the foetus. As long as more information is available, doctors may ask pregnant patients whether they have any background of ADHD or if they plan to take medication during the perinatal phase.
Many studies have shown that women can continue taking their ADHD medication safely while breastfeeding and during pregnancy. As a result, an increasing number of patients are choosing to do so and in consultation with their doctor they have found that the benefits of continuing their current medication far outweigh any potential risks.
Women with ADHD who are planning to more info breastfeed should seek advice from a specialist psychiatrist before becoming pregnant. They should review their medications with their prescriber and discuss the advantages and disadvantages of continuing treatment, including non-pharmacological strategies. Psychoeducation is also needed to help pregnant women suffering from ADHD understand the symptoms and underlying disorder. They should also be informed about treatment options and strengthen strategies for coping. This should include an approach that is multidisciplinary, including the GP, obstetricians and psychiatry. Counselling for pregnancy should include the discussion of a treatment plan for both mother and child, as well as monitoring for signs of deterioration, and the need for adjustments to the medication regimen.