ADHD Medication During Pregnancy and Breastfeeding

Women with ADHD face a difficult decision about whether to continue or stop taking ADHD medication during pregnancy and breastfeeding. There is a lack of information about how long-term exposure to these drugs could affect the foetus.

A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological disorders such as hearing loss or vision, febrile seizures, or IQ impairment. The authors acknowledge the need for higher-quality studies.

Risk/Benefit Analysis

Women who are pregnant and taking ADHD medication should weigh the benefits of taking it against the possible risks to the baby. Physicians don't have the information needed to give clear guidelines however they can provide information about benefits and risks that can help pregnant women make informed decisions.

A study published in Molecular Psychiatry concluded that women who took ADHD medication during early pregnancy were not at higher risk of fetal malformations, or structural birth defects. Researchers conducted a large population-based case-control study to determine the prevalence of major structural birth defects in infants born to mothers who took stimulants during the early stages of pregnancy and those who had not. Pediatric cardiologists and clinical geneticists reviewed the cases to ensure accurate case classification and to limit the chance of bias.

However, the study had its limitations. Most important, they were not able to differentiate the effects of the medication from the disorder at hand. This limitation makes it difficult for researchers to establish whether the few associations observed between the groups exposed were due to the use of medication or caused by comorbidities. The researchers did not examine long-term outcomes for the offspring.

The study did reveal that infants whose mothers had taken ADHD medications during pregnancy were at slightly higher risk of being admitted to the neonatal intensive care unit (NICU) than those who whose mothers did not take any medication or cut back on their medications prior to or during pregnancy. This was due to central nervous system disorders. The higher risk of admission was not influenced by the stimulant medication that was used during pregnancy.

Women who used stimulant ADHD medication during pregnancy were also at an elevated chance of having a caesarean section or having a baby born with an low Apgar score (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 could be offset by the more beneficial outcomes for both 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 that can lessen 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 issue of whether to keep or end treatment during pregnancy is one that doctors are having to confront. Most of the time, these decisions are taken in the absence of clear and authoritative evidence regardless, so doctors must weigh what they know about their experiences, the experiences of other doctors, and what the research suggests about the subject and their own judgments for each patient.

The issue of risk to infants is difficult to determine. Many of the studies on this topic are based on observational evidence rather than controlled research, and their conclusions are often contradictory. Furthermore, most studies restrict their analysis to live births, which could undervalue the serious teratogenic effects that can result in abortion or termination of the pregnancy. The study presented in the journal club addresses these issues, by examining both the data from deceased and live births.

The conclusion: While some studies have found a positive association between ADHD medications and the risk of certain birth defects, other studies have not found any evidence of a link, and most studies show a neutral or even slightly negative impact. Therefore, a careful risk/benefit assessment must be conducted in every case.

For many women with ADHD, the decision to stop taking medication is difficult if not impossible. In a recent article in the Archives of Women's Mental Health, psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can lead to increased depression, feelings of loneliness and family conflict for those suffering from the disorder. Furthermore, a loss of medication can affect the ability to perform jobs and drive safely that are crucial aspects of a normal life for a lot of people with ADHD.

She recommends women who are unsure about whether to keep or stop medication in light of their pregnancy consider educating family members, friends and colleagues about the condition, its impact on daily functioning, and on the advantages of staying on the current treatment regimen. Educating them can also help the woman feel supported when she is struggling with her decision. It is important to remember that some medications can be absorbed through the placenta so if a woman decides to discontinue her ADHD medication during pregnancy and breastfeeding, she should be aware that the effects of the drug can be transferred to the child.

Birth Defects and Risk of

As the use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases as do concerns about what impact the drugs could have on the fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge regarding this issue. Utilizing two huge data sets researchers were able to look at more than 4.3 million pregnancies to determine whether stimulant medication use increased the risk of birth defects. Researchers discovered that although the overall risk is low, the first trimester ADHD medication use was associated with slightly higher rates of certain heart defects, like ventriculoseptal defects.

The researchers of the study found no association between the use of early medications and other congenital abnormalities, like facial clefting, or club foot. The findings are in line with previous studies showing a small but significant increase in the risk of cardiac malformations among women who began taking ADHD medications prior to the time of pregnancy. This risk increased during the latter half of pregnancy when many women began to stop taking their medication.

Women who were taking ADHD medication during the first trimester were more likely need a caesarean and also have an insufficient Apgar after birth and have a baby that needed help breathing at birth. The authors of the study were not able 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 that their research will help doctors when they see pregnant women. The researchers advise that while discussing risks and benefits are important, the decision regarding whether or not to stop medication should be in light of the severity of each woman's ADHD symptoms and her requirements.

The authors also caution that while discontinuing the medications is an alternative, it is not a recommended practice because of the high prevalence of depression and other mental health issues among women who are pregnant or who are recently postpartum. Research has also shown that women who stop taking their medication will have a difficult transitioning to life without them after the baby is born.

Nursing

It can be a challenge to become a mother. Women with ADHD who have to manage their symptoms while attending physician appointments, getting ready for the arrival of a baby and getting used to new routines at home are often faced with a number of difficulties. As such, many women elect to continue taking their ADHD medication throughout the pregnancy.

The majority of stimulant medicines are absorbed by breast milk in small amounts, so the risk for breastfeeding infant is minimal. However, the rate of medication exposure to the newborn may differ based on the dosage, frequency it is taken and the time of the day it is administered. Additionally, different medications enter the baby's system differently through the gastrointestinal tract and breast milk and the impact of this on a newborn is not well understood.

Because of the lack of research, some doctors may be inclined to discontinue stimulant medications during a woman's pregnancy. This is a difficult decision for the mother, who must weigh the benefits of taking her medication as well as the potential risks to the fetus. Until check here more information is available, GPs should ask all pregnant patients about their history of ADHD and whether they plan or are taking to take medication during the perinatal period.

Numerous studies have proven that women can continue taking their ADHD medication without risk during pregnancy and breast-feeding. This has led to an increasing number of patients choose to do so, and in consultation with their doctor they have discovered that the benefits of continuing their current medication far outweigh any risks.

Women who suffer from ADHD who are planning to nurse should seek advice from a specialist psychiatrist before becoming pregnant. They should discuss their medication with their prescriber and discuss the pros and cons of continued treatment, including non-pharmacological management strategies. Psychoeducation is also required to help pregnant women suffering from ADHD be aware of their symptoms and underlying disorder Learn about the available treatments and to reinforce existing coping strategies. This should involve an approach that is multidisciplinary, including the GP doctors, obstetricians and psychiatrists. Pregnancy counseling should include a discussion of a treatment plan for the mother as well as the child, monitoring of signs of deterioration, and, if necessary, adjustments to the medication regimen.