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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 aren't many studies regarding how exposure over time may affect a foetus.

A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication during utero do not develop neurological disorders such as impaired vision or hearing seizures, febrile seizures, or IQ impairment. The authors acknowledge that more high quality studies are required.

Risk/Benefit Analysis

Pregnant women who use ADHD medications need to balance the advantages of taking them against the potential risks to the foetus. Physicians don't have the information needed to provide clear recommendations however they can provide information on risks and benefits that assist pregnant women in making informed choices.

A study published in Molecular Psychiatry concluded that women who took ADHD medication during their 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 major structural defects in infants born to mothers who took stimulants during pregnancy. Clinical geneticists and pediatric cardiologists reviewed the cases to ensure correct case classification and to minimize the chance of bias.

However, the study had its limitations. Most important, they were unable to distinguish the effects of the medication from the underlying disorder. That limitation makes it difficult to know whether the small differences observed in the exposed groups are due to medication use or confounding by comorbidities. Additionally the researchers did not examine the long-term effects of offspring on their parents.

The study did show that infants whose mothers took ADHD medication during pregnancy were at a slightly greater risk of being admitted to the neonatal intensive care unit (NICU) than those whose mothers had not taken any medication or had taken off their medication prior to or during pregnancy. The reason for this was central nervous system-related disorders, and the increased risk for admission was not found to be influenced by the stimulant medications were taken during pregnancy.

Women who took stimulant ADHD medications during pregnancy also had a higher risk of having to have an emergency caesarean section or having one whose baby scored low on the Apgar scale (less than 7). These risks did not appear to be affected by the type of medication that was used during pregnancy.

Researchers suggest that the minor risks associated with the use ADHD medications in early pregnancies can be offset by greater benefits to both mother and baby from continuing treatment for the woman’s disorder. Physicians should talk to their patients about this issue and, if possible, help them improve coping skills which may reduce the impact of her disorder in her daily functioning and her relationships.

Medication Interactions

Many doctors are confronted with the dilemma of whether to maintain treatment or stop as more women are diagnosed with ADHD. The majority of these decisions are made without any evidence that is clear and definitive in either case, which means that doctors must weigh what they know about their experiences, the experiences of other doctors, and what the research says on the topic as well as their best judgment for each individual patient.

The issue of risk to the infant can be particularly tricky. The research on this issue is based on observations rather than controlled studies and a lot of the results are in conflict. In addition, most studies limit their analysis to live births, which may underestimate severe teratogenic effects that cause abortion or termination types of adhd medication the pregnancy. The study presented in this journal club addresses these shortcomings by looking at data from both live and deceased births.

Conclusion A few studies have revealed a positive correlation between ADHD medications and certain birth defects However, other studies haven't shown such a relationship. Most studies show an unintended, or slightly negative, impact. In the end an accurate risk-benefit analysis must be done in each instance.

It can be difficult, if not impossible, for women suffering from safest adhd medication for adults to stop taking their medication. In a recent article 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 being isolated. Furthermore, a loss of medication may affect the ability to complete jobs and drive safely which are essential aspects of a normal life for many people suffering from ADHD.

She recommends women who are unsure about whether to continue or stop taking medication because 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. It can also help a woman feel more confident in her decision. Certain medications can pass through the placenta. If a woman decides not to take her ADHD medication while pregnant and breastfeeding, it is important to be aware that the drug could be passed on to her infant.

Birth Defects and Risk of

As the use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) grows there are concerns over the impact that these drugs might have on the fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge regarding this topic. Researchers used two huge data sets to study over 4.3 million pregnant women and determine whether stimulant medications increased the risk of birth defects. Researchers discovered that, while the overall risk is low, the first trimester ADHD medication use was associated with slightly higher risk of certain heart defects, like ventriculoseptal defect.

The authors of the study found no link 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 an increase, but not significant, in the risk of developing cardiac malformations among women who began taking ADHD medications before the time of pregnancy. The risk increased in the latter half of pregnancy when many women began to stop 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 birth and have a baby that needed breathing assistance when they were born. The authors of the study were not able to eliminate bias due to selection because they limited their study to women with no other medical conditions that might have contributed to the findings.

The researchers hope that their research will serve to inform the clinical decisions of physicians who treat pregnant women. They recommend that, while the discussion of the benefits and risks is important but the decision to stop or continue treatment must be based on each woman's needs and the severity of her ADHD symptoms.

The authors also caution that, while stopping the medication is an alternative, it is not a recommended practice because of the high prevalence of depression and other mental health problems among women who are pregnant or postpartum. Further, the research suggests that women who decide to stop taking their medications are more likely to have a difficult time adjusting to life without them after the baby's arrival.

Nursing

The responsibilities of being a new mother can be overwhelming. Women with ADHD are often faced with a number of difficulties when they have to manage their symptoms, attend doctor appointments and prepare for the birth of a child and adjust to a new routine. Many women decide to continue taking their ADHD medication during pregnancy.

The risk to breastfeeding infant is not too high since the majority of stimulant medication is absorbed through breast milk at low levels. The amount of exposure to medications can vary depending upon the dosage the medication is administered, its frequency and the time of the day. Additionally, individual medications enter the body of the baby differently through the gastrointestinal tract as well as breast milk, and the effect of this on a newborn isn't fully known.

Due to the absence of research, some physicians might be tempted to stop taking stimulant drugs during a woman's pregnancy. It's a difficult choice for the woman who must weigh the advantages of taking her medication as well as the risk to the fetus. Until more information becomes available, GPs can inquire about pregnant patients if they have an background of ADHD or if they are planning to take medication during the perinatal stage.

A growing number of studies have shown that most women can safely continue their ADHD medication while they are pregnant and nursing. In response, an increasing number of patients are opting to do this. They have concluded through consultation with their doctors, that the benefits of continuing their current medication outweigh any potential risks.

It's important for women with ADHD who are thinking of breastfeeding to seek out a specialist psychiatrist's advice prior to becoming pregnant. They should discuss the medication they are taking with their physician, and the pros and cons for continuing treatment. This includes non-pharmacological strategies. Psychoeducation is also required to help pregnant women suffering from ADHD recognize the signs and the underlying disorder. They should also learn about treatment options and build the coping mechanisms. This should be a multidisciplinary approach together with obstetricians, GPs and psychiatry. Pregnancy counseling should include a discussion of a treatment plan for the mother and child, monitoring of indicators of deterioration, and, if needed modifications to the medication regimen.