ADHD Medication During Pregnancy and Breastfeeding
The choice of whether to stop or continue ADHD medication during pregnancy and breastfeeding is challenging for women with the condition. There is a lack of information about how long-term exposure to these medications could affect the fetus.
A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus do not develop neurological developmental disorders such as hearing loss or impaired vision seizures, febrile seizures or IQ impairment. The authors acknowledge the need for more high-quality research.
Risk/Benefit Analysis
Women who are expecting and taking ADHD medication should evaluate the benefits of using it against the possible risks to the foetus. Physicians don't have the necessary data to give clear guidelines but they can provide information regarding the risks and benefits to aid pregnant women in making informed choices.
A study published in Molecular Psychiatry concluded that women who were taking ADHD medication in early pregnancy did not have a higher risk of fetal malformations, or structural birth defects. Researchers used a vast, population-based case-control study to determine the prevalence of major structural birth defects in babies born to mothers who had taken stimulants during the early stages of pregnancy, and those who did not. Clinical geneticists, pediatric cardiologists and other experts looked over the cases to ensure that the classification was accurate and to minimize any bias.
However, the study was not without its flaws. Most important, they were unable to separate the effects of the medication from the effects of the disorder that is underlying. This limitation makes it difficult for researchers to establish whether the few associations observed between the exposed groups were due to medication use, or if they were caused by comorbidities. In addition the study did not look at the long-term outcomes of offspring.
The study did reveal that babies whose mothers had taken ADHD medications during pregnancy were at a more risk of being admitted to the neonatal intensive care unit (NICU) than those who whose mothers did not take any medication or had stopped their medications before or during pregnancy. medication for adhd adults for this was central nervous system disorders. The higher risk of admission was not affected by the stimulant medication used during pregnancy.
Women who took stimulant ADHD medication during pregnancy were also at an increased risk of having a caesarean delivery or having a baby with a low Apgar score (less than 7). These increases appear to be independent of the type of medication used during pregnancy.
The research suggests that the risk of a small amount with the use of ADHD medications during the early stages of pregnancy could be offset by the higher benefit to both the mother and child from continued treatment for the woman's condition. Physicians should discuss this with their patients and, when possible, help them develop strategies for improving their coping skills that may minimize the effects of her disorder on her daily life and relationships.
Interactions with Medication
Doctors are increasingly faced with the decision of whether to maintain treatment or stop during pregnancy as more women are diagnosed with ADHD. These decisions are usually made without clear and authoritative evidence. Instead, doctors must consider their own expertise in conjunction with the experiences of other doctors, and the research on the topic.
The issue of potential risks for infants can be particularly tricky. Many studies on this topic are based on observations rather than controlled research, and their findings are often contradictory. Additionally, the majority of studies limit their analysis to live births, which may underestimate the severity of teratogenic effects that could cause abortion or termination of the pregnancy. The study that is discussed in this journal club addresses these limitations by looking at data from both live and deceased births.
The conclusion is that while some studies have found that there is a positive correlation between ADHD medications and the risk of certain birth defects, others have found no connection, and most studies have a neutral or slightly negative effect. In the end, a careful risk/benefit analysis is required in every situation.
For a lot of women with ADHD and ADD, the decision to stop taking medication is difficult if not impossible. In fact, in an article recently published 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 patients with ADHD. Furthermore, a loss of medication can affect the ability to do work-related tasks and safely drive which are essential aspects of daily life for many people with ADHD.
She recommends women who are unsure about whether to keep or discontinue medication due to their pregnancy should consider educating family members, friends, and coworkers on the condition, its effects on daily functioning, and on the advantages of staying on the current treatment plan. In addition, educating them can make the woman feel more comfortable in her struggle with her decision. It is also worth noting that some medications are able to be absorbed through the placenta so if a woman decides to discontinue her ADHD medication during pregnancy and breastfeeding, she must be aware that the effects of the drug can be transferred to the infant.
Risk of Birth Defects
As the use of ADHD medication to treat the symptoms of attention deficit hyperactivity disorder (ADHD) grows, so 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 knowledge on this subject. Researchers used two massive datasets to analyze over 4.3 million pregnant women and determine if the use of stimulant medications caused birth defects. While the overall risk is low, the researchers discovered that the first-trimester exposure to ADHD medications was linked to a slightly higher rate of specific heart defects, like ventriculo-septal defects (VSD).
The authors of the study found no link between early use of medication and other congenital abnormalities, like facial clefting, or club foot. The results are in agreement with previous studies which showed an insignificant, but small increase in the number of cardiac malformations among women who began taking ADHD medication prior to the time of pregnancy. The risk increased in the latter part of pregnancy when many women decided to stop taking their medication.
Women who took ADHD medications during the first trimester of their pregnancy were also more likely to undergo caesarean section, low Apgar score following delivery, and a baby who required help breathing at birth. However the authors of the study were unable to eliminate selection bias by limiting the study to women who didn't have other medical issues that could have contributed to these findings.
Researchers hope that their research will help doctors when they see pregnant women. The researchers recommend that, while discussing benefits and risks are important, the decision about whether to continue or stop medication should be made according to the severity of each woman's ADHD symptoms and the needs of the woman.
The authors also advise that even though stopping the medication is an option, it is not a recommended practice because of the high incidence of depression and other mental health issues for women who are expecting or post-partum. Additionally, the research suggests that women who decide to stop their medications are more likely to have a difficult time adapting to life without them following the birth of their baby.
Nursing
The responsibilities of being a new mom can be overwhelming. Women with ADHD who have to manage their symptoms while attending doctor appointments as well as getting ready for the arrival of a baby and getting used to new routines at home can experience severe challenges. Many women decide to continue taking their ADHD medication during pregnancy.
The majority of stimulant medicines are absorbed by breast milk in very small quantities, so the risk to the breastfeeding infant is minimal. The rate of medication exposure will differ based on dosage the medication is administered, its frequency and time of day. Additionally, individual medications enter the infant's system differently through the gastrointestinal tract and breast milk and the impact of this on a newborn is not well known.
Due to the absence of research, some physicians might be tempted to stop taking stimulant medication during the course of pregnancy. This is a difficult choice for the patient, who must weigh the benefits of continuing her medication against the possible risks to the fetus. Until more information is available, doctors should inquire with all pregnant patients about their experience with ADHD and if they are planning or taking to take medication during the perinatal period.
Numerous studies have demonstrated that women can continue taking their ADHD medication without risk during pregnancy and breast-feeding. In the end, more and more patients are choosing to do so, and after consulting with their doctor, they have found that the benefits of maintaining their current medication far outweigh any potential risks.
Women with ADHD who plan to breastfeed should seek advice from a specialist psychiatrist before becoming pregnant. They should review their medications with their doctor and discuss the advantages and disadvantages of continued treatment, including non-pharmacological strategies. Psychoeducation is also required to help pregnant women suffering from ADHD recognize their symptoms and the underlying disorder and learn about treatments and to reinforce existing strategies for coping. This should be a multidisciplinary approach with the GPs, obstetricians and psychiatrists. Pregnancy counseling should include a discussion of a treatment plan for the mother as well as the child, and monitoring for indicators of deterioration, and, if necessary modifications to the medication regimen.