ADHD Medication During Pregnancy and Breastfeeding
The decision to stop or keep ADHD medication during pregnancy and breastfeeding is a challenge for women suffering from the condition. There are few data on how exposure to ADHD for a long time could affect a pregnant fetus.
A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication in utero do not develop neurological conditions like hearing or vision impairment seizures, febrile seizures or IQ impairment. The authors acknowledge that more high-quality studies are needed.
Risk/Benefit Analysis
Women who are pregnant and taking ADHD medications need to balance the advantages of taking them against potential risks to the foetus. Physicians don't have the data to provide clear recommendations but they can provide information on risks and benefits to help pregnant women make informed decisions.
A study published in Molecular Psychiatry concluded that women who took ADHD medication in early pregnancy did not have a greater risk of fetal malformations or structural birth defects. Researchers conducted a massive population-based case control study to assess the frequency of structural defects that were major in infants who were born to mothers who were taking stimulants during pregnancy. Pediatric cardiologists, clinical geneticists and other experts examined the cases to make sure that the classification was accurate and to eliminate any bias.
However, the study had its limitations. In particular, they were not able to differentiate the effects of the medication from the disorder at hand. This limitation makes it difficult to know whether the limited associations observed in the exposed groups result from medication use or the confounding effect of comorbidities. Additionally, the researchers did not study the long-term outcomes of offspring.
The study revealed that babies whose mothers had taken ADHD medication during pregnancy had a higher risk of admission to the neonatal care unit (NICU) in comparison to mothers who did not take any medication during pregnancy or had quit taking the medication prior to or during pregnancy. The reason for this was central nervous system disorders, and the increased risk for admission did not appear to be influenced by the stimulant medications were taken during pregnancy.
Women who took stimulant ADHD medication during pregnancy were also at an elevated chance of having a caesarean birth or having a baby with low Apgar score (less than 7). These increases did appear to be independent of the type of medication taken during pregnancy.
The research suggests that the low risk associated with the use of ADHD medications during early pregnancy may be offset by the greater benefits for both mother and child of continued treatment for the woman's disorder. Physicians should discuss this with their patients and, where possible, help them develop strategies for improving their coping skills that can lessen the negative impact of her condition on her daily functioning and relationships.
Medication Interactions
Many doctors are confronted with the dilemma of whether to keep treatment or stop it during pregnancy as more women are diagnosed with ADHD. These decisions are usually made without clear and authoritative evidence. Instead, doctors have to take into account their own experience and experience, as well as the experiences of other doctors and the research that has been conducted on the subject.
In particular, the issue of potential risks to the infant can be difficult. Many studies on this subject are based on observational data rather than controlled research and their conclusions are often contradictory. Most studies restrict their analysis to live births, which may underestimate the severity of teratogenic effects leading to terminations or abortions of pregnancy. The study that is discussed in the journal club addresses these issues by analyzing the data from deceased and live births.
Conclusion: While some studies have found an association between ADHD medications and certain birth defects however, other studies haven't found a correlation. Most studies have shown an unintended, or somewhat negative, effect. In the end, a careful risk/benefit assessment is required in every situation.
For women suffering from ADHD and ADD, the decision to discontinue medication is difficult if not impossible. 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 increase depression and feelings of being isolated. Furthermore, a loss of medication may affect the ability to do jobs and drive safely which are essential aspects of a normal life for many people suffering from ADHD.
She suggests that women who are unsure whether to continue taking medication or stop due to pregnancy, educate their family members, coworkers, and acquaintances about the condition, its impact on daily functioning and the benefits of continuing the current treatment. Educating them can also help the woman feel supported when she is struggling with her decision. Certain medications can pass through the placenta. If a woman decides to not take her ADHD medication while breastfeeding, it is important to be aware that the drug could be passed on to her infant.
Birth Defects Risk
As the use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases there are concerns over the impact that these drugs could have on foetuses. A recent study published in the journal Molecular Psychiatry adds to the existing knowledge about this subject. Researchers used two huge data sets to study more than 4.3 million pregnant women and determine whether stimulant medications increased birth defects. Researchers discovered that, while the overall risk is low, the first trimester ADHD medication exposure was associated with slightly higher risk of specific heart defects such as ventriculoseptal defect.
The researchers of the study didn't find any association between early use of medication and other congenital anomalies, such as facial deformities or club feet. medication for adhd Iam Psychiatry are in line 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. The risk was higher in the latter half of pregnancy, when a lot of women begin to discontinue their medication.
Women who were taking ADHD medication during the first trimester were more likely require a caesarean delivery or have an insufficient Apgar after delivery and have a baby that needed breathing assistance when they were born. The authors of the study were not able 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 encounter pregnant women. They advise that while a discussion of risks and benefits is important but the decision to stop or keep treatment should be based on each woman's needs and the severity of her ADHD symptoms.
The authors also warn that, while stopping the medication is an option, it isn't a recommended practice because of the high prevalence of depression and other mental health problems for women who are expecting or recently post-partum. Research has also shown that women who stop taking their medications will have a tough time adjusting to a life without them after the baby is born.
Nursing
The responsibilities of being a new mom can be overwhelming. Women who suffer from ADHD who have to deal with their symptoms while attending doctor appointments as well as making preparations for the arrival of a baby and getting used to new routines at home may face a lot of challenges. Many women decide to continue taking their ADHD medication during pregnancy.
The majority of stimulant drugs pass through breast milk in low quantities, so the risk to breastfeeding infant is minimal. However, the rate of exposure to medications by the newborn may differ based on the dosage, frequency it is taken and the time of the day it is administered. In addition, different medications are introduced into the baby's system through the gastrointestinal tract or through breast milk. The effect on a newborn's health is not fully understood.
Some doctors may stop taking stimulant medication during a woman’s pregnancy due to the absence of research. This is a difficult decision for the patient, who must weigh the benefit of continuing her medication against the possible dangers to the fetus. Until more information is available, GPs should ask all pregnant patients about their experience with ADHD and whether they plan or are taking to take medication during the perinatal period.
A growing number of studies have shown that the majority of women are able to safely continue to take their ADHD medication during pregnancy and while breastfeeding. In response, a rising number of patients are choosing to do so. They have discovered after consulting with their doctor that the benefits of keeping their current medication far outweigh any possible risks.
Women who suffer from ADHD who are planning to breastfeed should seek advice from an expert psychiatrist prior to becoming pregnant. They should discuss their medication with their prescriber as well as the pros and cons of continuing treatment. This includes non-pharmacological methods. Psychoeducation is also required to help women with ADHD understand their symptoms and the underlying disorder Learn about the available treatments and to reinforce existing strategies for managing. This should include an approach that is multidisciplinary, including the GP, obstetricians and psychiatry. The pregnancy counselling should consist of the discussion of a plan for management for both the mother and child, as well as monitoring for signs of deterioration and the need for adjustments to the medication regimen.