ADHD Medication Pregnancy 10 Things I'd Like To Have Known Earlier
ADHD Medication During Pregnancy and BreastfeedingThe choice of whether to stop or continue ADHD medication during breastfeeding and pregnancy is challenging for women with the condition. There is a lack of information about how long-term exposure to these medications may affect the foetus.
A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological issues such as impaired hearing or vision, febrile seizures or IQ impairment. The authors acknowledge that more high quality studies are needed.
Risk/Benefit Analysis
Pregnant women who use ADHD medications must weigh the benefits of using them against the risks to the fetus. Physicians don't have the data to make unambiguous recommendations however they can provide information on the risks and benefits to assist pregnant women to make informed decisions.
A study published in Molecular Psychiatry found that women who used ADHD medications during early pregnancy did not have an higher risk of fetal cardiac malformations or major structural birth defects. Researchers conducted a massive population-based study of case control to compare the incidence of structural defects that were major in infants who were born to mothers who took stimulants during pregnancy. Pediatric cardiologists, clinical geneticists and other experts examined the cases to make sure that the classification was correct and to eliminate any bias.
The study of the researchers was not without limitations. Most important, they were unable to separate the effects of the medication from the underlying disorder. This makes it difficult for researchers to determine whether the few associations observed between the groups exposed were due to the use of medications or if they were caused by comorbidities. The researchers did not study long-term outcomes for the offspring.
The study found that infants whose mother had taken ADHD medication during pregnancy had a higher risk of admission to the neonatal care unit (NICU) as compared to those whose mothers 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. The increased 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 delivery or having a baby born with an low Apgar score (less than 7). These increases didn't appear to be affected by the kind of medication 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 of continuing treatment for the woman's condition. Physicians should discuss the issue with their patients and, where possible, help them develop strategies to improve their coping abilities that may minimize the negative impact of her condition on her daily functioning and relationships.
Medication Interactions
More and more doctors are confronted with the dilemma of whether to continue treatment or stop it during pregnancy as more women are diagnosed with ADHD. These decisions are frequently taken without clear and authoritative evidence. Instead, doctors have to weigh their own knowledge, the experience of other physicians and the research on the topic.
The issue of possible risks to infants is difficult to determine. A lot of studies on this subject are based on observational data rather than controlled research, and their conclusions are often contradictory. In addition, most studies limit their analysis to live births, which may underestimate severe teratogenic effects that lead to abortion or termination of the pregnancy. The study discussed in the journal club addresses these issues by analyzing both information on deceased and live births.
Conclusion Some studies have found an association between ADHD medications and certain birth defects However, other studies haven't found a correlation. Most studies show a neutral, or even slightly negative, effect. In all cases, a careful evaluation of the risks and benefits should be conducted.
It isn't easy, but not impossible for women suffering from ADHD to stop taking their medication. In an article published in Archives of Women's Mental Health psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can cause depression, feelings of isolation, and family conflict for those suffering from the disorder. A decrease in medication could affect the ability to safely drive and perform work-related tasks, which are vital aspects of everyday life for those with ADHD.
She recommends that women who are unsure about whether to continue or stop medication in light of their pregnancy, consider educating family members, friends, and coworkers on the condition, its impact on daily functioning, and on the benefits of keeping the current treatment regimen. It can also help women feel supported in her decision. It is important to remember that certain drugs can pass through the placenta, therefore, if a patient decides to stop taking her ADHD medication during pregnancy and breastfeeding, she must be aware that traces of the drug could be transferred to the child.
Birth Defects and Risk of
As the use and abuse of ADHD drugs to treat symptoms of attention deficit disorder hyperactivity disorder (ADHD), increases, so does concern about the possible effects of the drugs on foetuses. A recent study published in the journal Molecular Psychiatry adds to the body of knowledge about this subject. Researchers used two huge data sets to examine more than 4.3 million pregnancy and determine whether stimulant medications increased the risk of birth defects. Although the risk overall is low, the researchers found that exposure in the first trimester to ADHD medicines was associated with an increased risk of certain heart defects like ventriculo-septal defects (VSD).
The authors of the study found no connection between early medication use and congenital abnormalities such as facial clefting or club foot. The results are in the same vein as previous studies that showed an insignificant, but small increase in the number of cardiac malformations among women who started taking ADHD medication prior to pregnancy. The risk was higher in the latter half of pregnancy, as many women are forced to stop taking their ADHD medications.
Women who used ADHD medications in the first trimester of their pregnancy were also more likely to have a caesarean section, a low Apgar score following delivery, and a baby that required breathing assistance during birth. However, the authors of the study were not able to eliminate bias due to selection by limiting the study to women who didn't have other medical issues that could be a contributing factor to these findings.
The researchers hope that their research will aid in the clinical decisions of physicians who see pregnant women. They recommend that, while the discussion of the risks and benefits is crucial but the decision to stop or maintain treatment must be based on each woman's requirements and the severity of her ADHD symptoms.
The authors warn that, while stopping the medication is a possibility to look into, it is not recommended due to the high prevalence of depression and mental health issues for women who are pregnant or who have recently given birth. Research has also shown that women who stop taking their medication will have a harder adjustment to life without them once the baby is born.
Nursing
The responsibilities that come with being a new mom can be overwhelming. Women who suffer from ADHD who have to deal with their symptoms while attending physician appointments and getting ready for the arrival of a child and adjusting to new household routines can experience severe challenges. Many women opt to continue taking their ADHD medication during pregnancy.
The majority of stimulant medications pass through breast milk in low amounts, therefore the risk to nursing infant is very low. The rate of medication exposure can vary depending upon the dosage, frequency of administration and the time of the day. In addition, various medications are introduced into the baby's system via the gastrointestinal tract, or through breast milk. The effect on the health of a newborn isn't fully understood.
Some read more doctors may decide to stop stimulant medications during a woman's pregnancy due to the lack of research. This is a difficult choice for the patient, who must weigh the benefit of continuing her medication against the potential risks to the embryo. Until more information is available, GPs should ask all pregnant patients about their history of ADHD and if they plan or are taking to take medication during the perinatal time.
Numerous studies have proven that women can continue taking their ADHD medication in a safe manner during pregnancy and while breast-feeding. In response, a growing number of patients are opting to do this. They have found, in consultation with their doctor, that the benefits of retaining their current medication outweigh potential risks.
Women who suffer from ADHD who plan to breastfeed should seek the advice of an expert psychiatrist prior to becoming pregnant. They should discuss their medication with their prescriber as well as the pros and cons for continuing treatment. This includes non-pharmacological methods. Psychoeducation is also needed to help pregnant women suffering from ADHD recognize the signs and underlying disorder. They should also be informed about treatment options and reinforce the coping mechanisms. This should be a multidisciplinary approach together with obstetricians, GPs and psychiatrists. The pregnancy counselling should consist of discussion of a management plan for both the mother as well as the child, as well as monitoring for signs of deterioration and, if necessary, adjustments to the medication regimen.