ADHD Medication During Pregnancy and Breastfeeding
The choice of whether to stop or continue ADHD medication during pregnancy and breastfeeding is a difficult decision for women suffering from the condition. There is a lack of information about how long-term exposure to these medications can affect the fetus.
A recent study published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological problems such as impaired hearing or vision, febrile seizures or IQ impairment. The authors acknowledge that more high-quality studies are required.
Risk/Benefit Analysis
Pregnant women who take ADHD medications need to balance the benefits of taking them against potential risks to the fetus. The doctors don't have the information to make unambiguous recommendations but they can provide information on the risks and benefits to help pregnant women make informed choices.
A study published in Molecular Psychiatry concluded that women who were taking ADHD medication during their early pregnancy were not at a higher risk of fetal malformations or structural birth defects. Researchers used a vast population-based case-control study to assess the risk of major structural birth defects in infants born to mothers who had taken stimulants in the early stages of pregnancy, and those who did not. Clinical geneticists, pediatric cardiologists and other experts examined the cases to make sure that the classification was accurate and to eliminate any bias.
The study of the researchers was not without limitations. The researchers were unable to, in the first place to differentiate the effects triggered by the medication from the disorder. This makes it difficult for researchers to determine if the small differences observed between the groups exposed were due to the use of medications, or if they were confounded by comorbidities. Additionally, the researchers did not study the long-term effects of offspring on their parents.
The study showed that infants whose mothers had taken ADHD medication during pregnancy had a higher risk of admission to the neonatal care unit (NICU) as compared to mothers who did not take any medication during pregnancy or discontinued taking their medication prior to or during pregnancy. This increase was caused by central nervous system disorders. The increased risk of admission was not affected by the stimulant medication used during pregnancy.
Women who took stimulant ADHD medications during pregnancy also had a higher risk of having a caesarean section or a baby that scored low on the Apgar scale (less than 7). These increases appeared to be unrelated to 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 greater benefit for both mother and child of continued treatment for the woman's condition. Physicians should discuss the issue with their patients and, where possible, assist them in developing strategies for improving their coping skills which can reduce the impact of her disorder on her daily functioning and relationships.
Medication Interactions
As more women than ever before are being diagnosed with ADHD and being treated with medication, the issue of whether to continue or stop treatment during pregnancy is one that more and more physicians face. These decisions are often taken without clear and authoritative evidence. Instead, doctors must take into account their own experience, the experience of other doctors and the research on the topic.
Particularly, the subject of potential risks for the infant can be difficult. Many studies on this subject are based on observational evidence rather than controlled research and their conclusions are often contradictory. Most studies restrict their analysis to live-births, which could underestimate the severity of teratogenic effects leading to terminations or abortions of pregnancy. The study presented in the journal club addresses these limitations by analyzing both information on deceased and live births.
Conclusion A few studies have shown a positive correlation between ADHD medications and certain birth defects, other studies have not shown such a relationship. Most studies show an unintended, or somewhat negative, impact. In each case, a careful study of the benefits and risks must be performed.
It can be difficult, if not impossible for women suffering from ADHD to stop taking their medication. In a recent article in 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 loneliness. In addition, a decrease in medication can affect the ability to perform work-related tasks and safely drive, which are important aspects of a normal life for many people with ADHD.
She suggests that women who are unsure whether to take the medication or discontinue it due to pregnancy educate family members, colleagues, and acquaintances about the condition, the effects on daily functioning, and the benefits of continuing the current treatment regimen. It will also help a woman feel more confident in her decision. It is important to remember that some medications are able to pass through the placenta so if a woman decides to stop taking her ADHD medication during pregnancy and breastfeeding, she must be aware that traces of the drug could be passed on to the baby.
Birth Defects and Risk of
As the use of ADHD medication to treat the symptoms of attention deficit hyperactivity disorder (ADHD) grows there are concerns about the effects that the drugs might have on the fetuses. A study that was published in the journal Molecular Psychiatry adds to the existing knowledge about this subject. Researchers used two massive data sets to examine over 4.3 million pregnant women and determine if stimulant medication use increased birth defects. While the overall risk remains low, the researchers did find that first-trimester exposure to ADHD medications was associated with an increase in the risk of specific heart defects, such as ventriculoseptal defect (VSD).
The authors of the study didn't discover any connection between early medication usage and other congenital anomalies like facial deformities or club feet. The findings are in line with previous studies revealing a small but significant increase in the risk of cardiac malformations among women who began taking ADHD medications prior to the time of the time of pregnancy. The risk grew in the latter half of pregnancy, when many women are forced to stop taking their ADHD medication.
Women who took ADHD medication in the first trimester of pregnancy were also more likely to have caesarean sections, a low Apgar score after delivery and a baby that required breathing assistance during birth. The authors of the study could not eliminate selection bias because they limited the study to women who did not have any other medical conditions that might have contributed to the findings.
Researchers hope that their research will help doctors when they see pregnant women. They recommend that, while discussing the benefits and risks is important however, the decision to stop or maintain treatment should be based on each woman's needs and the severity of her ADHD symptoms.
The authors caution that, even though stopping the medication is a possibility to think about, it isn't recommended due to the high prevalence of depression and mental health issues among 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 time adjusting to a life without them after the baby is born.
Nursing
It can be a stressful experience to become a mother. Women who suffer from ADHD who have to manage their symptoms while attending physician appointments and making preparations for the arrival of a baby and adjusting to new household routines may face a lot of challenges. Many women choose to continue taking their ADHD medication during pregnancy.
The majority of stimulant medications pass through breast milk in very small quantities, so the risk for nursing infant is very low. However, adhd medication uk buy online of medication exposure to the infant can differ based on dosage, how often it is administered and at what time the medication is administered. In addition, individual medications enter the infant's system differently through the gastrointestinal tract and breast milk, and the effect of this on a newborn isn't yet fully known.
Some doctors may decide to stop stimulant medication during a woman’s pregnancy due to the lack of research. This is a difficult choice for the patient, who must balance the benefit of continuing her medication against the possible risks to the embryo. Until more information becomes available, GPs can inquire about pregnant patients if they have an background of ADHD or if they plan to take medication during the perinatal phase.
Numerous studies have proven that women can continue to take their ADHD medication safely during pregnancy and breast-feeding. This has led to many patients choose to do so and in consultation with their doctor they have discovered that the benefits of keeping their current medication far outweigh any risks.
It is crucial for women suffering from ADHD who are considering breastfeeding to seek a specialist psychiatrist's advice prior to becoming pregnant. They should discuss their medication with their prescriber and discuss the advantages and disadvantages of continuing treatment, including non-pharmacological management strategies. Psychoeducation should also be offered to help pregnant women suffering from ADHD be aware of their symptoms and the underlying disorder, learn about available treatment options and strengthen existing strategies for coping. This should involve a multidisciplinary approach, which includes the GP as well as obstetricians, psychiatry and obstetricians. Pregnancy counseling should consist of a discussion of a treatment plan for the mother and the child, monitoring of indicators of deterioration, and, if necessary, adjustments to the medication regimen.