ADHD Medication During Pregnancy and Breastfeeding

Women suffering from ADHD have to make a difficult choice about whether to continue or stop taking ADHD medication during pregnancy and breast-feeding. There isn't much information on how long-term exposure to these drugs 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 hearing loss or vision, febrile seizures, or IQ impairment. The authors acknowledge the need for more high-quality studies.

Risk/Benefit Analysis

Women who are expecting and taking ADHD medication need to weigh the benefits of taking it versus the risks to the fetus. Physicians don't have the data to provide clear recommendations but they can provide information on 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 during their early pregnancy did not have a higher risk of fetal malformations or structural birth defects. Researchers conducted a large population-based case-control study to evaluate the incidence of major structural birth defects in infants born to mothers who had taken stimulants in early pregnancy, as well as those who had not. Clinical geneticists, pediatric cardiologists and other experts reviewed the cases in order to make sure that the classification was correct and to minimize any bias.

The study of the researchers was not without its limitations. Most important, they were unable to separate the effects of the medication from the underlying disorder. This makes it difficult for researchers to establish whether the small associations observed among the exposed groups were due to the use of medication, or if they were affected by comorbidities. Additionally the researchers did not examine long-term offspring outcomes.

The study did reveal that infants whose mothers had taken ADHD medications during pregnancy were at slightly higher risk of being admitted to the neonatal intensive care unit (NICU) than infants who were born without any medication or had cut back on their medications prior to or during pregnancy. This increase was due to central nervous system-related disorders and the increased risk of admission did not appear to be influenced by which stimulant medications were taken during pregnancy.

Women who were taking stimulant ADHD medications during pregnancy also had a higher chance 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 influenced by the kind of medication used during pregnancy.

Researchers suggest that the small risks associated with the use ADHD medication during pregnancies in the early stages could be offset by the greater benefits for mother and baby from continuing treatment for the woman's condition. Physicians should discuss the issue with their patients and, where they are able, assist them in developing strategies for improving their coping skills that can lessen the negative impact of her condition on her daily functioning and relationships.

Medication Interactions

More and more doctors are 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, physicians must consider their own expertise in conjunction with the experiences of other physicians and the research on the subject.

Particularly, the issue of potential risks for the baby can be tricky. A lot of studies on this topic are based on observational evidence rather than controlled research and their conclusions are often contradictory. Most studies focus on live-births, which could underestimate the severity of teratogenic effects leading to terminations or abortions of pregnancy. The study discussed in this journal club addresses these shortcomings by examining data on both live and deceased births.

Conclusion: While some studies have shown a positive correlation between ADHD medications and certain birth defects However, other studies haven't established a link. Most studies have shown an unintended, or somewhat negative, effect. In each case, a careful analysis of the potential risks and benefits must be performed.

For a lot of women with ADHD and ADD, the decision to stop medication can be difficult, if not impossible. In fact, in an article published in Archives of Women's Mental Health, psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can lead to increased depression, feelings of isolation, and family conflict for those suffering from the disorder. In addition, a decrease in medication can affect the ability to complete job-related tasks and drive safely that are crucial aspects of daily life for many people suffering from ADHD.

She suggests that women who are unsure whether to take the medication or stop due to pregnancy educate family members, coworkers and friends about the condition, its impact on daily functioning and the benefits of keeping the current treatment regimen. It will also help a woman feel confident about her decision. It is important to note that certain medications can pass through the placenta therefore, if a patient decides to discontinue her ADHD medication during pregnancy and breastfeeding, she should be aware of the possibility that traces of the drug can be transferred to the infant.

Birth Defects and Risk of

As the use and abuse of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD), increases, so does concern about the potential adverse effects of the drugs on the fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge on this issue. Utilizing two huge data sets researchers were able analyze more than 4.3 million pregnancies and see whether stimulant medication use increased the risk of birth defects. Although the risk overall is low, the researchers found that exposure in the first trimester to ADHD medications was associated with an increased risk of specific heart defects, such as ventriculoseptal defect (VSD).

The researchers of the study found no association between early use of medication and other congenital abnormalities, like facial clefting, or club foot. The results are consistent with previous studies revealing a small but significant increase in the risk of developing cardiac malformations among women who began taking ADHD medications prior to the time of pregnancy. The risk was higher during the latter part of pregnancy, when a lot of women are forced to stop taking their ADHD medication.

Women who used ADHD medications during the first trimester of their pregnancies were also more likely to have caesarean sections, a low Apgar score following delivery, and a baby who needed breathing assistance at birth. The authors of the study were not able to eliminate selection bias because they restricted the study to women without other medical conditions that might have contributed to the findings.

Researchers hope that their study will inform physicians when they meet pregnant women. The researchers advise that, while discussing risks and benefits are important, the decision regarding whether or not to stop medication should be according to the severity of each woman's ADHD symptoms and her needs.

The authors also warn that while discontinuing the medications is an option, it isn't an option to consider due to the high rate of depression and other mental health issues for women who are expecting or who are recently postpartum. Further, the research suggests that women who decide to stop taking their medication are more likely to have difficulties getting used to life without them after the baby's arrival.

Nursing

The responsibilities that come with being a new mom can be overwhelming. Women who suffer from ADHD who must work through their symptoms while attending doctor appointments as well as making preparations for the arrival of a child and adjusting to new household routines can experience severe challenges. As such, many women decide to continue taking their ADHD medications throughout the course of pregnancy.

The majority of stimulant drugs are absorbed by breast milk in low amounts, therefore the risk for breastfeeding infant is minimal. The rate of exposure to medication can vary depending upon the dosage, frequency of administration and the time of day. Additionally, individual medications enter the body of the baby differently through the gastrointestinal tract as well as breast milk. The impact of this on a newborn isn't well understood.

Some doctors may decide to stop stimulant medication during a woman’s pregnancy due to the lack of research. This is a complicated decision for the patient, who must balance the benefit of continuing her medication with the potential dangers to the embryo. In the meantime, until more information is available, doctors should ask all pregnant patients about their experience with ADHD and if they are taking or planning to take medication during the perinatal time.

A increasing number of studies have revealed that most women can safely continue taking their ADHD medication during pregnancy and breastfeeding. As a result, many patients are choosing to do so and after consulting with their doctor, they have discovered that the benefits of maintaining their current medication far exceed any risk.

It is essential for women with ADHD who read more are considering breastfeeding to seek a specialist psychiatrist's advice prior becoming pregnant. They should discuss the medication they are taking with their physician and discuss the pros and cons of continuing treatment. This includes non-pharmacological methods. Psychoeducation should also be offered to help pregnant women suffering from ADHD understand their symptoms and the root cause, learn about available treatments and to reinforce existing strategies for managing. This should include a multidisciplinary approach, which includes the GP as well as obstetricians, psychiatry and obstetricians. Pregnancy counseling should include a discussion of a treatment plan for the mother and the child, as well as monitoring for signs of deterioration, and, if necessary adjustments to the medication regimen.