ADHD Medication During Pregnancy and Breastfeeding
The decision to stop or keep ADHD medications during breastfeeding and pregnancy is a difficult decision for women suffering from the condition. There aren't enough data regarding how exposure over time may affect the pregnant fetus.
A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus don't develop neurological developmental disorders like hearing or vision impairment seizures, febrile seizures or IQ impairment. The authors acknowledge the need for higher-quality research.
Risk/Benefit Analysis
Women who are pregnant and taking ADHD medications must weigh the benefits of using them against the risks to the fetus. Physicians do not have the data needed to make unequivocal recommendations but they can provide information about the risks and benefits to assist pregnant women in making informed choices.
A study published in Molecular Psychiatry found that women who took ADHD medications in early pregnancy did not have a significantly increased risk of fetal cardiac malformations or major structural birth defects. Researchers conducted a massive population-based case control study to compare the incidence of structural defects that were major in infants 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 unable to distinguish the effects of the medication from the underlying disorder. This limitation makes it difficult to know whether the small associations observed in the groups that were exposed result from medication use or confounding by comorbidities. The researchers also did not study long-term outcomes for the offspring.
The study did show that infants whose mothers had taken ADHD medications during pregnancy were at a slightly more risk of being admitted to the neonatal intensive care unit (NICU) than infants whose mothers had not taken any medication or stopped their medications before or during pregnancy. This was due to central nervous system disorders. The higher risk of admission was not affected by the stimulant medication used during pregnancy.
Women who were taking stimulant ADHD medications during pregnancy also had a higher chance of having caesarean sections or the baby was not scoring well on the Apgar scale (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 posed by the use of ADHD medications in early pregnancies can be offset by greater benefits to both mother and baby of continuing treatment for the woman’s disorder. Physicians should talk to their patients about this and as much as possible, assist them develop coping strategies that can lessen the effects of her disorder on her daily life and relationships.
Medication Interactions
As more women than ever before are being diagnosed with ADHD and being treated with medication, the issue of whether or not to discontinue treatment during pregnancy is a question that doctors are having to have to face. Often, these decisions are made without any evidence that is clear and definitive either way, so physicians have to weigh their experience about their experiences, the experiences of other doctors, and what research suggests on the subject and their own best judgment for each patient.
The issue of risk for infants can be particularly tricky. The research on this subject is based on observations rather than controlled studies, and a lot of the results are in conflict. Most studies focus on live-births, which could underestimate the teratogenic impact which can cause abortions or terminations of pregnancy. The study discussed in this journal club addresses these limitations by examining data on both live and deceased births.
The conclusion is that while some studies have shown an association between ADHD medications and the risk of certain birth defects, others have found no connection and the majority of studies show a neutral or even slightly negative impact. In the end, a careful risk/benefit analysis must be done in each situation.
For many women with ADHD, the decision to discontinue medication can be difficult, if not impossible. In a recent article published in 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 complete work-related tasks and safely drive which are essential aspects of daily life for a lot of people with ADHD.
She suggests that women who are unsure whether to take the medication or stop due to pregnancy, educate their family members, coworkers, and their friends about the condition, its impact on daily functioning and the benefits of keeping the current treatment plan. In addition, educating them can make the woman feel more comfortable when she is struggling with her decision. Certain medications can pass through the placenta. If a patient decides to stop taking her ADHD medication while pregnant and breastfeeding, it is important to be aware that the medication could be transferred to the infant.
Birth Defects Risk
As the use and use 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 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 whether stimulant medications increased birth defects. Researchers discovered that although the risk overall is low, the first trimester ADHD exposure to medication was associated with slightly higher risk of certain heart defects, like ventriculoseptal defect.
The authors of the study didn't discover any connection between the use of early medications and other congenital anomalies, such as facial deformities or club feet. The results are consistent with previous studies that have shown an increase, but not significant, in the risk of cardiac malformations in women who started taking ADHD medications before the time of pregnancy. The risk increased in the latter half of pregnancy when many women stopped taking their medication.
please click the following page who used ADHD medications in the first trimester of their pregnancy were also more likely to experience a caesarean section, a low Apgar score after delivery and a baby who required help breathing at birth. The researchers of the study were unable to remove bias in selection since they limited the study to women with no other medical conditions that could have contributed to the findings.
The researchers hope their research will aid in the clinical decisions of doctors who encounter pregnant women. They advise that while a discussion of the benefits and risks is important, the decision to stop or maintain treatment should be based on each woman's requirements and the severity of her ADHD symptoms.
The authors caution that, although stopping the medication is a possibility to consider, it is not recommended because of the high incidence of depression and other mental problems for women who are pregnant or who have recently given birth. Further, research shows that women who stop taking their medication will have a harder adjustment to life without them after the baby is born.
Nursing
The responsibilities of being a new mother can be overwhelming. Women with ADHD who must work through their symptoms while attending physician appointments, 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 medications are absorbed through breast milk in low quantities, so the risk to nursing infant is very low. However, the amount of medication exposure to the newborn may differ based on dosage, how often it is administered, and at what time it is administered. In addition, individual medications enter the baby's system differently through the gastrointestinal tract and breast milk, and the effect of this on a newborn infant is not well understood.
Due to the absence of evidence, some doctors may be inclined to discontinue stimulant medications during a woman's pregnancy. This is a difficult decision for the mother, who must weigh the benefits of continuing her medication against the risks to the embryo. Until more information becomes available, doctors can ask pregnant patients if they have an history of ADHD or if they plan to take medication in the perinatal period.
Numerous studies have proven that women can continue taking their ADHD medication without risk during pregnancy and breast-feeding. In the end, an increasing number of patients choose to do so, and in consultation with their physician, they have found that the benefits of continuing their current medication far outweigh any risks.
Women who suffer from ADHD who plan to breastfeed should seek the advice of a specialist psychiatrist prior to becoming pregnant. They should review their medications with their doctor and discuss the advantages and disadvantages of continuing treatment, including non-pharmacological management strategies. Psychoeducation is also required to help pregnant women suffering from ADHD be aware of their symptoms and the underlying disorder Learn about the available treatment options and reinforce existing strategies for managing. This should be an approach that is multidisciplinary, including the GP doctors, obstetricians and psychiatrists. Pregnancy counselling should include the discussion of a treatment plan for both mother and child, as well as monitoring for signs of deterioration, and, if necessary, adjustments to the medication regimen.