ADHD Medication During Pregnancy and Breastfeeding
Women with ADHD must make a difficult decision about whether to continue or stop taking ADHD medication during pregnancy and breast-feeding. There aren't enough data regarding how exposure over time may affect the foetus.
A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological problems like hearing loss or vision, febrile seizures or IQ impairment. The authors acknowledge that more high quality studies are required.
Risk/Benefit Analysis
Women who are pregnant and take ADHD medication must evaluate the benefits of using it against the possible risks for the foetus. Physicians don't have the data to give clear advice however they can provide information about risks and benefits to aid pregnant women in making an informed decision.
A study published in Molecular Psychiatry found that women who were taking ADHD medications during their early pregnancy did not have a significantly increased risk of fetal cardiac malformations or major structural birth defects. Researchers conducted a massive sample-based case control study to compare the incidence of major structural defects in infants born to mothers who were taking stimulants during pregnancy. Clinical geneticists, pediatric cardiologists and other experts looked over the cases to ensure that the classification was correct and to eliminate any bias.
However, the study had its limitations. The most important issue was that they were not able to differentiate the effects of the medication from the effects of the disorder that is underlying. This limitation makes it difficult to determine whether the small differences observed in the exposed groups are due to the use of medication or the confounding effect of comorbidities. In addition, the researchers did not study the long-term outcomes of offspring.
The study did reveal that infants whose mothers had taken ADHD medications during pregnancy were at a more risk of being admitted to the neonatal intensive care unit (NICU) than infants who whose mothers did not take any medication or cut back on their medications prior to or during pregnancy. This increase was due to central nervous system disorders, and the higher risk of admission was not found to be affected by the type of stimulant medications were used during pregnancy.
Women who took stimulant ADHD medications during pregnancy also had a higher chance of having to have an emergency caesarean section or having a baby that scored low on the Apgar scale (less than 7). These risks did not appear to be influenced by the type of medication that was used during pregnancy.
Researchers suggest that the minor risks posed by the use of ADHD medication during pregnancies in the early stages could be offset by the greater benefits to both baby and mother of continued treatment for the woman's condition. Physicians should discuss this with their patients and, if they are able, assist them in developing strategies for improving their coping skills which can reduce 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 treated with medication, the question of whether or not to stop treatment during pregnancy is a question that more and more physicians confront. The majority of these decisions are made in the absence of any evidence that is clear and definitive either way, so physicians must weigh their knowledge, the experiences of other doctors, and what research says on the topic as well as their best judgment for each individual patient.
The issue of possible risks to infants is particularly tricky. The research on this subject is based on observation rather than controlled studies, and a lot of the results are in conflict. Most studies limit their analysis to live births, which may underestimate the teratogenic impact leading to abortions or terminations of pregnancy. The study that is discussed in this journal club addresses these issues by examining data on both live and deceased births.
Conclusion A few studies have shown an association between ADHD medications and certain birth defects However, other studies haven't shown such a relationship. Most studies show an unintended, or slightly negative, impact. In each case, a careful analysis of the risks and benefits is required.
It can be difficult, if not impossible, for women suffering from ADHD to stop taking their medication. In a recent article in the Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can cause depression and feelings of being isolated. The loss of medication can also affect the ability to drive safely and complete work-related tasks, which are vital aspects of daily life for those suffering from ADHD.
She suggests that women who are not sure whether to continue taking medication or discontinue it due to pregnancy educate family members, colleagues, and acquaintances about the condition, its impact on daily functioning and the benefits of continuing the current treatment. It can also help women feel more confident in her decision. It is important to remember that certain medications are able to be absorbed through the placenta so if a woman decides to discontinue her ADHD medication during pregnancy and breastfeeding, she must be aware that the effects of the medication could be passed on to the baby.
Risk of Birth Defects
As the use and misuse of ADHD medication to treat symptoms of attention deficit disorder hyperactivity disorder (ADHD) is increasing as does the concern about the potential adverse effects of the drugs on 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 to determine whether stimulant medication use increased the risk of birth defects. Although the risk overall remains low, the scientists found that exposure in the first trimester to ADHD medications was associated with an increase in the risk of certain heart defects, like ventriculo-septal defects (VSD).
The researchers behind the study found no link between the use of early medications and other congenital anomalies, such as facial clefting or club foot. The results are in the same vein as previous studies which showed a small, but significant increase in the number of cardiac malformations among women who started taking ADHD medication before pregnancy. This risk increased during the latter part of pregnancy, as many women begin to discontinue their medication.
Women who took ADHD medications in the first trimester of their pregnancies were also more likely to have caesarean section, low Apgar score following delivery, and a baby who needed breathing assistance at birth. However, the authors of the study were unable 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.
Researchers hope that their research will help doctors when they see pregnant women. The researchers recommend that while discussing the risks and benefits are important, the decision on whether to continue or stop medication should be made in light of the severity of each woman's ADHD symptoms and the needs of the woman.
The authors caution that, while stopping the medication is an option to think about, it isn't advised due to the high prevalence of depression and mental health issues among women who are pregnant or recently gave birth. Additionally, research suggests that women who stop taking their medications 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 can face severe challenges when they must deal with their symptoms, go to doctor appointments, prepare for the birth of a child and adjust to a new routine. As such, many women elect to continue taking their ADHD medication throughout the pregnancy.
The risk to a nursing infant is low because the majority of stimulant medication passes through breast milk at a low level. However, the rate of medication exposure to the newborn may differ based on dosage, frequency it is administered, and the time of the day the medication is administered. In addition, individual medications enter the infant's system differently through the gastrointestinal tract and breast milk and the impact of this on a newborn infant is not fully understood.
Due to the absence of evidence, some doctors may be inclined to discontinue stimulant drugs during a woman's pregnancy. This is a difficult choice for the patient, who must weigh the benefit of continuing her medication against the possible risks to the embryo. In the meantime, until more information is available, doctors may ask pregnant patients whether they have an background of ADHD or if they plan to take medication during the perinatal stage.
Many studies have shown that women can continue taking their ADHD medication without risk during pregnancy and while breast-feeding. In hop over to this web-site , an increasing number of patients are opting to do so. They have found through consultation with their physicians, that the benefits of continuing their current medication far outweigh any possible risks.
Women who suffer from ADHD who plan to breastfeed should seek the advice of an expert psychiatrist prior to becoming pregnant. They should review their medications with their physician and discuss the advantages and disadvantages of continued treatment, including non-pharmacological strategies. Psychoeducation is also required to help pregnant women with ADHD understand the symptoms and underlying disorder. They should also be informed about treatment options and build the coping mechanisms. 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 the need for adjustments to the medication regimen.