ADHD Medication During Pregnancy and Breastfeeding
Women suffering from ADHD have to make a difficult choice regarding whether or not to stop taking ADHD medication during pregnancy and breast-feeding. Little data exists about how long-term exposure to these medications may affect the foetus.
A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication during the uterus do not develop neurological conditions like hearing or vision impairment seizures, febrile seizures or IQ impairment. The authors acknowledge the need for more high-quality research.
Risk/Benefit Analysis
Pregnant women who use ADHD medications need to balance the advantages of taking them against potential risks to the fetus. Physicians don't have the data to provide clear recommendations however 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 took ADHD medication in early pregnancy were not at a greater risk of fetal malformations or structural birth defects. Researchers used a vast, population-based case-control study to determine the prevalence of major structural birth defects in babies born to mothers who had taken stimulants in early pregnancy and those who had not. Clinical geneticists, pediatric cardiologists and other experts examined the cases to confirm that the classification was accurate and to minimize any bias.
However, the researchers' study was not without its flaws. The researchers were not able in the beginning to differentiate the effects caused by the medication from the disorder. This makes it difficult to determine whether the small associations observed in the exposed groups are due to the use of medication or the confounding effect of comorbidities. Additionally the researchers did not study the long-term outcomes of offspring.
The study did show that infants whose mothers had taken ADHD medication during pregnancy were at slightly greater risk of being admitted to the neonatal intensive care unit (NICU) than infants who were born without any medication or taken off their medication prior to or during pregnancy. This increase was caused by 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 likelihood 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 affected by the type of medication that was used during pregnancy.
Researchers suggest that the small risks associated with the use ADHD medication during pregnancies in the early stages may be offset by the greater benefits for mother and baby of continuing treatment for the woman's condition. Physicians should talk to their patients about this issue and, if possible, help them develop coping skills that could reduce the effects of her disorder on her daily functioning and her relationships.
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As more women than ever are diagnosed with ADHD and being treated with medication, the issue of whether or not to end treatment during pregnancy is a question that more and more physicians confront. These decisions are often made without clear and reliable evidence. Instead, doctors must weigh their own knowledge, the experience of other physicians and the research on the subject.
The issue of potential risks for infants can be particularly tricky. Many of the studies on this topic are based on observations rather than controlled research, and their findings are often contradictory. Most studies focus on live births, which may underestimate the teratogenic impact leading to terminations or abortions of pregnancy. The study presented in this journal club addresses these shortcomings by looking at data from both live and deceased births.
Conclusion Some studies have revealed an association between ADHD medications and certain birth defects, other studies have not found a correlation. Most studies have shown an unintended, or slightly negative, impact. In each case an in-depth study of the risks and benefits should be conducted.
For a lot of women with ADHD, the decision to stop medication is difficult if not impossible. In a recent article 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. In addition, a decrease in medication can affect the ability to complete work-related tasks and safely drive that are crucial aspects of daily life for many people with ADHD.
She suggests that women who are not sure whether to continue taking the medication or discontinue it due to pregnancy educate family members, coworkers and friends about the condition, the impact on daily functioning and the benefits of continuing the current treatment. Educating them can also aid in ensuring that the woman feels supported as she struggles with her decision. Certain medications can be passed through the placenta. If a woman decides not to take her ADHD medication while pregnant and breastfeeding, it's important to be aware that the medication could be transferred to the baby.
Risk of Birth Defects
As the use and use of ADHD medications to treat the symptoms of attention deficit hyperactivity disorder (ADHD) is increasing the concern over the potential adverse effects of the drugs on the fetuses. A study that was published in the journal Molecular Psychiatry adds to the body of information on this topic. Researchers used two massive data sets to study over 4.3 million pregnancy and determine if stimulant medication use caused birth defects. Although the risk overall remains low, the researchers discovered that the first-trimester exposure to ADHD medicines was associated with an increased risk of specific heart defects, such as ventriculoseptal defect (VSD).
The researchers behind the study found no connection between the use of early medications and other congenital abnormalities, like facial clefting, or club foot. The results are consistent with previous studies showing a small but significant increase in the risk of developing cardiac malformations among women who started taking ADHD medications prior to pregnancy. The risk grew during the latter part of pregnancy, as many women begin to discontinue their medication.
Women who took ADHD medication in the first trimester were more likely require a caesarean birth, have an insufficient Apgar after birth and have a baby that needed breathing assistance after birth. The researchers of the study could not remove bias in selection since they limited their study to women who did not have any other medical conditions that could have contributed to the findings.
The researchers hope their study will aid in the clinical decisions of doctors who treat pregnant women. The researchers suggest that, while discussing risks and benefits are crucial, the decision about whether to continue or stop medication should be according to the severity of each woman's ADHD symptoms and her requirements.
The authors warn that, while stopping the medication is an option to look into, it is not recommended due to the high rate depression and mental health issues for women who are pregnant or recently gave birth. Further, research shows that women who stop taking their medications will have a harder transitioning to life without them once the baby is born.
Nursing
The responsibilities of a new mom can be overwhelming. Women who suffer from ADHD who have to manage their symptoms while attending doctor appointments and preparing for the arrival of a baby and getting used to new routines at home may face a lot of challenges. This is why many women decide to continue taking their ADHD medications throughout the course of pregnancy.
The risk to nursing infant is low because the majority of stimulant medication is absorbed through breast milk in low amounts. The rate of exposure to medication can vary depending upon the dosage, frequency of administration and time of day. Additionally, individual medications enter the baby's system differently through the gastrointestinal tract as well as breast milk. The impact of this on a newborn isn't fully understood.
Due to the absence of research, some physicians may recommend stopping stimulant medications during the pregnancy of a woman. This is a difficult decision for the patient, who must balance the benefits of keeping her medication against the potential risks to the fetus. As long as there is no more information, doctors should inquire with all pregnant patients about their history of ADHD and if they are planning or taking to take medication during the perinatal time.
Numerous studies have demonstrated that women can continue taking their ADHD medication safely during pregnancy and breast-feeding. In the end, many patients opt to do this and, in consultation with their physician, they have found that the benefits of continuing their current medication outweigh any risks.
It is crucial for women suffering from ADHD who are contemplating breastfeeding to seek a specialist psychiatrist's advice prior becoming pregnant. They should discuss the medication they are taking with their physician, and the pros and cons of continuing treatment. This includes non-pharmacological strategies. Psychoeducation is also necessary to help pregnant women suffering from ADHD understand the symptoms and underlying disorder. They should also be educated about treatment options and strengthen strategies for coping. This should be a multidisciplinary approach, which includes the GP, obstetricians and psychiatry. Pregnancy counselling should include discussion of a management plan for both mother and child, monitoring for signs of deterioration and when necessary, making adjustments to the medication regimen.