ADHD Medication During Pregnancy and Breastfeeding
The decision to stop or continue ADHD medications during breastfeeding and pregnancy is a difficult decision for women suffering from the condition. Little data exists about how long-term exposure to these medications may affect the foetus.
A recent study published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological disorders such as impaired hearing or vision, febrile seizures or IQ impairment. add in adults medication acknowledge the need for more high-quality research.
Risk/Benefit Analysis
Women who are pregnant and taking ADHD medications must weigh the advantages of taking them against potential risks to the fetus. Physicians do not have the information needed to make unequivocal recommendations however they can provide information on the risks and benefits to help pregnant women make informed decisions.
A study published in Molecular Psychiatry concluded that women who were taking ADHD medication during early pregnancy were not at higher risk of fetal malformations or structural birth defects. Researchers used a large population-based case control study to assess the frequency of major structural defects in infants who were born to mothers who were taking stimulants during pregnancy. Clinical geneticists, pediatric cardiologists and other experts reviewed the cases in order to confirm that the classification was accurate and to eliminate any bias.
However, the researchers' study was not without its flaws. Most important, they were unable to distinguish the effects of the medication from the disorder that is underlying. This limitation makes it difficult for researchers to determine if the small associations observed among the groups that were exposed to the use of medications or confounded by comorbidities. In addition the study did not examine the long-term effects of offspring on their parents.
The study did find that infants whose mothers took ADHD medications during pregnancy were at a slightly more risk of being admitted to the neonatal intensive care unit (NICU) than those who were born without any medication or had 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 medications used during pregnancy.
Women who were taking stimulant ADHD medications during pregnancy also had a higher risk of having to have an emergency caesarean section or having a baby that scored low on the Apgar scale (less than 7). These increases appear to be unrelated to the type of medication taken during pregnancy.
Researchers suggest that the small risk of using ADHD medication during pregnancies in the early stages may be offset by the greater benefits for baby and mother of continued treatment for the woman’s disorder. Physicians should discuss this with their patients and, where they are able, assist them in developing strategies to improve coping skills which can reduce the negative impact of her condition on her daily functioning and relationships.
Interactions with Medication
Many doctors are faced with the decision of whether to continue treatment or stop as more women are diagnosed with ADHD. Most of the time, these decisions are made without solid and reliable evidence in either case, which means that doctors must weigh what they know from their own experiences, those of other doctors, and what the research says on the topic and their own best judgment for each patient.
Particularly, the subject of potential risks for the baby can be a challenge. The research on this issue is based on observations instead of controlled studies and the results are in conflict. The majority of studies focus on live births, which can underestimate the teratogenic impact which can cause terminations or abortions of pregnancy. The study discussed in the journal club addresses these issues, by examining both data on live and deceased births.
Conclusion: While some studies have found a positive correlation between ADHD medications and certain birth defects, other studies have not found a correlation. Most studies show an unintended, or slightly negative, impact. As a result an accurate risk-benefit analysis must be conducted in every instance.
It can be challenging, if not impossible for women with ADHD to stop taking their medication. In fact, 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 patients with ADHD. A decrease in medication could also impact the ability to safely drive and complete work-related tasks, which are vital aspects of daily life for those with ADHD.
She suggests that women who aren't sure whether to continue taking the medication or discontinue it due to pregnancy, educate their family members, coworkers and acquaintances about the condition, its impact on daily functioning and the advantages of staying on the current treatment. In addition, educating them can aid in ensuring that the woman feels supported in her struggle with her decision. It is also worth noting that certain medications can pass through the placenta, so if a woman decides to discontinue her ADHD medication during pregnancy and breastfeeding, she should be aware of the possibility that traces of the medication could be transferred to the infant.
Birth Defects Risk
As the use of ADHD medications to treat symptoms of attention deficit hyperactivity disorder (ADHD) grows, so do concerns over the impact that these drugs could have on the fetuses. A study that was published in the journal Molecular Psychiatry adds to the body of knowledge on this subject. Researchers used two massive datasets to analyze more than 4.3 million pregnant women and determine whether stimulant medications increased the risk of birth defects. While the overall risk remains low, the scientists found that exposure in the first trimester to ADHD medications was associated with an increase in the risk of specific heart defects, like ventriculo-septal defects (VSD).
The researchers of the study did not discover any link between early medication usage and other congenital anomalies like facial deformities or club feet. The results are in line with previous studies showing the presence of a small, but significant increase in the risk of heart malformations in women who started taking ADHD medications prior to the time of the time of pregnancy. The risk grew in the latter half of pregnancy, when a lot of women begin to discontinue their ADHD medications.
Women who used ADHD medications in the first trimester of their pregnancy were also more likely to experience caesarean sections, a low Apgar score following delivery, and a baby that required breathing assistance during birth. The authors of the study were unable to eliminate selection bias because they limited their study to women who did not have any 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 crucial, the decision about whether to continue or stop medication should be made based on the severity of each woman's ADHD symptoms and her needs.
The authors also advise that even though stopping the medication is an option, it isn't a recommended practice because of the high prevalence of depression and other mental health issues among women who are pregnant or who are recently post-partum. Additionally, research suggests 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 who suffer from ADHD who must work through their symptoms while attending doctor appointments, 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 choose to continue taking their ADHD medications throughout pregnancy.
The risk to breastfeeding infant is not too high since the majority of stimulant medications passes through breast milk at a low level. The rate of exposure to medication will vary based on the dosage and frequency of administration as well as the time of the day. Additionally, different medications enter the baby's system differently through the gastrointestinal tract as well as breast milk and the impact of this on a newborn infant is not well 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 weigh the benefits of continuing her medication with the potential risks to the foetus. As long as more information is available, GPs may ask pregnant patients if they have an background of ADHD or if they intend to take medication in the perinatal period.
Numerous studies have proven that women can continue taking their ADHD medication in a safe manner during pregnancy and breast-feeding. In the end, many patients are choosing to do so, and in consultation with their physician, they have found that the benefits of maintaining their current medication exceed any risk.
Women with ADHD who are planning to breastfeed should seek the advice of a specialist psychiatrist before becoming pregnant. They should discuss their medication with their prescriber, and the pros and cons for continuing treatment. This includes non-pharmacological strategies. Psychoeducation is also required to help pregnant women suffering from ADHD understand the symptoms and underlying disorder. They should also be educated about treatment options and reinforce strategies for coping. This should be a multidisciplinary effort together with obstetricians, GPs and psychiatrists. add adult medications should include a discussion of a treatment plan for the mother and child, as well as monitoring for signs of deterioration, and, if needed modifications to the medication regimen.