ADHD Medication During Pregnancy and Breastfeeding
The choice of whether to stop or continue ADHD medications during pregnancy and breastfeeding is a difficult decision for women suffering from the condition. There aren't many studies on how exposure to ADHD for a long time could affect the fetus.
A study recently 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 research.
Risk/Benefit Analysis
Women who are pregnant and taking ADHD medications must weigh the benefits of taking them against the potential risks to the fetus. Doctors don't have the data needed to provide clear recommendations however they can provide information regarding risks and benefits that help pregnant women make informed decisions.
A study published in Molecular Psychiatry found that women who used ADHD medications in early pregnancy did not have a significantly increased risk of fetal cardiac malformations or major birth defects that are structural. 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, as well as those who had not. Pediatric cardiologists, clinical geneticists and other experts looked over the cases to make sure that the classification was accurate and to reduce any bias.
However, the study was not without its flaws. The researchers were unable in the beginning, to separate the effects triggered by the medication from the disorder. This limitation makes it difficult for researchers to establish whether the small associations observed among the exposed groups were due to medication use or confounded by the presence of comorbidities. Additionally the researchers did not examine the long-term effects of offspring on their parents.
The study found that infants whose mothers had taken ADHD medication during pregnancy had a slightly higher risk of admission to the neonatal care unit (NICU) in comparison to mothers who didn't take any medication during pregnancy, or had stopped taking their medication before or during pregnancy. This increase was caused by central nervous system disorders. The increased risk of admission was not influenced by the stimulant medication that was used during pregnancy.
Women who were taking stimulant ADHD medications during pregnancy also had a higher likelihood of having to have caesarean sections or one whose baby scored low on the Apgar scale (less than 7). These increases didn't appear to be affected by the kind of medication used during pregnancy.
The researchers suggest that the risk of a small amount with the use of ADHD medications during the early stages of pregnancy may be offset by the greater benefits for both mother and child of continuing treatment for the woman's disorder. Physicians should discuss the issue with their patients and, if possible, assist them in developing strategies for improving their coping skills which can reduce the impact of her disorder on her daily functioning and relationships.
Medication Interactions
As more women than ever are being diagnosed with ADHD and treated with medication, the question of whether to keep or end treatment during pregnancy is a question that more and more physicians confront. Most of the time, these decisions are taken in the absence of any evidence that is clear and definitive either way, so physicians must weigh their knowledge about their experiences, the experiences of other doctors, and what the research suggests on the subject as well as their best judgment for each patient.
The issue of potential risks to the infant can be particularly tricky. The research on this subject is based on observation rather than controlled studies and a lot of the results are contradictory. The majority of studies focus on live births, which may underestimate the teratogenic impact which can cause terminations or abortions of pregnancy. The study that is discussed in this journal club addresses these shortcomings by looking at data from both live and deceased births.
Conclusion A few studies have shown a positive correlation between ADHD medications and certain birth defects However, other studies haven't found a correlation. Most studies show that there is a neutral, or somewhat negative, effect. In each case it is imperative to conduct a thorough analysis of the benefits and risks must be performed.
It can be challenging, if not impossible, for women suffering from ADHD to stop taking their medication. In fact, in a recent article in the 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 these patients. In addition, a decrease in medication may affect the ability to do jobs and drive safely that are crucial aspects of a normal life for a lot of people with ADHD.
She suggests that women who are unsure whether to continue taking the medication or stop due to pregnancy educate family members, coworkers, and friends about the condition, its effects on daily functioning, and the benefits of keeping the current treatment. It can also help a woman feel confident about her decision. It is important to note that some drugs can be absorbed through the placenta therefore, if a patient decides to stop her ADHD medication during pregnancy and breastfeeding, she should be aware that the effects of the drug could be transferred to the infant.
Birth Defects and Risk of
As the use of ADHD medication to treat the symptoms of attention deficit hyperactivity disorder (ADHD) grows as do concerns over the impact that these drugs could have on foetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge on this issue. With two massive data sets researchers were able to look at more than 4.3 million pregnancies to determine whether stimulant medications increased the risk of birth defects. Researchers discovered that, while the overall risk is low, the first trimester ADHD medication exposure was associated with slightly higher rates of specific heart defects such as ventriculoseptal defect.
The authors of the study didn't discover any connection between the use of early medications and congenital anomalies such as facial deformities or club feet. The results are consistent with previous studies that have shown a small but significant increase in the risk of developing cardiac malformations in women who started taking ADHD medications before pregnancy. This risk increased during the latter part of pregnancy when many women stopped taking their medication.
Women who took ADHD medication in the first trimester were more likely require a caesarean delivery, have a low Apgar after birth and had a baby that required help breathing at birth. The researchers of the study could not eliminate selection bias because they limited the study to women with no other medical conditions that could have contributed to the findings.
Researchers hope their research will help doctors when they meet pregnant women. They recommend that, while the discussion of the risks and benefits is crucial but the decision to stop or continue medication must be based on each woman's requirements and the severity of her ADHD symptoms.
The authors warn that, while stopping the medication is an option to consider, it is not recommended because of the high incidence of depression and mental health issues for women who are pregnant or check here recently gave birth. Research has also shown that women who stop taking their medications will have a difficult time adjusting to a life without them once the baby is born.
Nursing
It can be overwhelming becoming a mother. Women with ADHD may face a lot of challenges when they must deal with their symptoms, attend doctor appointments and prepare for the birth of their child and adjust to a new routine. This is why many women choose to continue taking their ADHD medications throughout the course of pregnancy.
The risk to a breastfeeding infant is minimal because the majority of stimulant medication is absorbed through breast milk at low levels. However, the frequency of medication exposure to the infant can differ based on dosage, how often it is administered, and the time of the day the medication is administered. Additionally, different medications enter the baby’s system via the gastrointestinal tract or breast milk. The effect on the health of a newborn is not fully known.
Some physicians may discontinue stimulant medication during a woman’s pregnancy due to the absence of research. This is a difficult decision for the patient, who must balance the benefits of keeping her medication with the potential dangers to the fetus. As long as more information is available, GPs may inquire about pregnant patients if they have a background of ADHD or if they plan to take medication during the perinatal period.
Many studies have shown that women can continue to take their ADHD medication without risk while breastfeeding and during pregnancy. In the end, many patients are choosing to do so, and in consultation with their doctor they have discovered that the benefits of continuing their current medication exceed any risk.
It is essential for women with ADHD who are contemplating breastfeeding to seek out a specialist psychiatrist's guidance prior to 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 strategies. Psychoeducation is also required to help pregnant people with ADHD be aware of their symptoms and the underlying disorder, learn about available treatments and to reinforce existing strategies for coping. This should be a multidisciplinary approach with the GP as well as obstetricians, psychiatry and obstetricians. Pregnancy counseling should include discussion of a treatment plan for the mother and the child, as well as monitoring for indicators of deterioration, and, if necessary modifications to the medication regime.