ADHD Medication During Pregnancy and Breastfeeding

The decision to stop or keep ADHD medication during pregnancy and nursing is challenging for women with the condition. There isn't much information on how long-term exposure to these drugs can affect the foetus.

A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus don't develop neurological conditions like impaired vision or hearing, febrile seizures, or IQ impairment. The authors acknowledge that more high-quality studies are needed.

Risk/Benefit Analysis

Pregnant women who use ADHD medications must weigh the advantages of using them against the risks to the foetus. Physicians don't have the data to make unambiguous recommendations, but can provide information about risks and benefits to assist pregnant women to make an informed decision.

A study published in Molecular Psychiatry found that women who used ADHD medications in early pregnancy did not face a significantly higher risk of fetal cardiac malformations or major birth defects that are structural. Researchers used a vast population-based study of case-control to determine the prevalence of major structural birth defects in infants born to mothers who had taken stimulants during the early stages of pregnancy, and those who did not. Pediatric cardiologists, clinical geneticists and other experts examined the cases to confirm that the classification was correct and to eliminate any bias.

However, the study was not without its flaws. The most important issue was that they were unable to distinguish the effects of the medication from the effects of the disorder at hand. This limitation makes it difficult to know whether the small associations observed in the groups that were exposed are due to medication use or comorbidities that cause confusion. The researchers also did not examine long-term outcomes for the offspring.

The study did reveal that babies whose mothers had taken ADHD medications during pregnancy were at a more risk of being admitted to the neonatal intensive care unit (NICU) than those who whose mothers did not take any medication or taken off their medication prior to or during pregnancy. The reason for this was central nervous system-related disorders, and the higher risk of admission did not appear to be influenced by which stimulant medication was used during pregnancy.

Women who used stimulant ADHD medication during pregnancy also had an elevated risk of having a caesarean section or having a child with a low Apgar score (less than 7). These increases didn't appear to be influenced by the kind of medication used during pregnancy.

The research suggests that the small risk associated with the use of ADHD medications during early pregnancy may be offset by the greater benefit to both mother and child from continued treatment for the woman's condition. Physicians should discuss the issue with their patients and, where possible, help them develop strategies to improve coping skills which can reduce the impact of her disorder on her daily functioning and relationships.

Interactions with Medication

As more women than ever are diagnosed with ADHD and treated with medication, the question of whether to continue or end treatment during pregnancy is one that more and more doctors confront. These decisions are usually taken without clear and authoritative evidence. Instead, physicians must weigh their own knowledge in conjunction with the experiences of other physicians and the research that has been conducted on the subject.

The issue of potential risks for infants can be extremely difficult. Many of the studies on this topic are based on observations rather than controlled research, and their findings are often contradictory. In addition, most studies limit their analysis to live births, which can underestimate the severity of teratogenic effects that could cause abortion or termination of the pregnancy. The study presented in this journal club addresses these shortcomings by analyzing data on live and deceased births.

The conclusion The conclusion: While some studies have found a positive association between ADHD medications and the risk of certain birth defects, others have found no connection, and most studies demonstrate a neutral or slightly negative effect. In every case an in-depth evaluation of the potential risks and benefits should be conducted.

It can be challenging, if not impossible, for women suffering from ADHD to stop taking their medication. In a recent piece published in the Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can lead to depression and feelings of loneliness. The loss of medication can also impact the ability to safely drive and complete work-related tasks, which are essential aspects of everyday life for people with prescribe adhd medication.

She suggests that women who are unsure about whether to keep or stop taking medication because of their pregnancy, consider the possibility of educating friends, family members and colleagues about the condition, its effects on daily functioning, and on the advantages of continuing the current treatment plan. Educating them can also make the woman feel more comfortable in her struggle with her decision. It is important to note that certain medications can be absorbed through the placenta so if a woman decides to discontinue her ADHD medication during pregnancy and breastfeeding, she should be aware that traces of the medication could be transferred to the infant.

Risk of Birth Defects

As the use of ADHD medications to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases, so do concerns about the effects that the drugs might have on foetuses. Recent research published in the journal Molecular Psychiatry has added to the body knowledge on this issue. With two massive data sets researchers were able look at more than 4.3 million pregnancies and determine whether stimulant medication use increased the risk of birth defects. While the overall risk remains low, the researchers found that exposure in the first trimester to ADHD medications was associated with an increased risk of certain heart defects such as ventriculo-septal defect (VSD).

The authors of the study did not discover any link between early medication usage and other congenital anomalies like facial deformities, or club feet. The findings are in line with previous studies revealing an increase, but not significant, in the risk of heart malformations in women who started taking ADHD medications prior to the time of the time of pregnancy. The risk increased in the latter stages of pregnancy when a large number of women decided to stop taking their medication.

Women who took ADHD medications in the first trimester of their pregnancy were also more likely to have caesarean section, low Apgar score after delivery and a baby that required breathing assistance during birth. The researchers of the study were not able to remove bias in selection since they limited the study to women with no other medical conditions that might have contributed to the findings.

The researchers hope their study will help inform the clinical decisions of doctors who treat pregnant women. They advise that while a discussion of the risks and benefits is crucial however, the decision to stop or maintain treatment should be based on the woman's needs and the severity of her ADHD symptoms.

The authors also advise that while discontinuing the medications is an option, it is not a recommended practice because of the high rate of depression and other mental health issues among women who are pregnant or post-partum. Additionally, the research suggests that women who choose to stop their medications are more likely to have a difficult time getting used to life without them after the birth of their baby.

Nursing

The responsibilities that come with being a new mother can be overwhelming. Women with ADHD who have to deal with their symptoms while attending doctor appointments, making preparations for the arrival of their child and adapting to new routines in the home can experience severe challenges. As such, many women choose to continue taking their ADHD medications throughout pregnancy.

The risk for breastfeeding infant is minimal because the majority of stimulant medication passes through breast milk at low levels. However, the frequency of medication exposure to the newborn may differ based on dosage, frequency it is taken and the time of day the medication is administered. In addition, different medications are introduced into the baby's system through the gastrointestinal tract, or through breast milk. The effect on the health of a newborn isn't fully understood.

Due to the absence of evidence, some doctors might be tempted to stop taking stimulant medications during a woman's pregnancy. This is a difficult decision for the patient, who must balance the benefits of keeping her medication against the potential dangers to the foetus. In the meantime, until more information is available, GPs should ask all pregnant patients about their history of ADHD and whether they are planning or taking to take medication during the perinatal time.

A increasing number types Of adhd medication (emery-Bendix.federatedjournals.com) studies have shown that women can continue their ADHD medication while they are pregnant and nursing. In response, a rising number of patients are opting to continue their medication. They have found through consultation with their doctor that the benefits of retaining their current medication outweigh risk.

Women who suffer from ADHD who are planning to nurse should seek the advice of a specialist psychiatrist prior to becoming pregnant. They should review their medications with their prescriber and discuss the advantages and disadvantages of continued treatment, including non-pharmacological management strategies. Psychoeducation should also be provided to help pregnant women suffering from ADHD recognize their symptoms and the underlying disorder and learn about treatment options and reinforce existing coping strategies. This should be a multidisciplinary effort including obstetricians, GPs, and psychiatry. Pregnancy counseling should include discussion of a treatment plan for the mother as well as the child, and monitoring for indicators of deterioration, and, if needed adjustments to the medication regime.