ADHD Medication During Pregnancy and Breastfeeding

The decision to stop or keep ADHD medication during pregnancy and nursing is a challenge for women suffering from the condition. Little data exists about how long-term exposure to these drugs may affect the foetus.

A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus do not develop neurological developmental disorders like impaired vision or hearing, febrile seizures, or IQ impairment. The authors acknowledge the need for more high-quality studies.

Risk/Benefit Analysis

Pregnant women who take ADHD medications need to balance the benefits of taking them against the potential risks to the foetus. Physicians don't have the data to provide clear recommendations, but can provide information on risks and benefits to aid pregnant women in making informed choices.

A study published in Molecular Psychiatry concluded that women who were taking ADHD medication in early pregnancy did not have a higher risk of fetal malformations, or structural birth defects. Researchers conducted a large population-based case-control study to evaluate the incidence of major structural birth defects in babies born to mothers who had taken stimulants in the early stages of pregnancy, and those who did not. Clinical geneticists, pediatric cardiologists and other experts examined the cases to confirm that the classification was correct and to eliminate any bias.

However, the researchers' study was not without its flaws. The researchers were unable, in the first place to distinguish the effects caused by the medication from the disorder. This makes it difficult for researchers to establish whether the small associations observed among the groups exposed were due to the use of medications or if they were affected by the presence of comorbidities. Researchers also did not examine long-term outcomes for offspring.

The study did show that infants whose mothers had taken ADHD medication during pregnancy were at a higher risk of being admitted to the neonatal intensive care unit (NICU) than those who whose mothers did not take any medication or had cut back on their medications prior to or during pregnancy. This was due to central nervous system disorders. The increased risk of admission was not affected by the stimulant medication that was used during pregnancy.

Women who took stimulant ADHD medications during pregnancy also had a higher risk of having a caesarean section or a baby that scored low on the Apgar scale (less than 7). These increases did not seem to be influenced by the kind of medication used during pregnancy.

The researchers suggest that the low risk associated with the use of ADHD medications during early pregnancy may be offset by the greater benefit to both the mother and child of continuing treatment for the woman's condition. Doctors should discuss with their patients about this issue and, if possible, help them develop coping skills that could reduce the impact of her disorder in her daily life and relationships.

Medication Interactions

Doctors are increasingly confronted with the dilemma of whether to continue treatment or stop as more women are diagnosed with ADHD. Often, these decisions are taken in the absence of clear and authoritative evidence in either case, which means that doctors must weigh their knowledge, the experiences of other doctors, and what the research suggests on the subject and their own Best Medication For Adhd Combined Type judgment for each patient.

In particular, the issue of potential risks to the baby can be a challenge. The research on this issue is based on observation instead of controlled studies and a lot of the results are contradictory. Furthermore, most studies restrict their analysis to live births, which may undervalue the serious teratogenic effects that can cause abortion or termination of the pregnancy. The study discussed in the journal club addresses these shortcomings, by examining both information on deceased and live births.

Conclusion Some studies have found an association between ADHD medications and certain birth defects, other studies have not shown such a relationship. The majority of studies show a neutral, or even somewhat negative, impact. In all cases an in-depth study of the benefits and risks should be conducted.

For many women with ADHD and ADD, the decision to stop medication is difficult if not impossible. In a recent piece published in Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping adhd medication weekends adults ADHD medications during pregnancy can increase depression and feelings of isolation. In addition, a decrease in medication can interfere with the ability to perform work-related tasks and safely drive, which are important aspects of daily life for a lot of people with ADHD.

She suggests that women who are unsure whether to continue taking medication or stop it due to their pregnancy educate family members, coworkers, and acquaintances about the condition, the effects on daily functioning, and the benefits of continuing the current treatment. In addition, educating them can help the woman feel supported when she is struggling with her decision. Certain medications can pass 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 drug could be passed on to her baby.

Risk of Birth Defects

As the use and abuse of adhd medication guide medication to treat symptoms of attention deficit disorder hyperactivity disorder (ADHD) increases the concern over the potential effects of these drugs on fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge on this topic. Utilizing two huge data sets researchers were able to examine more than 4.3 million pregnancies and determine whether the use of stimulant medications increased the risk of birth defects. Researchers discovered that although the overall risk is low, the first trimester ADHD exposure to medication was associated with slightly higher risk of specific heart defects like ventriculoseptal defect.

The authors of the study found no association between the use of early medications and other congenital anomalies, such as facial clefting or club foot. The results are in agreement with previous studies that showed a small, but significant increase in the number of cardiac malformations among women who began taking private adhd medication cost medication before the birth of their child. This risk increased during the latter stages of pregnancy, when a lot of women began to stop taking their medication.

Women who used ADHD medications during the first trimester of their pregnancies were also more likely to experience a caesarean section, a low Apgar score after delivery and a baby who required help breathing at birth. However the authors of the study were not able to eliminate selection bias by limiting the study to women who did not have any other medical conditions that could be a contributing factor to these findings.

Researchers hope that their study will provide doctors with information when they encounter pregnant women. They suggest that although discussing the benefits and risks is important but the decision to stop or maintain treatment should be based on each woman's needs and the severity of her ADHD symptoms.

The authors also caution that while discontinuing the medications is an alternative, it is not a recommended practice because of the high incidence of depression and other mental health problems among women who are pregnant or who are recently post-partum. Furthermore, research suggests that women who choose to stop taking their medication are more likely to experience a difficult time adapting to life without them following the birth of their baby.

Nursing

It can be a stressful experience to become a mom. Women who suffer from ADHD who must work through their symptoms while attending doctor appointments, preparing for the arrival of their child and getting used to new routines at home can experience severe challenges. Many women decide to continue taking their ADHD medication during pregnancy.

The risk for breastfeeding infant is not too high since the majority of stimulant medications is absorbed through breast milk at low levels. However, the rate of medication exposure to the newborn can vary depending on dosage, frequency it is taken and at what time the medication is administered. In addition, different drugs enter the infant's system through the gastrointestinal tract, or through breast milk. The impact on the health of a newborn isn't completely known.

Some physicians may discontinue stimulant medication during a woman's pregnancy due to the absence of research. It is a difficult decision for the woman who must weigh the advantages of her medication against the potential risks to the foetus. In the meantime, until more information is available, doctors should ask all pregnant patients about their history of ADHD and whether they plan or are taking to take medication during the perinatal period.

Numerous studies have demonstrated that women can continue to take their ADHD medication without risk while breastfeeding and during pregnancy. This has led to an increasing number of patients choose to do so, and in consultation with their doctor they have discovered that the benefits of maintaining their current medication outweigh any risks.

It is crucial for women suffering from ADHD who are considering breastfeeding to seek a specialist psychiatrist's guidance prior to becoming pregnant. They should review their medications with their physician and discuss the pros and cons of continued treatment, including non-pharmacological management strategies. Psychoeducation is also required to help pregnant women suffering from ADHD understand the symptoms and underlying disorder. They should also learn about treatment options and reinforce coping mechanisms. This should be a multidisciplinary process with the GPs, obstetricians, and psychiatry. Counselling for pregnancy should include the discussion of a treatment plan for both mother and child, and monitoring for signs of deterioration and when necessary, making adjustments to the medication regimen.