ADHD Medication During Pregnancy and Breastfeeding
The choice of whether to stop or continue ADHD medications during pregnancy and breastfeeding is a challenge for women suffering from the condition. Little data exists about how long-term exposure to these drugs could affect the fetus.
A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication during the uterus don't develop neurological disorders like impaired vision or hearing, febrile seizures, or IQ impairment. The authors acknowledge that further high-quality studies are required.
Risk/Benefit Analysis
Women who are expecting and taking ADHD medication should evaluate the benefits of using it against the potential dangers for the foetus. Physicians don't have the data to provide clear recommendations but they can provide information on risks and benefits to help pregnant women make informed decisions.
A study published in Molecular Psychiatry found that women who were taking ADHD medications during their early pregnancy did not face an higher risk of fetal cardiac malformations or major structural birth defects. Researchers conducted a large sample-based case control study to assess the frequency of major structural defects in infants who were born to mothers who used stimulants during pregnancy. Pediatric cardiologists, clinical geneticists and other experts looked over the cases to confirm that the classification was accurate and to eliminate any bias.
The research conducted by the researchers was not without its limitations. The most important issue was that they were unable to distinguish the effects of the medication from the effects of the disorder that is underlying. This limitation makes it difficult for researchers to determine whether the small differences observed between the exposed groups were due to medication use or affected by co-morbidities. In addition the study did not examine the long-term effects of offspring on their parents.
The study showed that infants whose mother had taken ADHD medication during pregnancy were at a slightly higher chance of being admitted to the neonatal care unit (NICU), compared to mothers who did not use any medication during pregnancy or had stopped taking their medication before or during pregnancy. This was due to central nervous system disorders, and the increased risk for admission did not appear to be influenced by the stimulant medication was used during pregnancy.
Women who took stimulant ADHD medications during pregnancy also had a higher risk of having an emergency caesarean section or having a baby that scored low on the Apgar scale (less than 7). These risks did not seem to be influenced by the kind of medication used during pregnancy.
Researchers suggest that the minor risks posed by the use of ADHD medications during early pregnancies can be offset by greater benefits for mother and baby from continuing treatment for the woman's condition. Physicians should discuss the issue with their patients and, when they are able, assist them in developing strategies to improve coping skills that may minimize the negative impact of her condition on her daily life and relationships.
Interactions with Medication
More and more doctors are confronted with the dilemma of whether to maintain treatment or stop as more women are diagnosed with ADHD. Often, these decisions are made 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 research suggests about the subject, along with their own best judgment for each individual patient.
Particularly, the issue of potential risks to the infant can be difficult. Many of the studies on this issue are based on observations rather than controlled research, and their conclusions are often contradictory. Additionally, the majority of studies limit their analysis to live births, which can underestimate severe teratogenic effects that lead to abortion or termination of the pregnancy. The study discussed in this journal club addresses these issues by analyzing data on live and deceased births.
Conclusion Some studies have found a positive correlation between ADHD medications and certain birth defects, other studies have not established a link. The majority of studies show an unintended, or somewhat negative, impact. In every case it is imperative to conduct a thorough evaluation of the benefits and risks is required.
For a lot of women with ADHD and ADD, the decision to stop taking medication can be difficult, if not impossible. In fact, in an article published 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 these patients. Additionally, the loss of medication can interfere with the ability to do job-related tasks and drive safely, which are important aspects of a normal life for a lot of people with ADHD.
She suggests that women who are not sure whether to continue taking the medication or stop due to pregnancy educate family members, colleagues, and acquaintances about the condition, its impact on daily functioning and the advantages of staying on the current treatment. It can also help a woman feel more confident in her decision. Some medications can pass through the placenta. If a woman decides to not take her ADHD medication while pregnant and breastfeeding, it is crucial to be aware that the drug could be passed on to her baby.
Birth Defects Risk
As the use of ADHD medication to treat the symptoms of attention deficit hyperactivity disorder (ADHD) grows there are concerns about the effects that the drugs could have on the fetuses. A study that was published in the journal Molecular Psychiatry adds to the body of information on this topic. Using two massive data sets, researchers were able to look at more than 4.3 million pregnancies to determine whether stimulant medication use increased the risk of birth defects. Researchers found that while the risk overall is low, first-trimester ADHD medication use was associated with slightly higher risk of certain heart defects, such as ventriculoseptal defect.
adhd without medication of the study didn't discover any connection between early use of medication and other congenital anomalies, like facial deformities, or club feet. The results are in agreement with previous studies that showed an insignificant, but small increase in cardiac malformations for women who began taking ADHD medication before pregnancy. The risk grew in the later part of pregnancy, when many women begin to discontinue their ADHD medication.
Women who were taking ADHD medication in the first trimester were more likely require a caesarean birth or have an insufficient Apgar after delivery, and had a baby that 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 issues that could have contributed to the findings.
Researchers hope that their study will inform physicians when they meet pregnant women. They advise that while discussing risks and benefits is important however, the decision to stop or maintain medication must be based on each woman's needs and the severity of her ADHD symptoms.
The authors also advise that, while stopping the medication is an option, it is not an option to consider due to the high rate of depression and other mental health problems in women who are pregnant or post-partum. Research has also shown that women who stop taking their medications will have a harder time adjusting to a life without them after the baby is born.
Nursing
The responsibilities of being a new mom can be overwhelming. Women who suffer from ADHD who have to manage their symptoms while attending doctor appointments and getting ready for the arrival of a baby and adjusting to new household routines can experience severe challenges. This is why many women elect to continue taking their ADHD medication throughout the pregnancy.
The majority of stimulant medications are absorbed through breast milk in very small amounts, therefore the risk to the infant who is breastfeeding is low. The rate of exposure to medication will differ based on dosage and frequency of administration as well as the time of the day. Additionally, different medications enter the baby’s system via the gastrointestinal tract, or through breast milk. The impact on a newborn's health is not fully known.
Because of the lack of evidence, some doctors may recommend stopping stimulant drugs during the pregnancy of a woman. This is a difficult decision for the mother, who must weigh the benefits of her medication against the risk to the embryo. In the meantime, until more information is available, doctors can inquire about pregnant patients if they have any background of ADHD or if they are planning to take medication during the perinatal stage.
Many studies have shown that women can continue to take their ADHD medication safely during pregnancy and breast-feeding. In response, a rising number of patients are choosing to continue their medication. They have found, in consultation with their physicians that the benefits of keeping their current medication outweigh risk.
Women who suffer from ADHD who are planning to breastfeed should seek advice from an expert psychiatrist prior to becoming pregnant. They should discuss their medication with their doctor as well as the pros and cons for continuing treatment. This includes non-pharmacological strategies. Psychoeducation is also required to help pregnant women suffering from ADHD recognize the signs and underlying disorder. They should also be informed about treatment options and strengthen strategies for coping. This should be a multidisciplinary process together with obstetricians, GPs and psychiatry. Pregnancy counselling should include the discussion of a plan for management for both the mother and child, and monitoring for signs of deterioration, and, if necessary, adjustments to the medication regimen.