ADHD Medication During Pregnancy and Breastfeeding

Women suffering from ADHD face a difficult decision regarding whether or not to stop taking ADHD medication during pregnancy and breast-feeding. There isn't much information on how long-term exposure to these medications may affect the fetus.

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

Risk/Benefit Analysis

Women who are pregnant and take ADHD medication need to consider the benefits of taking it versus the risks for the baby. Physicians don't have the information needed to provide clear recommendations but they can provide information on the risks and benefits to assist pregnant women in making informed decisions.

A study published in Molecular Psychiatry found that women who took 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 population-based study of case control to examine the prevalence of structural defects that were major in infants who were born to mothers who used stimulants during pregnancy. Clinical geneticists and pediatric cardiologists looked over the cases to ensure an accurate classification of the cases and to reduce the possibility of bias.

However, the researchers' study was not without its flaws. The researchers were not able to, in the first place to differentiate the effects triggered by the best medication for adhd from the disorder. This makes it difficult for researchers to determine whether the small differences observed between the groups that were exposed to the use of medications or affected by comorbidities. Additionally the researchers did not study the long-term effects of offspring on their parents.

The study showed that infants whose mother took ADHD medication during pregnancy had a slightly greater risk of being admitted to the neonatal care unit (NICU), compared to mothers who did not use any medication during pregnancy, or had discontinued taking their medication prior to or during pregnancy. The reason for this was central nervous system-related disorders and the increased risk of admission did not appear to be influenced by which stimulant medications were used during pregnancy.

Women who took 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 risks did not seem to be influenced by the kind of medication used during pregnancy.

The research suggests that the low risk associated with the use of ADHD medications during early pregnancy could be offset by the greater benefits to both mother and child from continued treatment for the woman's disorder. Doctors should discuss with their patients about this issue and as much as possible, assist them develop coping skills that can lessen the effects of her disorder on her daily functioning and her relationships.

Medication Interactions

As more women than ever before are being diagnosed with ADHD and being treated with medication, the question of whether to continue or end treatment during pregnancy is one that more and more doctors have to face. These decisions are usually made without clear and authoritative evidence. Instead, doctors must consider their own expertise in conjunction with the experiences of other doctors and the research on the subject.

Particularly, the subject of potential risks to the baby can be tricky. A lot of studies on this issue are based on observations rather than controlled research, and their findings are often contradictory. Additionally, the majority of studies limit their analysis to live births, which may underestimate the severity of teratogenic effects that could cause abortion or termination of the pregnancy. The study discussed in this journal club addresses these shortcomings by examining data on both live and deceased births.

The conclusion: While some studies have found an association between ADHD medications and the risk of certain birth defects, other studies have not found any evidence of a link and the majority of studies show a neutral or even slightly negative effect. As a result an accurate risk-benefit analysis is required in every case.

For a lot of women with ADHD and ADD, the decision to discontinue medication is difficult if not impossible. 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 loneliness and family conflict for those suffering from the disorder. Furthermore, a loss of medication can interfere with the ability to do work-related tasks and safely drive which are essential aspects of daily life for a lot of people with intuitive adhd medication.

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, the effects on daily functioning, and the advantages of staying on the current treatment regimen. It will also help a woman feel confident about her decision. It is also worth noting that some medications can pass through the placenta so if a woman decides to discontinue her ADHD medication during pregnancy and breastfeeding, she should be aware that the effects of the drug can be passed on to the baby.

Risk of Birth Defects

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

The authors of the study could 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 revealing a small but significant increase in the risk of heart malformations in women who started taking ADHD medications prior to the time of the birth of their child. The risk increased in the latter stages of pregnancy when a large number 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 have caesarean sections, a low Apgar score following delivery, and a baby who needed help breathing at birth. However the researchers of the study were unable to eliminate selection bias by limiting the study to women who did not have other medical issues that could have contributed to the findings.

The researchers hope their research will help inform the clinical decisions of physicians who encounter pregnant women. They advise that while a discussion of the risks and benefits is crucial, the decision to stop or continue medication should be based on the woman's needs and the severity of her ADHD symptoms.

The authors caution that, while stopping the medication is a possibility to look into, it is not advised due to the high prevalence of depression and other mental disorders in women who are expecting or have recently given birth. Furthermore, research suggests that women who decide to stop taking their medications are more likely to experience difficulties getting used to life without them following the baby's arrival.

Nursing

The responsibilities of being a new mom can be overwhelming. Women with ADHD are often faced with a number of difficulties when they must deal with their symptoms, go to doctor appointments, prepare for the birth of a baby and adjust to a new routine. This is why many women decide to continue taking their ADHD medications throughout the course of pregnancy.

The majority of stimulant medications are absorbed by breast milk in very small amounts, so the risk to breastfeeding infant is minimal. The rate of medication exposure can vary depending upon the dosage the medication is administered, [empty] its frequency and the time of the day. Additionally, different medications enter the infant's system differently through the gastrointestinal tract and 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 absence of research. This is a difficult decision for the mother, who must weigh the advantages of taking her medication as well as the potential risks to the embryo. Until more information is available, doctors should ask all pregnant patients about their history of adhd medication pregnancy (look here) and if they are planning or taking to take medication during the perinatal time.

A growing number of studies have revealed that the majority of women are able to safely continue their ADHD medication during pregnancy and breastfeeding. In response, a growing number of patients are choosing to continue their medication. They have discovered after consulting with their doctors, that the benefits of continuing their current medication far outweigh any possible risks.

It's important for women with ADHD who are considering breastfeeding to seek a specialist psychiatrist's advice prior to becoming pregnant. They should discuss their medication with their doctor and discuss the advantages and disadvantages of continued treatment, including non-pharmacological management strategies. Psychoeducation should also be offered to help pregnant women suffering from ADHD understand their symptoms and the root cause Learn about the available treatment options and strengthen existing strategies for coping. This should involve an approach that is multidisciplinary, including the GP as well as obstetricians, psychiatry and obstetricians. The pregnancy counselling should consist of the discussion of a plan for management for both the mother as well as the child, and monitoring for signs of deterioration, and the need for adjustments to the medication regimen.