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. Little data exists about how long-term exposure to these drugs can 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 that further high-quality studies are needed.

Risk/Benefit Analysis

Women who are pregnant and taking ADHD medications must weigh the advantages of taking them against potential risks to the foetus. Physicians don't have the data to give clear advice however they can provide information on risks and benefits to assist pregnant women to make informed decisions.

A study published in Molecular Psychiatry found that women who used ADHD medications during early pregnancy did not have an increased risk of fetal cardiac malformations or major birth defects that are structural. Researchers used a vast population-based study of case-control to evaluate the incidence of major structural birth defects in babies born to mothers who took stimulants during the early stages of pregnancy, and those who did not. Clinical geneticists, pediatric cardiologists and other experts looked over the cases to confirm that the classification was accurate and to eliminate any bias.

However, the researchers' study was not without its flaws. The researchers were unable in the beginning to distinguish the effects triggered by the medication from the disorder. This makes it difficult to determine whether the limited associations observed in the groups that were exposed are due to medication use or confounding by comorbidities. Researchers also did not look at the long-term effects for the offspring.

The study found that babies whose mothers took ADHD medication during pregnancy were at a slightly higher risk of admission to the neonatal care unit (NICU), compared to mothers who did not use any medication during pregnancy or discontinued taking their medication prior to or during pregnancy. This increase was caused by central nervous system disorders. The higher risk of admission was not influenced by the stimulant medication used during pregnancy.

Women who used stimulant ADHD medication during pregnancy were also at an increased chance of having a caesarean delivery or having a baby born with low Apgar score (less than 7). These increases did not appear to be influenced by the kind of medication used during pregnancy.

Researchers suggest that the minor risk of using ADHD medications in early pregnancies could be offset by the greater benefits to both baby and mother of continued treatment for the woman's condition. Physicians should discuss this with their patients and, where possible, help them develop strategies to improve coping skills that can lessen the negative impact of her condition on her daily life and relationships.

Medication Interactions

As more women than ever before are being diagnosed with ADHD and being treated with medication, the dilemma of whether or not to end treatment during pregnancy is a question that doctors are having to face. Often, these decisions are made without clear and authoritative evidence either way, so physicians must weigh what they know 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 possible risks to infants is extremely difficult. The research on this issue is based on observations rather than controlled studies and a lot of the results are contradictory. In addition, most studies limit their analysis to live births, which may underestimate severe teratogenic effects that lead to abortion or termination of the pregnancy. The study discussed in the journal club addresses these limitations by analyzing the data from deceased and live births.

Conclusion Some studies have revealed 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 slight negative effect. In all cases it is imperative to conduct a thorough study of the benefits and risks is required.

For a lot of women with ADHD, the decision to stop medication can be difficult, if not impossible. In a recent article in Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping adhd medication private prescription (placefront8.werite.net published a blog post) medications during pregnancy can lead to depression and feelings of being isolated. A decrease in medication could also impact the ability to safely drive and complete work-related tasks, which are vital aspects of daily life for those with ADHD.

She suggests that women who are unsure whether to continue taking the medication or discontinue it due to pregnancy educate family members, coworkers, and friends about the condition, the effects on daily functioning, and the benefits of continuing the current treatment plan. It can also help a woman feel more confident in her decision. It is also worth noting that certain medications are able to pass through the placenta so if the patient decides to discontinue her ADHD medication during pregnancy and breastfeeding, she must 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, so do concerns about what impact the drugs might have on fetuses. Recent research published in the journal Molecular Psychiatry has added to the body knowledge on this topic. With two massive data sets researchers were able to analyze more than 4.3 million pregnancies to determine whether the use of stimulant medications increased the risk of birth defects. While the overall risk is low, the researchers discovered that the first-trimester exposure to ADHD medications was associated with an increase in the risk of certain heart defects such as ventriculo-septal defect (VSD).

The authors of the study could not discover any link between early medication usage and other congenital anomalies, such as 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 started taking ADHD medication before the birth of their child. This risk increased during the latter part of pregnancy, as many women begin to discontinue their ADHD medication.

Women who used adhd medication without prescribing medications in the first trimester of their pregnancies were also more likely to undergo caesarean sections, a low Apgar score after delivery and a baby who required help breathing at birth. The researchers of the study were unable to eliminate selection bias because they limited their study to women who did not have any other medical conditions that might have contributed to the findings.

The researchers hope their study will help inform the clinical decisions of physicians who see pregnant women. The researchers advise that while discussing benefits and risks are important, the choice regarding whether or not to stop medication should be made according to the severity of each woman's ADHD symptoms and her requirements.

The authors warn that, although stopping the medication is a possibility to look into, it is not recommended because of the high incidence of depression and mental health issues for women who are pregnant or who have recently given birth. Research has also shown that women who stop taking their medication will have a difficult time adjusting to a life without them once the baby is born.

Nursing

The responsibilities that come with being a new mom can be overwhelming. Women who suffer from ADHD who have to deal with their symptoms while attending doctor appointments as well as preparing for the arrival of a child and adjusting to new household routines are often faced with a number of difficulties. Therefore, many women choose to continue taking their ADHD medications throughout pregnancy.

The risk to a breastfeeding infant is minimal because the majority of stimulant medication passes through breast milk at a low level. However, the rate of exposure to medication by the infant can differ based on the dosage, frequency it is administered and the time of day the medication is administered. Additionally, different medications enter the infant's system differently through the gastrointestinal tract and breast milk, and the effect of this on a newborn is not yet fully known.

Due to the absence of evidence, some doctors might be tempted to stop taking stimulant drugs during the course of pregnancy. This is a complicated decision for the patient, who must balance the benefit of continuing her medication with the potential risks to the foetus. Until more information becomes available, GPs can ask pregnant patients whether they have an background of ADHD or if they plan to take medication during the perinatal period.

A growing number of studies have proven that most women can safely continue taking their ADHD medication while they are pregnant and nursing. As a result, an increasing number of patients choose to do so and in consultation with their physician, they have found that the benefits of continuing their current medication exceed any risk.

It is crucial for women suffering from ADHD who are contemplating breastfeeding to seek a specialist psychiatrist's guidance 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 methods. Psychoeducation is also needed to help pregnant women with ADHD understand the symptoms and the underlying disorder. They should also learn about treatment options and reinforce coping mechanisms. This should involve an approach that is multidisciplinary, including the GP as well as obstetricians, psychiatry and obstetricians. Pregnancy counseling should include a discussion of a treatment plan for the mother and the child, monitoring of signs of deterioration and, if necessary adjustments to the medication regimen.