ADHD Medication During Pregnancy and Breastfeeding

The decision to stop or continue ADHD medication during pregnancy and nursing is a difficult decision for women suffering from the condition. There are few data on how exposure to ADHD for a long time could affect a pregnant fetus.

A recent study published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological problems such as impaired hearing or vision, febrile seizures, or IQ impairment. The authors acknowledge the need for more high-quality research.

Risk/Benefit Analysis

Women who are pregnant and taking ADHD medication must consider the benefits of taking it versus the dangers for the fetus. The doctors don't have the information to provide clear recommendations however they can provide information on risks and benefits to aid pregnant women in making an informed decision.

A study published in Molecular Psychiatry found that women who used 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 case-control study to assess the risk of major structural birth defects in babies born to mothers who took stimulants during early pregnancy, and those who did not. Pediatric cardiologists, clinical geneticists and other experts reviewed the cases in order to confirm that the classification was correct and to reduce any bias.

The research conducted by the researchers was not without its limitations. Researchers were unable in the beginning to distinguish the effects triggered by the medication from the disorder. This limitation makes it difficult for researchers to establish whether the small differences observed between the groups that were exposed to medication use or caused by comorbidities. In addition the study did not examine long-term offspring outcomes.

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

Women who were taking stimulant ADHD medications during pregnancy also had a higher likelihood of having to have caesarean sections or one whose baby 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 small risks associated with the use ADHD medications in early pregnancies can be offset by greater benefits to both mother and baby from continuing treatment for the woman’s disorder. Physicians should discuss this with their patients and, when possible, assist them in developing strategies to improve coping skills which can reduce the negative impact of her condition on her daily functioning and relationships.

Medication Interactions

As more women than ever before are being diagnosed with ADHD and treated with medication, the dilemma of whether to keep or stop treatment during pregnancy is one that more and more doctors have to face. Most of the time, these decisions are made in the absence of any evidence that is clear and definitive regardless, so doctors must weigh what they know from their own experiences, those of other doctors, and what research suggests on the subject as well as their own judgments for each patient.

The issue of possible risks for infants can be particularly tricky. The research on this issue is based on observations rather than controlled studies, and a lot of the results are conflicting. In addition, most studies limit their analysis to live births, which may underestimate severe teratogenic effects that result in abortion or termination of the pregnancy. The study that is discussed in this journal club addresses these shortcomings by analyzing data on live and deceased births.

Conclusion: While some studies have found a positive correlation between ADHD medications and certain birth defects however, other studies haven't found a correlation. The majority of studies show that there is a neutral, or somewhat negative, effect. In the end, a careful risk/benefit analysis must be conducted in every situation.

For women suffering from ADHD, the decision to discontinue medication is difficult, if not impossible. In an article published in Archives of Women's Mental Health, psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can increase depression, feelings of isolation, and family conflict for those suffering from the disorder. The loss of medication can also affect the ability to drive safely and perform work-related tasks, which are essential aspects of normal life for those suffering from ADHD.

She suggests that women who are not sure whether to continue taking the medication or stop it due to their pregnancy educate family members, coworkers and friends about the condition, the effects on daily functioning, and the benefits of keeping the current treatment. It can also make the woman feel more comfortable in her struggle with 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 of the possibility that traces of the drug can i get adhd medication without a diagnosis be transferred to the child.

Risk of Birth Defects

As the use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) grows, so do concerns about the effects that the drugs could have on fetuses. A recent study published in the journal Molecular Psychiatry adds to the body of information on this topic. Researchers used two huge data sets to study more than 4.3 million pregnant women and determine whether stimulant medications caused birth defects. While the overall risk is low, the researchers discovered that the first-trimester exposure to ADHD medications was associated with an increased risk of certain heart defects, such as ventriculoseptal defect (VSD).

The authors of the study didn't find any association between early medication usage and congenital anomalies like facial deformities or club feet. The findings are in line with previous studies revealing the presence of a small, but significant increase in the risk of cardiac malformations among women who started taking ADHD medications prior to pregnancy. The risk increased in the latter half of pregnancy, when a lot of women stopped taking their medication.

Women who were taking ADHD medication for adhd during the first trimester were more likely require a caesarean birth, have an insufficient Apgar after delivery and have a baby that needed breathing assistance at birth. The authors of the study were not able to eliminate selection bias because they limited their study to women who did not have any other medical conditions that could have contributed to the findings.

Researchers hope their research will inform physicians when they meet pregnant women. They advise that while the discussion of the risks and benefits is crucial but the decision to stop or maintain medication should be based on the woman's requirements and the severity of her ADHD symptoms.

The authors also caution that, while stopping the medication is an option, it is not an option that is recommended due to the high prevalence of depression and other mental health problems in women who are pregnant or postpartum. Additionally, the research suggests that women who choose to stop taking their medication are more likely to experience a difficult time adjusting to life without them following the baby's arrival.

Nursing

The responsibilities of being a new mom can be overwhelming. Women with ADHD may face a lot of challenges when they must manage their symptoms, go to doctor appointments, prepare for the birth of their child and adjust to new routines. Many women opt 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. The amount types of adhd medication exposure to medications will vary based on the dosage, frequency of administration and the time of the day. In addition, various drugs enter the infant's system through the gastrointestinal tract or through breast milk. The effect on a newborn's health is not completely known.

Some physicians may discontinue stimulant medication during a woman’s pregnancy due to the absence of research. This is a difficult decision for the patient, who must balance the benefits of continuing her medication against the possible risks to the fetus. As long as more information is available, doctors can my general practitioner prescribe adhd medication ask pregnant patients whether they have a background of ADHD or if they intend to take medication during the perinatal phase.

Many studies have shown that women can continue taking their ADHD medication in a safe manner during pregnancy and while breast-feeding. In response, a growing number of patients are opting to do so. They have found after consulting with their physicians that the benefits of keeping their current medication far outweigh any risk.

Women with ADHD who are planning to breastfeed should seek advice from an expert psychiatrist prior to becoming pregnant. They should discuss their medication with their physician and discuss the advantages and disadvantages of continuing treatment, including non-pharmacological strategies. Psychoeducation is also required to help pregnant women with add adhd medications recognize the signs and underlying disorder. They should also be educated about treatment options and build coping mechanisms. This should be a multidisciplinary effort together with obstetricians, GPs, and psychiatry. Pregnancy counseling should consist of a discussion of a treatment plan for the mother and the child, as well as monitoring for signs of deterioration and, if needed, adjustments to the medication regimen.