ADHD Medication During Pregnancy and Breastfeeding

Women with ADHD face a difficult decision regarding whether or not to stop taking ADHD medication during pregnancy and breastfeeding. There aren't enough data regarding how exposure over time may affect the pregnant fetus.

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

Risk/Benefit Analysis

Women who are pregnant and take ADHD medication must evaluate the benefits of using it against the potential dangers for the fetus. The doctors don't have the information to give clear advice, but can provide information on the risks and benefits to aid pregnant women in making informed decisions.

A study published in Molecular Psychiatry concluded that women who took ADHD medication during early pregnancy were not at higher risk of fetal malformations, or structural birth defects. The researchers used a large population-based study of case-control to evaluate the incidence of major structural birth defects in infants born to mothers who had taken stimulants in the early stages of pregnancy and those who had not. Pediatric cardiologists and clinical geneticists reviewed the cases to ensure correct case classification and to minimize the chance of bias.

However, the study was not without its flaws. Researchers were unable in the beginning to differentiate the effects triggered by the medication from the disorder. This makes it difficult for researchers to determine if the small differences observed between the exposed groups were due to medication use or if they were confounded by the presence of comorbidities. Researchers also did not look at long-term outcomes for the offspring.

The study revealed that infants whose mother took ADHD medication during pregnancy had a greater risk of being admitted to the neonatal care unit (NICU) as compared to those whose mothers did not take any medication during pregnancy or discontinued taking their medication prior to or during pregnancy. This increase was caused by central nervous system disorders. The increased risk of admission was not influenced by the stimulant medication used during pregnancy.

Women who were taking stimulant adhd depression medication medications during pregnancy also had a higher risk of having to have an emergency caesarean section or having the baby was not scoring well on the Apgar scale (less than 7). These increases appeared to be independent of the type of medication taken during pregnancy.

The researchers suggest that the risk of a small amount with the use of ADHD medications during early pregnancy may be offset by the higher benefit to both mother and child of continued treatment for the woman's disorder. Physicians should discuss the issue with their patients and, where possible, assist them in developing strategies to improve their coping abilities that can lessen the effects of her disorder on her daily functioning and relationships.

Medication Interactions

Doctors are increasingly confronted with the dilemma of whether to keep treatment or stop as more women are diagnosed with adhd medication pregnancy. These decisions are frequently made without clear and reliable evidence. Instead, doctors have to consider their own expertise in conjunction with the experiences of other physicians and the research on the topic.

The issue of possible risks for infants can be extremely difficult. Many of the studies on this subject are based on observational evidence rather than controlled research and their conclusions are often contradictory. The majority of studies restrict their analysis to live births, which may underestimate the teratogenic impact that can lead to abortions or terminations of pregnancy. The study that is discussed in this journal club addresses these limitations by looking at data from both live and deceased births.

Conclusion A few studies have shown a positive correlation between ADHD medications and certain birth defects, other studies have not shown such a relationship. Most studies have shown a neutral, or even slight negative impact. In every case an in-depth analysis of the benefits and risks is required.

It can be difficult, if not impossible, for women suffering from ADHD to stop taking their medication. In an article recently 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 patients with common adhd medications. In addition, a decrease in medication can interfere with the ability to do work-related tasks and safely drive, which are important aspects of a normal life for a lot of people with ADHD.

She recommends that women who are unsure about whether to continue or discontinue medication due to their pregnancy consider educating family members, friends and colleagues about the condition, its impact on daily functioning, and the advantages of staying on the current treatment regimen. In addition, educating them can aid in ensuring that the woman feels supported as she struggles with her decision. It is also worth noting that some medications are able to be absorbed through the placenta therefore, if a patient decides to stop taking her ADHD medication during pregnancy and genetic Testing for adhd medications breastfeeding, she should be aware that the effects of the drug can be transferred to the infant.

Risk of Birth Defects

As the use of ADHD medications to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases there are concerns over the impact that these drugs could have on fetuses. A recent study published in the journal Molecular Psychiatry adds to the existing knowledge on this subject. Researchers used two massive data sets to examine over 4.3 million pregnant women and determine if the use of stimulant medications increased the risk of birth defects. While the overall risk remains low, the scientists discovered that the first-trimester exposure to ADHD medications was linked to an increase in the risk of certain heart defects, like ventriculo-septal defects (VSD).

The authors of the study found no link between the use of early medications and congenital abnormalities like facial clefting, or club foot. The findings are in line with previous studies showing an increase, but not significant, in the risk of heart malformations in women who started taking ADHD medications prior to the time of pregnancy. The risk increased in the latter part of pregnancy when many women stopped taking their medication.

Women who took ADHD medications in the first trimester of pregnancy were also more likely to have a caesarean section, a low Apgar score following delivery, and a baby that required breathing assistance at birth. The researchers 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 that their research will help doctors when they meet pregnant women. The researchers recommend that, while discussing the risks and benefits are crucial, the decision about whether to continue or stop medication should be based on the severity of each woman's ADHD symptoms and her needs.

The authors caution that, while stopping the medication is an option to look into, it is not recommended due to the high prevalence of depression and other mental problems among women who are pregnant or recently gave birth. Additionally, research suggests that women who stop taking their medication will have a difficult transitioning to life without them once the baby is born.

Nursing

It can be a stressful experience to become a mother. Women with ADHD who have to manage their symptoms while attending physician appointments as well as preparing for the arrival of a baby and adapting to new routines in the home are often faced with a number of difficulties. Many women choose to continue taking their ADHD medication during pregnancy.

The risk to a breastfeeding infant is not too high since the majority of stimulant medication passes through breast milk at a low level. The rate of exposure to medication can vary depending upon the dosage the medication is administered, its frequency and the time of day. Additionally, different medications enter the infant's system differently through the gastrointestinal tract as well as breast milk and the impact of this on a newborn is not yet fully known.

Some doctors may stop taking stimulant medication during a woman’s pregnancy due to the absence of research. This is a difficult decision for the woman, who must weigh the benefits of her medication against the risks to the fetus. In the meantime, until more information is available, GPs can ask pregnant patients whether they have an history of ADHD or if they intend to take medication in the perinatal stage.

Numerous studies have proven that women can continue to take their ADHD medication in a safe manner during pregnancy and breast-feeding. In response, an increasing number of patients are choosing to do this. They have discovered through consultation with their physicians, that the benefits of retaining their current medication outweigh potential risks.

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 prescriber and discuss the advantages and disadvantages of continuing treatment, including non-pharmacological strategies. Psychoeducation should also be offered to help women with ADHD be aware of their symptoms and underlying disorder, learn about available treatment options and strengthen existing strategies for managing. This should include a multidisciplinary approach with the GP, obstetricians and psychiatry. Pregnancy counseling should include a discussion of a treatment plan for the mother and the child, and monitoring genetic testing for adhd medications (Full Write-up) indicators of deterioration, and, if necessary modifications to the medication regime.