ADHD Medication During Pregnancy and Breastfeeding

Women with ADHD have to make a difficult choice on whether to keep or stop taking ADHD medication during pregnancy and breastfeeding. There are few data on how long-term exposure may affect a fetus.

A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological issues like hearing loss or vision, febrile seizures, or IQ impairment. The authors acknowledge the need for more high-quality studies.

Risk/Benefit Analysis

Pregnant women who use adhd medication pregnancy medications must weigh the advantages of using them against the risks to the fetus. Physicians don't have the data to give clear advice however they can provide information about risks and benefits to aid pregnant women in making informed choices.

A study published in Molecular Psychiatry concluded that women who took ADHD medication in early pregnancy were not at higher risk of fetal malformations or structural birth defects. Researchers used a large population-based study of case control to examine the prevalence of major structural defects in infants who were born to mothers who used stimulants during pregnancy. Pediatric cardiologists and clinical geneticists examined the cases to ensure an accurate case classification and to limit the chance of bias.

However, the study had its limitations. In particular, they were not able to differentiate the effects of the medication from the disorder that is underlying. This makes it difficult for researchers to determine if the small differences observed between the groups exposed were due to the use of medications, or if they were affected by the presence of comorbidities. Additionally the researchers did not look at the long-term effects of offspring on their parents.

The study showed that infants whose mothers took ADHD medication during pregnancy were at a slightly greater risk of being admitted to the neonatal care unit (NICU) in comparison to those whose mothers did not take any medication during pregnancy, or had 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 medications used during pregnancy.

Women who were taking stimulant ADHD medication during pregnancy also had an elevated risk of having a caesarean birth or having a baby born with an low Apgar score (less than 7). These increases did not seem to be influenced by the kind of medication used during pregnancy.

The researchers suggest that the low risk associated with the use of ADHD medications during early pregnancy could be offset by the greater benefits for both mother and child of continuing treatment for the woman's condition. Physicians should discuss the issue with their patients and, where they are able, assist them in developing strategies to improve their coping abilities which can reduce the effects of her disorder on her daily life and relationships.

Medication Interactions

Doctors are increasingly confronted with the dilemma of whether to maintain treatment or stop as more women are diagnosed with ADHD. These decisions are frequently taken without clear and authoritative evidence. Instead, physicians must consider their own expertise, the experience of other doctors and the research on the subject.

Particularly, the issue of possible risks to the baby can be a challenge. Many studies on this topic are based on observational evidence instead of controlled research and their conclusions are often contradictory. In addition, most studies limit their analysis to live births, which adhd medication is the best could underestimate the severity of teratogenic effects that could cause abortion or termination of the pregnancy. The study discussed in this journal club addresses these limitations by examining data on both live and deceased births.

The conclusion is that while certain studies have demonstrated an association between ADHD medications and the possibility of certain birth defects, others have not found any evidence of a link, and most studies demonstrate a neutral or slight negative effect. As a result an accurate risk-benefit analysis must be conducted in every situation.

For many women with ADHD who suffer from ADHD, the decision to stop medication can be difficult, if not impossible. In a recent article published in the Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping adhd medication adults ADHD medications during pregnancy can lead to depression and feelings of loneliness. A decrease in medication could also affect the ability to drive safely and to perform work-related tasks which are vital aspects of daily life for those with ADHD.

She suggests that women who are unsure whether to take the medication or stop it due to their pregnancy educate family members, coworkers and friends about the condition, its effects on daily functioning, and the benefits of keeping the current treatment. Educating them can also help the woman feel supported when she is struggling with her decision. Certain medications can pass through the placenta. If the patient decides to stop taking her ADHD medication while breastfeeding, it's important to be aware that the medication may be transferred to her baby.

Risk of Birth Defects

As the use of ADHD medication to treat the symptoms of attention deficit hyperactivity disorder (ADHD) increases as do concerns about what impact the medications could have on foetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge on this subject. Researchers utilized two massive data sets to examine more than 4.3 million pregnancy and determine whether stimulant medications caused birth defects. Although the risk overall is low, the researchers found that exposure in the first trimester to ADHD medicines was associated with an increased risk of specific heart defects, such as ventriculo-septal defect (VSD).

The researchers of the study found no link between early use of medication and other congenital anomalies, like facial clefting, or club foot. The results are in the same vein as previous studies that have shown a small, but significant increase in cardiac malformations for women who started taking ADHD medication before the time of pregnancy. This risk increased during the latter half of pregnancy, when a lot of women decided to stop taking their medication.

Women who took ADHD medications in the first trimester of their pregnancy were also more likely to experience caesarean sections, a low Apgar score after delivery and a baby who required help breathing at birth. The authors of the study could not remove bias in selection since they limited the study to women with no other medical conditions that could have contributed to the findings.

The researchers hope their research will help inform the clinical decisions of physicians who treat pregnant women. The researchers suggest that while discussing benefits and risks are important, the choice regarding whether or not to 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 consider, it is not recommended due to the high prevalence of depression and other mental disorders for women who are pregnant or recently gave birth. Further, research shows that women who stop taking their medication will have a difficult time adjusting to a life without them after the baby is born.

Nursing

It can be a stressful experience to become a mother. Women who suffer from ADHD can face severe challenges when they must deal with their symptoms, attend doctor appointments and prepare for the birth of a child and adjust to a new routine. Many women choose to continue taking their ADHD medication during pregnancy.

The risk to breastfeeding infant is minimal because the majority of stimulant medications passes through breast milk in low amounts. However, the rate of exposure to medications by the newborn can vary depending on dosage, how does adhd medication work for adults often it is administered, and at what time the medication is administered. Additionally, different medications enter the baby's system differently through the gastrointestinal tract and breast milk. The impact of this on a newborn isn't fully understood.

Due to the absence of research, some physicians might be tempted to stop taking stimulant medication during a woman's pregnancy. This is a difficult decision for the patient, who must weigh the benefit of continuing her medication against the potential dangers to the foetus. As long as there is no more information, doctors should inquire with all pregnant patients about their history of ADHD and if they are planning or taking to take medication during the perinatal period.

Numerous studies have demonstrated that women can continue taking their ADHD medication in a safe manner during pregnancy and breast-feeding. In response, a rising number of patients are opting to continue their medication. They have found after consulting with their doctors, that the benefits of keeping their current medication far outweigh any possible risks.

Women who suffer from ADHD who can prescribe adhd medication for adults are planning to nurse should seek the advice of a specialist psychiatrist before becoming pregnant. They should discuss their medication with their doctor and discuss the pros and cons of continued treatment, including non-pharmacological strategies. Psychoeducation is also required to help women with ADHD be aware of their symptoms and underlying disorder and learn about treatment options and reinforce existing coping strategies. This should be a multidisciplinary approach including obstetricians, GPs and psychiatrists. Pregnancy counseling should include discussion of a treatment plan for the mother as well as the child, monitoring of indicators of deterioration, and, if necessary modifications to the medication regime.