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 are few data on how exposure to ADHD for a long time could affect a pregnant fetus.
A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological problems like hearing loss or vision, febrile seizures, or IQ impairment. medication for adult add acknowledge that more high quality research is needed.
Risk/Benefit Analysis
Women who are pregnant and taking ADHD medications must weigh the benefits of using them against the risks to the fetus. Physicians don't have the data needed to give clear guidelines, but they can provide information about benefits and risks that can assist pregnant women in making informed decisions.
A study published in Molecular Psychiatry found that women who were taking ADHD medications during their early pregnancy did not face an increased risk of fetal cardiac malformations or major structural birth defects. Researchers conducted a large sample-based case control study to assess the frequency of major structural defects in infants born to mothers who took stimulants during pregnancy. Pediatric cardiologists and clinical geneticists examined the cases to ensure correct case classification and to minimize the possibility of bias.
The study conducted by the researchers was not without limitations. In particular, they were unable to distinguish the effects of the medication from those of the underlying disorder. This limitation makes it difficult for researchers to determine whether the small associations observed among the exposed groups were due to the use of medications or if they were caused by comorbidities. Researchers also did not look at long-term outcomes for the offspring.
The study found that infants whose mothers had taken ADHD medication during pregnancy had a greater risk of being admitted to the neonatal care unit (NICU), compared to mothers who did not take 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 affected by the type of stimulant medication was used during pregnancy.
Women who were taking stimulant ADHD medications during pregnancy also had a higher risk of having caesarean sections or the baby was not scoring well on the Apgar scale (less than 7). These increases appeared to be unrelated to the type of medication used during pregnancy.
The research suggests that the low risk associated with the use of ADHD medications during the early stages of pregnancy may be offset by the greater benefit to both mother and child of continuing treatment for the woman's condition. Physicians should talk to their patients about this and as much as possible, assist them improve coping skills which can lessen the impact of her disorder in her daily life and relationships.
Medication Interactions
As more women than ever are being diagnosed with ADHD and being treated with medication, the dilemma of whether or not to discontinue treatment during pregnancy is one that more and more doctors confront. Often, these decisions are made in the absence of any evidence that is clear and definitive either way, so physicians have to weigh their experience, the experiences of other doctors, and what the research suggests on the subject and their own best judgment for each individual patient.
The issue of possible risks to infants is particularly tricky. The research on this issue is based on observation rather than controlled studies, and many of the findings are in conflict. Furthermore, most studies restrict their analysis to live births, which may underestimate severe teratogenic effects that cause abortion or termination of the pregnancy. The study discussed in the journal club addresses these shortcomings, by examining both information on deceased and live births.
The conclusion: While some studies have found a positive association between ADHD medications and the risk of certain birth defects, others have not found any evidence of a link, and most studies have a neutral or slightly negative effect. In every case an in-depth evaluation of the potential risks and benefits is required.
It isn't easy, but not impossible, for women with ADHD to stop taking their medication. In a recent article 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. A decrease in medication could also affect the ability to safely drive and to perform work-related tasks which are essential aspects of normal life for those with ADHD.
She suggests that women who are not sure whether to continue taking medication or stop due to pregnancy, educate their family members, coworkers, and friends about the condition, the impact on daily functioning and the advantages of staying on the current treatment. It can also help women feel supported in her decision. Certain medications can be passed through the placenta. If a patient decides to not take her ADHD medication while pregnant and breastfeeding, it's important to be aware that the drug could be passed on to her infant.
Risk of Birth Defects
As the use and misuse of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD), increases the concern over 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. Researchers utilized two massive data sets to examine over 4.3 million pregnancy and determine if the use of stimulant medications caused birth defects. Researchers discovered that, while the risk overall is low, first-trimester ADHD medication use was associated with slightly higher risk of certain heart defects, such as ventriculoseptal defect.
The authors of the study found no connection between the use of early medications and congenital abnormalities 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 prior to the time of pregnancy. This risk increased during the latter part of pregnancy, as many women begin to discontinue their ADHD medications.
Women who took ADHD medications in the first trimester of their pregnancies were also more likely to undergo a caesarean section, a low Apgar score following delivery, and a baby who required help breathing at birth. However the authors of the study were unable to eliminate selection bias by restricting the study to women who did not have any other medical conditions that could have contributed to these findings.
Researchers hope that their study will provide doctors with information when they meet pregnant women. The researchers suggest that, while discussing benefits and risks are important, the choice regarding whether or not to stop medication should be made in light of the severity of each woman's ADHD symptoms and the needs of the woman.
The authors also warn that while discontinuing the medications is an option, it is not a recommended practice because of the high incidence of depression and other mental health issues among women who are pregnant or recently post-partum. Furthermore, research suggests that women who choose to stop taking their medications are more likely to experience a difficult time adapting to life without them after the baby's arrival.
Nursing
The responsibilities of a new mom can be overwhelming. Women who suffer from ADHD who have to deal with their symptoms while attending physician appointments and making preparations for the arrival of a child and getting used to new routines at home can experience severe challenges. Many women opt to continue taking their ADHD medication during pregnancy.
The majority of stimulant medications are absorbed through breast milk in low amounts, therefore the risk for breastfeeding infant is minimal. The amount of exposure to medications can vary depending upon the dosage, frequency of administration and the time of the day. Additionally, individual medications enter the baby's system differently through the gastrointestinal tract as well as breast milk. The impact of this on a newborn infant is not well known.
Because of the lack of evidence, some doctors may be inclined to discontinue stimulant drugs during the pregnancy of a woman. It's a difficult choice for the mother, who must weigh the benefits of her medication against the potential risks to the fetus. In the meantime, until more information is available, doctors can inquire about pregnant patients whether they have a background of ADHD or if they are planning to take medication in the perinatal phase.
A growing number of studies have proven that the majority of women are able to safely continue to take their ADHD medication while they are pregnant and nursing. As a result, many patients opt to do this, and in consultation with their physician, they have found that the benefits of keeping their current medication far exceed any risk.
It is essential for women with ADHD who are considering breastfeeding to seek a specialist psychiatrist's guidance prior to becoming pregnant. They should discuss their medication with their prescriber as well as the pros and cons for continuing treatment. This includes non-pharmacological strategies. 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 the coping mechanisms. This should involve a multidisciplinary approach with the GP, obstetricians and psychiatry. Pregnancy counselling should include the discussion of a plan for management for both the mother as well as the child, monitoring for signs of deterioration, and, if necessary, adjustments to the medication regimen.