Ask Me Anything: 10 Responses To Your Questions About ADHD Medication Pregnancy
Ask Me Anything: 10 Responses To Your Questions About ADHD Medication Pregnancy
Blog Article
ADHD Medication During Pregnancy and Breastfeeding
The decision to stop or continue ADHD medications during pregnancy and breastfeeding is a difficult decision for women suffering from the condition. There aren't many studies regarding how exposure over time may affect the fetus.
A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological disorders such as impaired hearing or vision, febrile seizures or IQ impairment. The authors acknowledge the need for higher-quality studies.
Risk/Benefit Analysis
Women who are pregnant and taking ADHD medications need to balance the advantages of taking them against the potential risks to the fetus. Physicians don't have the data to make unambiguous recommendations, but can provide information on risks and benefits to help pregnant women make informed decisions.
A study published in Molecular Psychiatry found that women who were taking ADHD medications in 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 compare the incidence of major structural defects in infants who were born to mothers who took stimulants during pregnancy. Pediatric cardiologists and clinical geneticists looked over the cases to ensure correct classification of the cases and to reduce the chance of bias.
However, the researchers' study had its limitations. The most important issue was that they were unable to distinguish the effects of the medication from the effects of the disorder that is underlying. This makes it difficult for researchers to determine whether the few associations observed between the exposed groups were due to the use of medications or if they were affected by comorbidities. The researchers did not examine the long-term effects for the offspring.
The study did show that babies whose mothers had taken ADHD medications during pregnancy were at 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 influenced by the stimulant medication used during pregnancy.
Women who took stimulant ADHD medications during pregnancy also had a higher likelihood of having a caesarean section or a baby that scored low on the Apgar scale (less than 7). These risks did not appear to be influenced by the kind of medication used during pregnancy.
The researchers suggest that the risk of a small amount with the use of ADHD medications during early pregnancy could be offset by the greater benefit for both mother and child of continuing treatment for the woman's disorder. Physicians should discuss this with their patients and, if they are able, assist them in developing strategies to improve their coping abilities which can reduce the negative impact of her condition on her daily life and relationships.
Interactions with Medication
Many doctors are confronted with the dilemma of whether to keep treatment or stop during pregnancy as more women are diagnosed with ADHD. These decisions are usually made without clear and authoritative evidence. Instead, doctors must take into account their own experience in conjunction with the experiences of other doctors and the research on the subject.
Particularly, the subject of potential risks for the baby can be tricky. Many of the studies on this topic are based on observational evidence instead of controlled research and their findings are often contradictory. In addition, most studies limit their analysis to live births, which may underestimate the severity of teratogenic effects that could result in abortion or termination of the pregnancy. The study presented in this journal club addresses these limitations by analyzing data on live and deceased births.
Conclusion Some studies have revealed a positive correlation between ADHD medications and certain birth defects, other studies have not found a correlation. Most website studies show a neutral, or even slight negative impact. As a result, a careful risk/benefit assessment must be conducted in every situation.
For many women with ADHD and ADD, the decision to discontinue medication is difficult if not impossible. In a recent article in Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can lead to depression and feelings of being isolated. The loss of medication can also affect the ability to drive safely and perform work-related tasks, which are crucial aspects of daily life for those with ADHD.
She suggests that women who are unsure about whether to continue or stop medication in light of their pregnancy, consider informing family members, friends, and coworkers on the condition, its impact on daily functioning, and on the advantages of continuing the current treatment regimen. It can also help women feel confident about her decision. It is important to remember that some medications are able to pass through the placenta so if the patient decides to discontinue her ADHD medication during pregnancy and breastfeeding, she should be aware that the effects of the drug could be transferred to the infant.
Risk of Birth Defects
As the use and abuse of ADHD medications to treat the symptoms of attention deficit hyperactivity disorder (ADHD), increases the concern over the possible effects of the drugs on foetuses. A study that was published in the journal Molecular Psychiatry adds to the existing knowledge about this subject. Researchers used two massive data sets to examine over 4.3 million pregnant women and determine if stimulant medication use caused birth defects. Researchers discovered that, while the risk overall is low, first-trimester ADHD medication use was associated with slightly higher risk of specific heart defects like ventriculoseptal defect.
The authors of the study found no connection between early medication use and congenital abnormalities such as facial clefting or club foot. The findings are in line with previous studies showing a small but significant increase in the risk of heart malformations in women who started taking ADHD medications prior to pregnancy. The risk increased in the latter part of pregnancy when many women stopped taking their medication.
Women who took ADHD medication during the first trimester were more likely to require a caesarean delivery or have an insufficient Apgar after delivery, and have a baby who needed help breathing after birth. However the authors of the study were not able to eliminate selection bias by restricting the study to women who didn't have any other medical issues that could be a contributing factor to these findings.
The researchers hope their study will aid in the clinical decisions of physicians who see pregnant women. They recommend that, while discussing the risks and benefits is crucial however, the decision to stop or continue medication should be based on the woman's needs and the severity of her ADHD symptoms.
The authors warn that, while stopping the medication is a possibility to consider, it is not advised due to the high rate depression and mental health issues among women who are pregnant or who have recently given birth. Additionally, the research suggests that women who decide to stop their medications are more likely to have a difficult time adjusting to life without them following the birth of their baby.
Nursing
It can be overwhelming to become a mother. Women with ADHD may face a lot of challenges when they have to manage their symptoms, attend doctor appointments and prepare for the birth of a child and adjust to a new routine. Therefore, many women choose to continue taking their ADHD medications throughout the course of pregnancy.
The risk for breastfeeding infant is minimal because the majority of stimulant medication passes through breast milk at low levels. However, the rate of exposure to medication by the infant can differ based on dosage, how often it is administered, and the time of day the medication is administered. Additionally, individual medications enter the baby's system differently through the gastrointestinal tract and breast milk and the impact of this on a newborn infant is not well known.
Due to the absence of research, some doctors might be tempted to stop taking stimulant drugs during the pregnancy of a woman. This is a difficult choice for the patient, who must weigh the benefit of continuing her medication against the potential risks to the fetus. In the meantime, until more information is available, GPs should ask all pregnant patients about their experience with ADHD and if they are taking or planning to take medication during the perinatal period.
A increasing number of studies have proven that most women can safely continue taking their ADHD medication during pregnancy and while breastfeeding. In response, a growing number of patients are choosing to do so. They have concluded through consultation with their doctors, that the benefits of keeping their current medication outweigh risk.
It is crucial for women suffering from ADHD who are contemplating breastfeeding to seek out a specialist psychiatrist's advice prior becoming pregnant. They should discuss their medication with their physician and discuss the pros and cons of continued treatment, including non-pharmacological management strategies. Psychoeducation is also necessary to help pregnant women with ADHD be aware of the symptoms and underlying disorder. They should also learn about treatment options and strengthen coping mechanisms. This should include a multidisciplinary approach, which includes the GP, obstetricians and psychiatry. Pregnancy counseling should consist of a discussion of a treatment plan for the mother as well as the child, monitoring of signs of deterioration and, if needed adjustments to the medication regime.