ADHD Medication During Pregnancy and Breastfeeding
The decision to stop or keep ADHD medication during breastfeeding and pregnancy is a challenge for women suffering from the condition. There aren't many studies regarding how exposure over time may affect a pregnant fetus.
A recent study published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological disorders such as hearing loss or vision, febrile seizures or IQ impairment. The authors acknowledge that more high quality studies are needed.
Risk/Benefit Analysis
Women who are expecting and taking ADHD medication need to weigh the benefits of taking it against the possible risks to the baby. Doctors don't have the necessary data to make unequivocal recommendations however they can provide information on the risks and benefits to help pregnant women make informed decisions.
A study published in Molecular Psychiatry found that women who were taking ADHD medications during their early pregnancy did not face an higher risk of fetal cardiac malformations or major birth defects that are structural. Researchers conducted a large sample-based case control study to assess the frequency of structural defects that were major in infants who were born to mothers who were taking stimulants during pregnancy. Pediatric cardiologists, clinical geneticists and other experts reviewed the cases in order to make sure that the classification was correct and to minimize any bias.
The research conducted by the researchers had some limitations. Researchers were unable, in the first place, to separate the effects triggered by the medication from the disorder. This makes it difficult to know whether the small associations observed in the groups that were exposed are due to medication use or comorbidities that cause confusion. Additionally the study did not examine the long-term outcomes of offspring.
The study did show that infants whose mothers took ADHD medications during pregnancy were at a greater risk of being admitted to the neonatal intensive care unit (NICU) than those who whose mothers did not take any medication or taken off their medication prior to or during pregnancy. This increase was caused by central nervous system disorders. The higher 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 to have caesarean sections or one whose baby scored low on the Apgar scale (less than 7). These increases did appear to be unrelated to the type of medication taken during pregnancy.
Researchers suggest that the minor risks associated with the use ADHD medications in early pregnancies may be offset by the more beneficial outcomes for both mother and baby of continuing treatment for the woman's condition. Physicians should discuss the issue with their patients and, if they are able, assist them in developing strategies to improve coping skills which can reduce the negative impact of her condition on her daily life and relationships.
Medication Interactions
More and more doctors are confronted with the dilemma of whether to maintain treatment or stop 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 physicians and the research on the subject.
In particular, the issue of possible risks to the infant can be difficult. A lot of studies on this subject are based on observational data instead of controlled research and their conclusions are often contradictory. In addition, most studies limit their analysis to live births, which may underestimate the severity of teratogenic effects that could lead to abortion or termination of the pregnancy. The study that is discussed in the journal club addresses these issues, by examining both data on live and deceased births.
Conclusion Some studies have found an association between ADHD medications and certain birth defects However, other studies haven't shown such a relationship. Most studies have shown a neutral, or even slight negative effect. In the end, a careful risk/benefit analysis must be conducted in every situation.
For many women with ADHD and ADD, the decision to stop taking medication is difficult, if not impossible. In a recent piece published in Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can cause depression and feelings of loneliness. A loss of medication may affect the ability to drive safely and to perform work-related tasks which are vital aspects of everyday life for people with ADHD.
She recommends that women who are unsure about whether to keep or stop taking medication because of their pregnancy should consider informing family members, friends and colleagues about the condition, its effects on daily functioning, and the advantages of continuing the current treatment regimen. In addition, educating them can aid in ensuring that the woman feels supported when she is struggling with her decision. It is also worth noting that certain medications can pass through the placenta, so if the patient decides to discontinue her ADHD medication during pregnancy and breastfeeding, she should be aware that traces of the drug can be transferred to the child.
Birth Defects and Risk of
As the use and use of ADHD drugs to treat symptoms of attention deficit disorder hyperactivity disorder (ADHD) is increasing the concern over the possible effects of the drugs on the fetuses. A study that was published in the journal Molecular Psychiatry adds to the body of knowledge on this subject. Researchers used two huge data sets to examine more than 4.3 million pregnant women and determine whether stimulant medications caused birth defects. Researchers discovered that, while the overall risk is low, first-trimester ADHD exposure to medication was associated with slightly higher risk of certain heart defects, such as ventriculoseptal defect.
The researchers of the study found no association between the use of early medications and other congenital abnormalities, like facial clefting, or club foot. The results are in the same vein as previous studies that showed a small, but significant increase in cardiac malformations for women who began taking ADHD medication before pregnancy. The risk increased in the latter stages of pregnancy when many women decided to stop taking their medication.
Women who were taking ADHD medication in the first trimester were more likely to need a caesarean and also have a low Apgar after delivery and have a baby who needed help breathing after birth. The authors of the study were unable to remove bias in selection since they limited their study to women without other medical conditions that might have contributed to the findings.
The researchers hope their research will serve to inform the clinical decisions of physicians who encounter pregnant women. The researchers advise that, while discussing the risks and benefits are important, the decision on whether to continue or stop medication should be in light of the severity of each woman's ADHD symptoms and her needs.
The authors caution that, even though stopping the medication is an option to think about, it isn't recommended due to the high prevalence of depression and other mental problems for women who are pregnant or who have recently given birth. Further, research shows that women who stop taking their medication will have a difficult read more adjustment to life without them after the baby is born.
Nursing
The responsibilities of a new mom can be overwhelming. Women with ADHD who have to manage their symptoms while attending doctor appointments, making preparations for the arrival of a child and adjusting to new household routines may face a lot of challenges. Many women opt to continue taking their ADHD medication during pregnancy.
The risk to breastfeeding infant is not too high since the majority of stimulant medication passes through breast milk in low amounts. The rate of medication exposure will vary based on the dosage and frequency of administration as well as the time of the day. In addition, various drugs enter the infant's system through the gastrointestinal tract or through breast milk. The impact on a newborn's health is not completely understood.
Some physicians may discontinue stimulant medication during a woman's pregnancy due to the lack of research. This is a difficult choice for the patient, who must balance the benefits of keeping her medication with the potential risks to the foetus. In the meantime, until more information is available, GPs can inquire about pregnant patients if they have a background of ADHD or if they plan to take medication in the perinatal stage.
A increasing number of studies have shown that women can continue to take their ADHD medication during pregnancy and breastfeeding. In response, a growing number of patients are opting to do this. They have concluded, in consultation with their doctor, that the benefits of continuing their current medication outweigh any possible risks.
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 review their medications with their prescriber and discuss the advantages and disadvantages of continued treatment, including non-pharmacological management strategies. Psychoeducation is also required to help pregnant women with ADHD be aware of the symptoms and the underlying disorder. They should also be educated about treatment options and build coping mechanisms. This should involve a multidisciplinary approach, which includes the GP as well as obstetricians, psychiatry and obstetricians. Pregnancy counselling should include the discussion of a plan for management for both the mother as well as the child, and monitoring for signs of deterioration and when necessary, making adjustments to the medication regimen.