ADHD Medication During Pregnancy and Breastfeeding

Women with ADHD must make 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 foetus.

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 the need for higher-quality research.

Risk/Benefit Analysis

Pregnant women who take ADHD medications need to balance the benefits of taking them against potential risks to the fetus. Physicians do not have the necessary data to provide clear recommendations but they can provide information regarding the risks and benefits to assist pregnant women in making informed decisions.

A study published in Molecular Psychiatry concluded that women who were taking ADHD medication in early pregnancy were not at a higher risk of fetal malformations, or structural birth defects. The researchers used a large population-based case-control study to assess the risk of major structural birth defects in babies born to mothers who had taken stimulants during early pregnancy, and those who did not. Pediatric cardiologists and clinical geneticists looked over the cases to ensure accurate case classification and to limit the chance of bias.

The study conducted by the researchers had some limitations. In particular, they were unable to separate the effects of the medication from the effects of the underlying disorder. This limitation makes it difficult for researchers to establish whether the few associations observed between the exposed groups were due to medication use or confounded by the presence of comorbidities. Additionally the study did not examine the long-term outcomes of offspring.

The study revealed that infants whose mother had taken ADHD medication during pregnancy had a slightly higher chance of being admitted to the neonatal care unit (NICU), compared to mothers who didn't take any medication during pregnancy or had stopped taking their medication before or during pregnancy. This increase was caused by central nervous system disorders. The higher risk of admission was not affected by the stimulant medications used during pregnancy.

Women who took stimulant ADHD medications during pregnancy also had a higher likelihood of having caesarean sections or the baby was not scoring well on the Apgar scale (less than 7). These increases did not appear to be affected by the type of medication that was used during pregnancy.

Researchers suggest that the minor risks posed by the use of ADHD medication during pregnancies in the early stages can be offset by more beneficial outcomes for both mother and baby from continuing treatment for the woman’s disorder. Doctors should discuss with 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 functioning and her relationships.

Medication Interactions

As more women than ever before are being diagnosed with ADHD and being treated with medication, the dilemma of whether to continue or end treatment during pregnancy is one that doctors are having to have to face. The majority of these decisions are made without any evidence that is clear and definitive regardless, so doctors must weigh their knowledge, the experiences of other doctors, and what research says on the topic and their own judgments for each patient.

The issue of risk for infants can be particularly tricky. Many studies on this issue are based on observations rather than controlled research and their conclusions are often contradictory. The majority of studies limit their analysis to live births, which may underestimate the severity of teratogenic effects which can cause abortions or terminations of pregnancy. The study that is discussed in the journal club addresses these issues by analyzing both information on deceased and live births.

Conclusion Some studies have shown an association between ADHD medications and certain birth defects however, other studies haven't established a link. Most studies have shown an unintended, or slightly negative, impact. In each case, a careful analysis of the risks and benefits must be performed.

For a lot of women with ADHD and ADD, the decision to stop medication can be difficult, if not impossible. In an article recently published in the 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 loss of medication may also affect the ability to drive safely and perform work-related tasks, which are vital aspects of normal life for those with ADHD.

She suggests that women who are not sure whether to continue taking the medication or stop due to pregnancy should educate family members, colleagues, and their friends about the condition, the effects on daily functioning, and the advantages of staying on the current treatment plan. In addition, educating them can make the woman feel more comfortable in her struggle with her decision. Certain medications can be passed through the placenta. If a patient decides to stop taking her ADHD medication while pregnant and breastfeeding, it's important to be aware that the medication could be passed on to her infant.

Birth Defects Risk

As the use and misuse of ADHD medication to treat symptoms of attention deficit disorder hyperactivity disorder (ADHD) is increasing as does the concern about the potential effects of these drugs on foetuses. A recent study published in the journal Molecular Psychiatry adds to the body of information on this topic. Using two massive data sets, researchers were able to examine more than 4.3 million pregnancies and determine whether stimulant medication use increased the risk of birth defects. Although the risk overall remains low, the scientists did find that first-trimester exposure to ADHD medications was associated with an increased risk of specific heart defects, like ventriculo-septal defects (VSD).

The researchers of the study didn't find any association between the use of early medications and other congenital anomalies, like facial deformities, or club feet. The results are in agreement with previous studies that have shown the existence of a slight, 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 stages of pregnancy when many women stopped taking their medication.

Women who took ADHD medication during the first trimester were more likely need a caesarean and also have a low Apgar after delivery, and have a baby who needed breathing assistance after birth. However the authors of the study were unable to eliminate bias due to selection by restricting the more info study to women who didn't have any other medical issues that could have contributed to the findings.

The researchers hope that their research will aid in the clinical decisions of physicians who see pregnant women. They advise that while a discussion of the risks and benefits is crucial however, the decision to stop or maintain treatment should be based on each woman's requirements and the severity of her ADHD symptoms.

The authors caution that, although stopping the medication is a possibility to think about, it isn't advised because of the high incidence of depression and mental health issues for women who are pregnant or have recently given birth. Furthermore, research suggests that women who decide to stop their medications are more likely to experience a difficult time getting used to life without them following the birth of their baby.

Nursing

It can be a stressful experience to become a mom. Women suffering from ADHD may face a lot of challenges when they have to manage their symptoms, go to doctor appointments, prepare for the birth of a baby and adjust to new routines. Many women decide to continue taking their ADHD medication during pregnancy.

The majority of stimulant drugs pass through breast milk in very small amounts, therefore the risk to infant who is breastfeeding is low. However, the frequency of exposure to medications by the newborn may differ based on dosage, how often it is administered, and the time of the day the medication is administered. In addition, individual medications enter the body of the baby differently through the gastrointestinal tract and breast milk. The impact of this on a newborn infant is not yet fully known.

Because of the lack of research, some physicians may be inclined to discontinue stimulant drugs during the course of pregnancy. It is a difficult decision for the woman, who must weigh the benefits of her medication against the risks to the foetus. As long as more information is available, GPs may inquire about pregnant patients whether they have an background of ADHD or if they plan to take medication during the perinatal period.

Many studies have shown that women can continue taking their ADHD medication in a safe manner during pregnancy and breast-feeding. In the end, more and more patients are choosing to do so and, in consultation with their physician, they have found that the benefits of maintaining their current medication far exceed any risk.

It is essential for women with ADHD who are contemplating breastfeeding to seek a specialist psychiatrist's guidance prior to becoming pregnant. They should review their medications with their doctor and discuss the pros and cons of continued treatment, including non-pharmacological management strategies. Psychoeducation should also be provided to help pregnant people with ADHD be aware of their symptoms and the underlying disorder and learn about treatment options and reinforce existing strategies for managing. This should be a multidisciplinary approach, which includes the GP as well as obstetricians, psychiatry and obstetricians. Counselling for pregnancy should include the discussion of a plan for management for both mother and child, monitoring for signs of deterioration and when necessary, making adjustments to the medication regimen.