ADHD Medication During Pregnancy and Breastfeeding

The choice of whether to stop or continue ADHD medications during pregnancy and nursing is a challenge for women suffering from the condition. There aren't enough data on how exposure to ADHD for a long time could affect a pregnant fetus.

A recent study 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 higher-quality research.

Risk/Benefit Analysis

Women who are pregnant and taking ADHD medication should weigh the benefits of taking it against the possible risks to the fetus. Physicians don't have the data needed to make unequivocal recommendations however they can provide information regarding risks and benefits that help pregnant women make informed decisions.

A study published in Molecular Psychiatry found that women who took ADHD medications in early pregnancy did not face a significantly increased risk of fetal heart malformations or major structural birth defects. The researchers used a large population-based study of case-control to evaluate the incidence of major structural birth defects in babies born to mothers who had taken stimulants during the early stages of pregnancy and those who had not. Pediatric cardiologists and clinical geneticists reviewed the cases to ensure an accurate classification of the cases and to reduce the possibility of bias.

The study of the researchers was not without its limitations. The most important issue was that they were unable to separate the effects of the medication from the effects of the disorder that is underlying. This makes it difficult for researchers to establish whether the few associations observed between the exposed groups were due to the use of medications or if they were affected by the presence of comorbidities. Researchers also did not study long-term outcomes for offspring.

The study found that babies whose mothers had taken ADHD medication during pregnancy had a higher risk of admission to the neonatal care unit (NICU) as compared to those whose mothers did not take any medication during pregnancy, or had stopped taking their medication before or during pregnancy. This was due to central nervous system-related disorders and the increased risk for admission was not found to be influenced by which stimulant medications were taken during pregnancy.

Women who took stimulant ADHD medication during pregnancy were also at an elevated risk of having a caesarean birth or having a child with an low Apgar score (less than 7). These increases did appear to be unrelated to the type of medication taken during pregnancy.

Researchers suggest that the small risks associated with the use ADHD medication during pregnancies in the early stages could be offset by the greater benefits to both baby and mother of continued treatment for the woman's disorder. Physicians should discuss the issue with their patients and, when possible, assist them in developing strategies to improve coping skills that may minimize the impact of her disorder on her daily functioning and relationships.

Medication Interactions

As more women than ever are being diagnosed with ADHD and being treated with medication, the dilemma of whether to keep or end treatment during pregnancy is one that more and more physicians have to face. These decisions are frequently made without clear and authoritative evidence. Instead, doctors must consider their own expertise in conjunction with the experiences of other doctors and the research on the subject.

The issue of potential risks for infants can be difficult to determine. Many studies on this subject are based on observational data instead of controlled research and their conclusions are often contradictory. Furthermore, most studies restrict their analysis to live births, which can underestimate severe teratogenic effects that result in abortion or termination of the pregnancy. The study that is discussed in the journal club addresses these limitations by analyzing both the data from deceased and live births.

Conclusion A few studies have revealed an association between ADHD medications and certain birth defects, other studies have not shown such a relationship. Most studies show an unintended, or slightly negative, effect. In the end an accurate risk-benefit analysis is required in every situation.

For a lot of women with ADHD, the decision to stop taking medication is 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 cause depression, feelings of isolation, and family conflict for patients with ADHD. Furthermore, a loss of medication can affect the ability to do work-related tasks and safely drive which are essential aspects of a normal life for many people with ADHD.

She suggests that women who aren't sure whether to continue taking the medication or stop due to pregnancy should educate family members, coworkers, and acquaintances about the condition, the impact on daily functioning and the benefits of continuing the current treatment. In addition, educating them can aid in ensuring that the woman feels supported in her struggle with her decision. It is also worth noting that certain medications can pass through the placenta so if the patient decides to stop her ADHD medication during pregnancy and breastfeeding, she must be aware of the possibility that traces of the medication could be passed on to the baby.

Risk of Birth Defects

As the use of adhd inattentive type medication medications to treat symptoms of attention deficit hyperactivity disorder (ADHD) grows, so do concerns about what impact the drugs might have on fetuses. A recent study published in the journal Molecular Psychiatry adds to the body of knowledge about this subject. Researchers used two huge datasets to analyze more than 4.3 million pregnant women and determine whether stimulant medications increased the risk of birth defects. Researchers found that while the risk overall is low, the first trimester ADHD exposure to medication was associated with slightly higher risk of specific heart defects such as ventriculoseptal defect.

The researchers of the study did not discover any connection between early medication usage and congenital anomalies like facial deformities or club feet. The results are consistent with previous studies showing the presence of a small, but significant increase in the risk of cardiac malformations among women who began taking ADHD medications before the birth of their child. This risk increased during the latter half of pregnancy when a large number of women began to stop taking their medication.

Women who used ADHD medications during the first trimester of pregnancy were also more likely to experience caesarean section, low Apgar score following delivery, and a baby who required breathing assistance at birth. However, the authors of the study were unable to eliminate selection bias by restricting the study to women who didn't have any other medical conditions that could have contributed to these findings.

The researchers hope that their research will aid in the clinical decisions of doctors who see pregnant women. They suggest that although a discussion of the risks and benefits is crucial but the decision to stop or keep medication must be based on each woman's requirements and the severity of her ADHD symptoms.

The authors also caution that, while stopping the medication is an option, it isn't an option to consider due to the high prevalence of depression and other mental health problems in women who are pregnant or who are recently postpartum. Further, the research suggests that women who choose to stop taking their medications are more likely to experience a difficult time getting used to life without them following the baby's arrival.

Nursing

It can be a stressful experience to become a mom. Women with ADHD who have to manage their symptoms while attending physician appointments and 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 majority of stimulant medicines are absorbed by breast milk in very small amounts, so the risk to the breastfeeding infant is minimal. However, the amount of medication exposure to the newborn may differ based on dosage, how does medication for adhd work often it is administered and the time of day it is administered. In addition, individual medications enter the baby's system differently through the gastrointestinal tract and breast milk, and the effect of this on a newborn is not well known.

Some doctors may decide to stop stimulant medication for adhd and bipolar during a woman’s pregnancy due to the absence of research. It's a difficult choice for the woman who must weigh the advantages of taking her medication as well as the risks to the embryo. In the meantime, until more information is available, GPs can inquire about pregnant patients if they have an history of ADHD or if they are planning to take medication during the perinatal stage.

A increasing number of studies have proven that women can doctors prescribe adhd medication continue taking their ADHD medication during pregnancy and breastfeeding. In response, a growing number of patients are opting to do so. They have found through consultation with their doctors, that the benefits of keeping their current medication outweigh any potential risks.

Women with ADHD who are planning to nurse should seek the advice of an expert psychiatrist prior to becoming pregnant. They should review their medications with their prescriber and discuss the advantages and disadvantages of continued treatment, including non stimulant adhd medications for adults-pharmacological strategies. Psychoeducation should also be offered to help pregnant women suffering from adhd medication pregnancy [official website] recognize their symptoms and the underlying disorder and learn about treatment options and reinforce existing strategies for coping. This should be an approach that is multidisciplinary, including the GP, obstetricians and psychiatry. Pregnancy counseling should include a discussion of a treatment plan for the mother and the child, monitoring of signs of deterioration and, if necessary adjustments to the medication regimen.