ADHD Medication During Pregnancy and Breastfeeding

The choice of whether to stop or continue ADHD medications during breastfeeding and pregnancy is a challenge for women suffering from the condition. There isn't much information on how long-term exposure to these medications could affect the foetus.

A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus don't develop neurological developmental disorders like hearing loss or impaired vision seizures, febrile seizures, or IQ impairment. The authors acknowledge that more high-quality studies are required.

Risk/Benefit Analysis

Women who are expecting and taking ADHD medication must consider the benefits of taking it versus the risks for the foetus. Doctors don't have enough data to provide clear recommendations however they can provide information on risks and benefits to help pregnant women make informed choices.

A study published in Molecular Psychiatry found that women who were taking ADHD medications in early pregnancy did not face a significantly higher risk of fetal cardiac malformations or major birth defects that are structural. Researchers used a large population-based study of case control to examine the prevalence of structural defects that were major in infants born to mothers who took stimulants during pregnancy. Clinical geneticists and pediatric cardiologists reviewed the cases to ensure correct case classification and to limit the chance of bias.

However, the researchers' study had its limitations. The researchers were not able in the beginning to distinguish the effects caused by the medication from the disorder. That limitation makes it difficult to determine whether the small differences observed in the exposed groups result from medication use or comorbidities that cause confusion. The researchers did not look at long-term outcomes for the offspring.

The study did find that babies whose mothers had taken most popular adhd medication; site, 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 stopped their medications before or during pregnancy. This was due to central nervous system-related disorders and the increased risk for admission did not appear to be influenced by the stimulant medications were taken during pregnancy.

Women who were taking stimulant ADHD medications during pregnancy also had a higher chance of having to have a caesarean section or the baby was not scoring well on the Apgar scale (less than 7). These increases did not appear to be influenced by the kind of medication used during pregnancy.

Researchers suggest that the small risks associated with the use ADHD medications during early pregnancies could be offset by the greater benefits to both mother and baby from continuing treatment for the woman’s disorder. Physicians should discuss this with their patients and, when possible, help them develop strategies to improve coping skills that can lessen the effects of her disorder on her daily life and relationships.

Medication Interactions

More and more doctors are faced with the decision of whether to keep treatment or stop during pregnancy as more women are diagnosed with ADHD. Often, these decisions are taken in the absence of solid and reliable evidence regardless, so doctors have to weigh their experience from their own experiences, those of other doctors, and what research suggests about the subject, along with their own best judgment for each patient.

The issue of possible risks to the infant can be extremely difficult. Many of the studies on this subject are based on observations instead of controlled research and their conclusions are often contradictory. The majority of studies restrict their analysis to live-births, which could underestimate the teratogenic impact which can cause terminations or abortions of pregnancy. The study that is discussed in this journal club addresses these shortcomings by examining data on both live and deceased births.

The conclusion: While certain studies have demonstrated a positive association between ADHD medications and the risk of certain birth defects, other studies have found no connection and the majority of studies demonstrate a neutral or slightly negative effect. As a result an accurate risk-benefit analysis must be done in each case.

For a lot of women with ADHD who suffer from add adhd medications, the decision to stop 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 increase depression and feelings of being isolated. A decrease in medication could also affect the ability to drive safely and to perform work-related tasks which are crucial aspects of everyday life for people with ADHD.

She recommends women who are uncertain about whether to continue or stop taking medication because of their pregnancy, consider educating family members, friends, and coworkers on the condition, its effects on daily functioning, and on the advantages of staying on the current treatment regimen. It can also help a woman feel supported in her decision. It is important to note that some medications are able to pass through the placenta therefore, if a patient decides to discontinue her ADHD medication during pregnancy and breastfeeding, she must be aware of the possibility that traces of the drug could be transferred to the child.

Risk of Birth Defects

As the use of online adhd medication drugs to treat symptoms of attention deficit hyperactivity disorder (adhd medication uk buy online) grows, so do concerns over the impact that these drugs could have on foetuses. A recent study published in the journal Molecular Psychiatry adds to the body of information on this topic. Researchers utilized two massive data sets to examine more than 4.3 million pregnancies and determine if stimulant medication use increased birth defects. Researchers discovered that although the overall risk is low, the first trimester ADHD medication use was associated with slightly higher rates of specific heart defects such as ventriculoseptal defect.

The researchers behind the study found no association between early use of medication and congenital abnormalities such as facial clefting or club foot. The results are consistent with previous studies that have shown a small but significant increase in the risk of cardiac malformations among women who started taking ADHD medications prior to the time of pregnancy. This risk increased during the latter half of pregnancy when many women stopped taking their medication.

Women who took ADHD medications during the first trimester of their pregnancy were also more likely to undergo a caesarean section, a low Apgar score following delivery, and a baby that required breathing assistance at birth. The researchers of the study were not able to remove bias in selection since they limited their study to women who did not have any other medical conditions that could have contributed to the findings.

The researchers hope their study will help inform the clinical decisions of physicians who encounter pregnant women. The researchers suggest that while discussing the risks and benefits are important, the choice on whether to continue or stop medication should be made based on the severity of each woman's ADHD symptoms and her needs.

The authors also advise that, while stopping the medication is an alternative, it is not an option that is recommended due to the high prevalence of depression and other mental health issues in women who are pregnant or recently postpartum. Further, research shows that women who stop taking their medication will have a harder transitioning to life without them after the baby is born.

Nursing

It can be overwhelming to become a mom. Women suffering from ADHD can face severe challenges when they must manage their symptoms, attend doctor appointments and prepare for the birth of their child and adjust to a new routine. Many women choose to continue taking their mild adhd medication medication during pregnancy.

The risk to breastfeeding infant is minimal because the majority of stimulant medications is absorbed through breast milk in low amounts. However, the frequency of exposure to medications by the newborn may differ based on the dosage, frequency it is administered and the time of the day the medication is administered. Additionally, different medications enter the baby’s system through the gastrointestinal tract or through breast milk. The impact of these medications on a newborn's health is not fully understood.

Because of the lack of evidence, some doctors might be tempted to stop taking stimulant medications during a woman's pregnancy. This is a difficult decision for the patient, who must weigh the benefit of continuing her medication with the potential risks to the fetus. In the meantime, until more information is available, GPs can inquire about pregnant patients if they have an history of ADHD or if they plan to take medication during the perinatal phase.

Numerous studies have demonstrated that women can continue taking their ADHD medication without risk during pregnancy and breast-feeding. This has led to many patients opt to do this and in consultation with their doctor they have discovered that the benefits of continuing their current medication outweigh any risks.

Women who suffer from ADHD who are planning to breastfeed should seek the advice of an expert psychiatrist prior to becoming pregnant. They should review their medications with their prescriber and discuss the pros and cons of continued treatment, including non-pharmacological 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 strengthen coping mechanisms. This should be a multidisciplinary effort together with obstetricians, GPs, and psychiatry. Pregnancy counseling should include discussion of a treatment plan for the mother as well as the child, monitoring of indicators of deterioration, and, if necessary adjustments to the medication regimen.