adult add medication During Pregnancy and Breastfeeding
The decision to stop or keep ADHD medication during pregnancy and nursing is challenging for women with the condition. There is a lack of information about how long-term exposure to these drugs may affect the fetus.
A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication during utero do not develop neurological disorders such as hearing loss or impaired vision, febrile seizures, or IQ impairment. The authors acknowledge the need for higher-quality studies.
Risk/Benefit Analysis
Women who are pregnant and take ADHD medication need to consider the benefits of taking it versus the dangers for the foetus. Physicians don't have the information needed to give clear guidelines however they can provide information on risks and benefits that aid pregnant women in making informed choices.
A study published in Molecular Psychiatry found that women who used ADHD medications during their early pregnancy did not have an higher risk of fetal cardiac malformations or major structural birth defects. The researchers used a large population-based study of case-control to determine the prevalence of major structural birth defects in babies born to mothers who took stimulants during early pregnancy, and those who did not. Clinical geneticists, pediatric cardiologists and other experts reviewed the cases in order to make sure that the classification was correct and to eliminate any bias.
The study conducted by the researchers was not without limitations. Most important, they were not able to differentiate the effects of the medication from the disorder at hand. This limitation makes it difficult for researchers to determine if the small differences observed between the groups exposed were due to medication use, or if they were caused by the presence of comorbidities. The researchers did not study the long-term effects for the offspring.
The study did find that infants whose mothers took ADHD medication during pregnancy were at a slightly greater risk of being admitted to the neonatal intensive care unit (NICU) than infants whose mothers had not taken any medication or had stopped their medications before or during pregnancy. This increase was caused by central nervous system disorders. The higher risk of admission was not affected by the stimulant medication that was used during pregnancy.
Women who took stimulant ADHD medication during pregnancy were also at an elevated chance of having a caesarean section or having a child with an low Apgar score (less than 7). These increases didn't seem to be influenced by the kind of medication used during pregnancy.
The research suggests that the small risk associated with the use of ADHD medications during early pregnancy could be offset by the higher benefit for both mother and child from continued treatment for the woman's disorder. Physicians should speak with their patients about this issue and try to help them develop coping skills that could reduce the effects of her disorder on her daily functioning and her relationships.
Medication Interactions
As more women than ever before are being diagnosed with ADHD and treated with medication, the dilemma of whether or not to discontinue treatment during pregnancy is a question that doctors are having to have to face. Often, these decisions are made without solid and reliable evidence in either case, which means that doctors have to weigh their experience from their own experiences, those of other doctors, and what the research suggests about the subject and their best judgment for each patient.
The issue of potential risks to infants is extremely difficult. A lot of studies on this issue are based on observational data instead of controlled research and their findings are often contradictory. Additionally, the majority of studies limit their analysis to live births, which can underestimate severe teratogenic effects that lead to abortion or termination of the pregnancy. The study presented in this journal club addresses these issues by looking at data from both live and deceased births.
Conclusion Some studies have revealed an association between ADHD medications and certain birth defects However, other studies haven't found a correlation. The majority of studies show an unintended, or somewhat negative, impact. Therefore, a careful risk/benefit analysis must be conducted in every case.
For women suffering from ADHD who suffer from ADHD, 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 loneliness and family conflict for those suffering from the disorder. The loss of medication can affect the ability to safely drive and perform work-related tasks, which are crucial aspects of normal life for people with ADHD.
She suggests that women who are unsure about whether to continue or discontinue medication due to their pregnancy, consider the possibility of educating friends, family members, and coworkers on the condition, its effects on daily life, and the advantages of staying on the current treatment regimen. It can also help a woman feel confident about her decision. It is important to note that some medications can be absorbed through the placenta so if the patient decides to stop her ADHD medication during pregnancy and breastfeeding, she must be aware that traces of the drug could be transferred to the infant.
Risk of Birth Defects
As the use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases there are concerns about what impact the drugs might have on foetuses. A study that was published in the journal Molecular Psychiatry adds to the existing information on this topic. Utilizing two huge data sets, researchers were able to look at more than 4.3 million pregnancies and see whether stimulant medication use increased the risk of birth defects. Although the risk overall remains low, the researchers discovered that the first-trimester exposure to ADHD medications was associated with an increased risk of certain heart defects like ventriculo-septal defects (VSD).
The researchers of the study didn't discover any link between the use of early medications and congenital anomalies such as facial deformities or club feet. The results are in line with previous studies that have shown the existence of a slight, but significant increase in cardiac malformations for women who began taking ADHD medication before pregnancy. The risk increased in 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 undergo caesarean sections, a low Apgar score following delivery, and a baby who needed breathing assistance during birth. However, the authors of the study were not able to eliminate selection bias by limiting the study to women who didn't have other medical issues that could have contributed to the findings.
The researchers hope their study will aid in the clinical decisions of doctors who see pregnant women. They advise that while discussing the risks and benefits is crucial but the decision to stop or maintain treatment should be based on the woman's needs and the severity of her ADHD symptoms.
The authors caution that, while stopping the medication is an option to consider, it is not advised due to the high prevalence of depression and mental health issues in women who are expecting or recently gave birth. Additionally, research suggests that women who stop taking their medication will have a tough time adjusting to a life without them once the baby is born.
Nursing
It can be overwhelming to become a mother. Women who suffer 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 child and adjust to new routines. 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 medications passes through breast milk at a low level. The rate of exposure to medication can vary depending upon the dosage, frequency of administration and time of day. Additionally, different medications enter the baby’s system through the gastrointestinal tract or through breast milk. The impact of these medications on the health of a newborn isn't fully understood.
Because of the lack of research, some doctors may recommend stopping stimulant medications during the course of pregnancy. It's a difficult choice for the woman, who must weigh the benefits of continuing her medication against the risks to the foetus. Until more information becomes available, doctors can ask pregnant patients if they have an history of ADHD or if they plan to take medication during the perinatal phase.
Numerous studies have proven that women can continue to take their ADHD medication in a safe manner during pregnancy and breast-feeding. In the end, an increasing number of patients are choosing to do so, and after consulting with their doctor, they have discovered that the benefits of continuing their current medication far outweigh any potential risks.
Women who suffer from 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 doctor and discuss the pros and cons of continued treatment, including non-pharmacological strategies. Psychoeducation is also necessary to help pregnant women with ADHD recognize the signs and underlying disorder. They should also be informed about treatment options and reinforce coping mechanisms. This should be a multidisciplinary effort together with obstetricians, GPs and psychiatry. Pregnancy counselling should include discussion of a management plan for both the mother and child, as well as monitoring for signs of deterioration and when necessary, making adjustments to the medication regimen.