ADHD Medication During Pregnancy and Breastfeeding
The decision to stop or continue ADHD medication during pregnancy and breastfeeding is challenging for women with the condition. There aren't enough data on how long-term exposure may affect a pregnant fetus.
A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological problems such as hearing loss or 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 must consider the benefits of taking it versus the risks to the fetus. The doctors don't have the information to make unambiguous recommendations however they can provide information on risks and benefits to assist pregnant women to make informed choices.
A study published in Molecular Psychiatry concluded that women who took ADHD medication during early pregnancy were not at a higher risk of fetal malformations, or 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 had taken stimulants during early pregnancy, and those who did not. Clinical geneticists and pediatric cardiologists reviewed the cases to ensure correct case classification and to minimize the chance of bias.
However, the study had its limitations. Most important, they were unable to separate the effects of the medication from the disorder at hand. That limitation makes it difficult to know whether the small differences observed in the exposed groups are due to the use of medication or the confounding effect of comorbidities. The researchers also did not examine the long-term effects for the offspring.
The study did show that infants whose mothers took ADHD medication during pregnancy were at a slightly more risk of being admitted to the neonatal intensive care unit (NICU) than those who whose mothers did not take any medication or had cut back on their medications prior to or during pregnancy. This was due to central nervous system-related disorders and the higher risk of admission was not found to be affected by the type of stimulant medications were taken during pregnancy.
Women who took stimulant ADHD medications during pregnancy also had a higher risk of having to have caesarean sections or one whose baby scored low on the Apgar scale (less than 7). These increases did not appear to be influenced by the type of medication that was used during pregnancy.
The research suggests that the low risk associated with the use of ADHD medications during the early stages of pregnancy could be offset by the greater benefit to both the mother and child of continuing treatment for the woman's condition. Physicians should speak with their patients about this issue and, if possible, help them improve coping skills which can lessen the impact of her disorder in her daily life and relationships.
Interactions with Medication
As more women than ever are being diagnosed with ADHD and being treated with medication, the issue of whether or not to discontinue treatment during pregnancy is one that more and more doctors have to face. Most of the time, these decisions are made in the absence of any evidence that is clear and definitive regardless, so doctors must weigh what they know, the experiences of other doctors, and what research suggests on the subject, along with their best judgment for each patient.
Particularly, the issue of potential risks to the baby can be a challenge. The research that has been conducted on this topic is based on observations instead of controlled studies and many of the findings are contradictory. Furthermore, most studies restrict their analysis to live births, which could undervalue the serious teratogenic effects that can cause abortion or termination of the pregnancy. The study discussed in this journal club addresses these limitations by looking at data from both live and deceased births.
Conclusion A few studies have found 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, effect. In the end an accurate risk-benefit analysis must be done in each instance.
For a lot of women with ADHD and ADD, the decision to stop taking medication is difficult, if not impossible. In a recent article published in the Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can lead to depression and feelings of isolation. The loss of medication can also impact the ability to safely drive and perform work-related tasks, which are crucial aspects of everyday life for those with ADHD.
She suggests women who are unsure about whether to continue or discontinue medication due to their pregnancy should consider the possibility of educating friends, family members and colleagues about the condition, its impact on daily functioning, and on the benefits of keeping the current treatment plan. It can also help a woman feel confident about her decision. Some medications can pass through the placenta. If a woman decides to not take her ADHD medication while pregnant and breastfeeding, it's important to be aware that the medication 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 as do concerns about the effects that the drugs might have on foetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge on this issue. With two massive data sets researchers were able to examine more than 4.3 million pregnancies and see whether stimulant medications increased the risk of birth defects. While the overall risk remains low, the scientists did find that first-trimester exposure to ADHD medicines was associated with an increased risk of certain heart defects, such as ventriculoseptal defect (VSD).
The authors of the study found no connection between early medication use and other congenital abnormalities, like facial clefting, or club foot. The results are in line with previous studies showing an increase, but not significant, in the risk of cardiac malformations among women who began taking ADHD medications before the time of pregnancy. The risk was higher in the later part of pregnancy, when a lot of women decide to stop taking their ADHD medication.
Women who used ADHD medications during the first trimester of pregnancy were also more likely to undergo a caesarean section, a low Apgar score following delivery, and a baby that required help breathing at birth. However the authors of the study were unable to eliminate bias due to selection by restricting the study to women who did not have other medical issues that could have contributed to these findings.
Researchers hope that their research will inform physicians when they encounter pregnant women. The researchers advise that, while discussing risks and benefits are important, the decision about whether to continue or stop taking medication should be based on the severity of each woman's ADHD symptoms and her requirements.
The authors caution that, even though stopping the medication is an option to think about, it isn't advised due to the high prevalence of depression and other mental disorders among women who are pregnant or recently gave birth. Further, the research suggests that women who choose to stop taking their medication are more likely to experience difficulties getting used to life without them after the birth of their baby.
Nursing
The responsibilities of a new mother can be overwhelming. adhd treatment without medication who suffer from ADHD are often faced with a number of difficulties when they must manage their symptoms, go to doctor appointments and prepare for the birth of a baby and adjust to a new routine. This is why many women elect to continue taking their ADHD medications throughout the course of 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 frequency of exposure to medications by the newborn can vary depending on dosage, frequency it is taken and the time of day the medication is administered. In addition, various medications are introduced into the baby's system via the gastrointestinal tract or through breast milk. The effect on the health of a newborn is not fully understood.
Some doctors may stop taking stimulant medication during a woman’s pregnancy due to the absence of research. It is a difficult decision for the mother, who must weigh the benefits of continuing her medication against the risks to the embryo. Until more information is available, GPs should ask all pregnant patients about their experience with ADHD and if they plan or are taking to take medication during the perinatal time.
Numerous studies have demonstrated that women can continue taking their ADHD medication safely while breastfeeding and during pregnancy. In response, a growing number of patients are opting to do this. They have discovered after consulting with their physicians that the benefits of continuing their current medication far outweigh any risk.
It is essential for women with ADHD who are considering breastfeeding to seek out a specialist psychiatrist's advice prior becoming pregnant. They should discuss their medication with their prescriber as well as the pros and cons of continuing treatment. This includes non-pharmacological strategies. Psychoeducation should also be provided to help women with ADHD understand their symptoms and the underlying disorder Learn about the available treatment options and strengthen existing strategies for coping. This should be a multidisciplinary process including obstetricians, GPs, and psychiatry. Pregnancy counseling should consist of a discussion of a treatment plan for the mother and the child, as well as monitoring for signs of deterioration and, if needed adjustments to the medication regimen.