ADHD Medication During Pregnancy and Breastfeeding

The decision to stop or keep ADHD medication during pregnancy and nursing is challenging for women with the condition. Little data exists about how does adhd medication work for adults long-term exposure to these drugs can affect the foetus.

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

Risk/Benefit Analysis

Women who are expecting and taking ADHD medication should weigh the benefits of taking it versus the risks for the foetus. Physicians don't have the data needed to provide clear recommendations but they can provide information regarding benefits and risks that can assist pregnant women in making informed decisions.

A study published in Molecular Psychiatry concluded that women who were taking ADHD medication during early pregnancy were not at a higher risk of fetal malformations or structural birth defects. Researchers conducted a large sample-based case control study to compare the incidence of structural defects that were major in infants born to mothers who were taking stimulants during pregnancy. Clinical geneticists and pediatric cardiologists examined the cases to ensure an accurate classification of the cases and to reduce the chance of bias.

However, the researchers' study was not without its flaws. The researchers were unable in the beginning to differentiate the effects caused by the medication from the disorder. That limitation makes it difficult to determine whether the small associations observed in the groups that were exposed are due to the use of medication or confounding by comorbidities. The researchers also did not examine long-term outcomes for offspring.

The study did find that infants whose mothers had taken ADHD medication during pregnancy were at a greater risk of being admitted to the neonatal intensive care unit (NICU) than infants who were born without any medication or had taken off their medication prior to or during pregnancy. This increase was caused by central nervous system disorders. The higher risk of admission was not affected by the stimulant medication used during pregnancy.

Women who took stimulant adhd and medication medication during pregnancy also had an increased chance of having a caesarean section or having a child with an low Apgar score (less than 7). These increases appeared to be unrelated to the type of medication taken during pregnancy.

Researchers suggest that the small risk of using ADHD medications in early pregnancies may be offset by the more beneficial outcomes for both mother and baby from continuing treatment for the woman’s disorder. Doctors should discuss with their patients about this issue and as much as possible, assist them improve coping skills which may reduce the effects of her disorder on her daily functioning and her relationships.

Interactions with Medication

Many doctors are faced with the decision of whether to continue treatment or stop during pregnancy as more women are diagnosed with ADHD. The majority of these decisions are taken in the absence of any evidence that is clear and definitive regardless, so doctors must weigh their knowledge, the experiences of other doctors, and what research suggests on the subject as well as their best judgment for each individual patient.

Particularly, the issue of potential risks for the baby can be a challenge. A lot of studies on this topic are based on observations rather than controlled research and their findings are often contradictory. The majority of studies restrict their analysis to live births, which may underestimate the teratogenic impact which can cause terminations or abortions of pregnancy. The study presented in the journal club addresses these limitations by analyzing both data on live and deceased births.

The conclusion The conclusion: While some studies have shown that there is a positive correlation between ADHD medications and the risk of certain birth defects, other studies have not found any evidence of a link and the majority of studies have a neutral or slightly negative effect. In all cases an in-depth study of the benefits and risks must be performed.

It isn't easy, but not impossible for women with ADHD to stop taking their medication. In an article recently published in 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 those suffering from the disorder. Furthermore, a loss of medication can interfere with the ability to perform job-related tasks and drive safely, which are important aspects of a normal life for many people suffering from ADHD.

She suggests that women who are unsure about whether to continue or stop taking medication because of their pregnancy, consider educating family members, friends and colleagues on the condition, its effects on daily functioning, and the advantages of staying on the current treatment plan. It can also help a woman feel confident about her decision. Some medications can pass through the placenta. If the patient decides to stop taking her ADHD medication while pregnant and breastfeeding, it is crucial to be aware that the drug could be transferred to the infant.

Birth Defects Risk

As the use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) grows, so do concerns about what impact the medications could have on fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge regarding this subject. With two massive data sets researchers were able analyze more than 4.3 million pregnancies to determine whether stimulant medications increased the risk of birth defects. Researchers found that while the overall risk is low, first-trimester ADHD exposure to medication was associated with slightly higher risk of certain heart defects, like ventriculoseptal defects.

The researchers of the study did not discover any connection between early use of medication and other congenital anomalies such as facial deformities or club feet. The findings are in line with previous studies revealing a small but significant increase in the risk of heart malformations among women who started taking ADHD medications before the birth of their child. This risk increased during the latter half of pregnancy, when a lot of women stopped taking their medication.

Women who were taking ADHD medication in the first trimester were more likely to need a caesarean and also have an insufficient Apgar after delivery and had a baby that required help breathing at birth. The authors of the study were unable to remove bias in selection since they limited the study to women with no other medical conditions that could have contributed to the findings.

The researchers hope their study will serve to inform the clinical decisions of doctors who encounter pregnant women. The researchers advise that while discussing benefits and risks are important, the decision regarding whether or not to stop taking medication should be in light of the severity of each woman's ADHD symptoms and her requirements.

The authors also advise that even though stopping the medication is an option, it isn't an option to consider due to the high rate of depression and other mental health problems among women who are pregnant or who are recently post-partum. Research has also shown that women who stop taking their medication will have a tough adjustment to life without them once the baby is born.

Nursing

It can be a stressful experience to become a mom. Women with ADHD are often faced with a number of difficulties when they must manage their symptoms, attend doctor appointments and prepare for the birth of a baby and adjust to new routines. This is why many women choose to continue taking their ADHD medications throughout pregnancy.

The majority of stimulant medications pass through breast milk in very small quantities, so the risk to breastfeeding infant is minimal. The rate of medication exposure will differ based on dosage and frequency of administration as well as the time of the day. In addition, individual medications enter the body of the baby differently through the gastrointestinal tract as well as breast milk, and the effect of this on a newborn is not well understood.

Some doctors may decide to stop stimulant medications during a woman's pregnancy due to the absence of research. This is a difficult decision for the patient, who must balance the benefit of continuing her medication against the potential dangers to the foetus. In the meantime, until more information is available, doctors can inquire about pregnant patients if they have an background of ADHD or if they are planning to take medication during the perinatal period.

A growing number of studies have proven that the majority of women are able to safely continue taking their ADHD medication while they are pregnant and nursing. This has led to an increasing number of patients are choosing to do so, and after consulting with their doctor, they have discovered that the benefits types of Adhd medication maintaining their current medication far outweigh any potential risks.

Women who suffer from ADHD who are planning to breastfeed should seek the advice of a specialist psychiatrist before becoming pregnant. They should discuss their medication with their prescriber and discuss the advantages and disadvantages of continuing treatment, including non-pharmacological strategies. Psychoeducation is also required to help pregnant women suffering from adhd stimulant medication be aware of their symptoms and the root cause and learn about treatment options and strengthen existing strategies for coping. This should be a multidisciplinary effort including obstetricians, GPs, and psychiatrists. Pregnancy counselling should include the discussion of a treatment plan for both the mother as well as the child, monitoring for signs of deterioration, and the need for adjustments to the medication regimen.