ADHD Medication During Pregnancy and Breastfeeding

Women with ADHD face a difficult decision about whether to continue or stop taking ADHD medication during pregnancy and breast-feeding. Little data exists about how long-term exposure to these drugs can affect the fetus.

A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological disorders such as hearing loss or vision, febrile seizures, or IQ impairment. The authors acknowledge that further high-quality studies are needed.

Risk/Benefit Analysis

Women who are expecting and taking ADHD medication need to evaluate the benefits of using it against the potential risks for the baby. Physicians do not have the data needed to make unequivocal recommendations but they can provide information about benefits and risks that can help pregnant women make informed choices.

A study published in Molecular Psychiatry found that women who took ADHD medications during their early pregnancy did not have a significantly increased risk of fetal cardiac malformations or major birth defects that are structural. The researchers used a large, population-based case-control study to determine the prevalence of major structural birth defects in infants born to mothers who had taken stimulants in early pregnancy and those who had not. Clinical geneticists and pediatric cardiologists reviewed the cases to ensure an accurate case classification and to minimize the possibility of bias.

The study conducted by the researchers was not without its limitations. Most important, they were unable to distinguish the effects of the medication from the underlying disorder. This makes it difficult for researchers to determine if the small differences observed between the groups exposed were due to the use of medications, or if they were confounded by comorbidities. The researchers 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 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 that was used during pregnancy.

Women who took stimulant ADHD medications during pregnancy also had a higher likelihood of having an emergency caesarean section or having a baby that scored low on the Apgar scale (less than 7). These increases did not appear to be affected by the kind of medication used during pregnancy.

Researchers suggest that the small risk of using ADHD medications during early pregnancies can be offset by greater benefits for mother and baby from continuing treatment for the woman’s disorder. Physicians should discuss the issue with their patients and, if possible, help them develop strategies for improving their coping skills that may minimize the effects of her disorder on her daily functioning and relationships.

Medication Interactions

More and more doctors are faced with the decision of whether to maintain treatment or stop it during pregnancy as more women are diagnosed with ADHD. The majority of these decisions are made in the absence of any evidence that is clear and definitive 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 as well as their own best judgment for each individual patient.

Particularly, the issue of potential risks for the infant can be difficult. The research on this subject is based on observations rather than controlled studies and a lot of the results are in conflict. Most studies limit their analysis to live births, which may underestimate the teratogenic impact leading to abortions or terminations of pregnancy. The study discussed in this journal club addresses these issues by analyzing data on live and deceased births.

Conclusion Some studies have revealed an association between ADHD medications and certain birth defects, other studies have not found a correlation. Most studies have shown a neutral, or even slightly negative, impact. In each case, a careful study of the benefits and risks is required.

For many women with ADHD who suffer from ADHD, the decision to discontinue 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 being isolated. The loss of medication can also affect the ability to drive safely and complete work-related tasks, which are crucial aspects of daily life for those suffering from ADHD.

She suggests that women who aren't sure whether to continue taking medication or stop due to pregnancy, educate their family members, coworkers, and acquaintances about the condition, the impact on daily functioning and the benefits of keeping the current treatment plan. It will also help a woman feel confident about her decision. Some medications can pass through the placenta. If a patient decides to stop taking her ADHD medication while pregnant and breastfeeding, it is important to be aware that the medication could be transferred to the infant.

Risk of Birth Defects

As the use and misuse of ADHD medication to treat symptoms of attention deficit hyperactivity disorder (buy adhd medication online uk), increases, so does concern about the potential effects of these drugs on fetuses. A study that was published in the journal Molecular Psychiatry adds to the body of information on this topic. Researchers used two massive data sets to study more than 4.3 million pregnancies and determine if the use of stimulant medications 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 like ventriculoseptal defects.

The researchers of the study found no association between early medication use and other congenital abnormalities, such as facial clefting or club foot. The results are in agreement with previous studies which showed the existence of a slight, but significant increase in cardiac malformations for women who began taking ADHD medication prior to pregnancy. This risk increased during the latter half of pregnancy when a large number of women decided to stop taking their medication.

Women who took ADHD medications in the first trimester of their pregnancies were also more likely to experience caesarean section, low Apgar score after delivery and a baby that required help breathing at birth. However the authors of the study were unable to eliminate selection bias by limiting the study to women who did not have other medical issues that could have contributed to the findings.

The researchers hope their research will help inform the clinical decisions of doctors who encounter pregnant women. The researchers advise that while discussing risks and benefits are important, the choice about whether to continue or stop medication should be in light of the severity of each woman's ADHD symptoms and her requirements.

The authors also advise that, while stopping the medication is an option, it isn't a recommended practice because of the high incidence of depression and other mental health issues in women who are pregnant or post-partum. Further, the research suggests that women who decide to stop taking their medication are more likely to have difficulties adjusting to life without them after the baby's arrival.

Nursing

It can be overwhelming becoming a mother. Women suffering from ADHD may face a lot of challenges when they have to manage their symptoms, attend doctor appointments, prepare for the birth of their child and adjust to new routines. Therefore, many women elect to continue taking their ADHD medication throughout the pregnancy.

The risk to nursing infant is low because the majority of stimulant medication passes through breast milk at a low level. The amount of exposure to medications can vary depending upon the dosage, frequency of administration and the time of the day. In addition, Different Adhd Medications medications enter the baby’s system through the gastrointestinal tract or breast milk. The effect on the health of a newborn isn't fully known.

Because of the lack of research, some physicians might be tempted to stop taking stimulant medications during the pregnancy of a woman. This is a complicated decision for the patient, who must balance the benefits of keeping her medication against the possible risks to the embryo. In the meantime, until more information is available, doctors can ask pregnant patients whether they have an history of ADHD or if they plan to take medication in the perinatal stage.

Numerous studies have demonstrated that women can continue to take their ADHD medication in a safe manner during pregnancy and while breast-feeding. As a result, many patients choose to do so and in consultation with their physician, they have discovered that the benefits of continuing their current medication far outweigh any risks.

Women who suffer from ADHD who are planning to nurse should seek the advice of a specialist psychiatrist prior to becoming pregnant. They should review their medications with their prescriber and discuss the advantages and disadvantages of continued treatment, including non-pharmacological management strategies. Psychoeducation is also required to help pregnant women suffering from ADHD understand their symptoms and underlying disorder and learn about treatments and to reinforce existing strategies for managing. This should include an approach that is multidisciplinary, including the GP doctors, obstetricians and psychiatrists. The pregnancy counselling should consist of the discussion of a plan for management for both mother and child, monitoring for signs of deterioration and the need for adjustments to the medication regimen.