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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. There aren't enough data on how long-term exposure may affect the pregnant fetus.
A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication during the uterus do not develop neurological developmental disorders like hearing or vision impairment seizures, febrile seizures, or IQ impairment. The authors acknowledge that further high-quality studies are required.
Risk/Benefit Analysis
Women who are pregnant and taking ADHD medications must weigh the advantages of taking them against the potential risks to the foetus. The doctors don't have the information to provide clear recommendations, but can provide information on the risks and benefits to 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 an higher risk of fetal cardiac malformations or major structural birth defects. The researchers used a large population-based study of case-control to evaluate the incidence of major structural birth defects in infants born to mothers who took stimulants during early pregnancy and those who had not. Clinical geneticists and pediatric cardiologists looked over the cases to ensure an accurate case classification and to minimize the chance of bias.
However, the study was not without its flaws. Researchers were unable in the beginning to distinguish the effects of the medication from the disorder. This makes it difficult to determine whether the small associations observed in the groups that were exposed result from medication use or confounding by comorbidities. Researchers also did not study the long-term effects for the offspring.
The study found that infants whose mothers had taken ADHD medication during pregnancy had a greater risk of being admitted to the neonatal care unit (NICU), compared to those whose mothers didn't take any medication during pregnancy, or had quit taking the medication prior to or during pregnancy. This increase was caused by central nervous system disorders. The increased risk of admission was not influenced by the stimulant medications used during pregnancy.
Women who were taking stimulant ADHD medication during pregnancy also had an increased chance of having a caesarean birth or having a child with low Apgar score (less than 7). These risks did not appear to be affected by the type of medication that was used during pregnancy.
Researchers suggest that the minor risks posed by the use of ADHD medication during pregnancies in the early stages may be offset by the more beneficial outcomes for both baby and mother of continued treatment for the woman's condition. Doctors should discuss with their patients about this and, if possible, help them develop coping skills that may reduce the impact of her disorder in her daily functioning and her relationships.
Medication Interactions
As more women than ever before are being diagnosed with ADHD and treated with medication, the question of whether to continue or discontinue treatment during pregnancy is one that more and more doctors have to face. The majority of these decisions are made without any evidence that is clear and definitive regardless, so doctors have to weigh their experience, the experiences of other doctors, and what the research suggests about the subject and their best judgment for each patient.
In particular, the issue of potential risks for the infant can be difficult. Many studies on this issue are based on observations rather than controlled research, and their findings are often contradictory. Most studies restrict their analysis to live births, which may underestimate the teratogenic impact that can lead to terminations or abortions of pregnancy. The study presented in this journal club addresses these limitations by examining data on both live and deceased births.
The conclusion is that while some studies have found a positive association between ADHD medications and the possibility of certain birth defects, other studies have found no such relationship and the majority of studies demonstrate a neutral or slight negative effect. As a result an accurate risk-benefit analysis must be done in each case.
It isn't easy, but not impossible, for women suffering from ADHD to stop taking their medication. In a recent article in Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can cause depression and feelings of being isolated. A decrease in medication could also affect the ability to safely drive and perform work-related tasks, which are essential aspects of everyday life for those suffering from ADHD.
She suggests that women who are not sure whether to continue taking the medication or discontinue it due to pregnancy, educate their family members, colleagues, and friends about the condition, the impact on daily functioning and the benefits of keeping the current treatment plan. It can also help a woman feel supported in her decision. Certain medications can be passed through the placenta. If the patient decides not to take her ADHD medication while pregnant and breastfeeding, it is crucial to be aware that the medication could be transferred to the infant.
Risk of Birth Defects
As the use and abuse of ADHD medications to treat the symptoms of attention deficit disorder hyperactivity disorder (ADHD) is increasing as does the concern about the potential adverse effects of the drugs on the fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge on this subject. Utilizing two huge data sets researchers were able examine more than 4.3 million pregnancies to determine whether stimulant medication use increased the risk of birth defects. Researchers found that while the overall risk is low, the first trimester ADHD medication exposure was associated with slightly higher rates of specific heart defects like ventriculoseptal defect.
The researchers of the study did not discover any connection between early use of medication and other congenital anomalies like facial deformities or club feet. The results are in agreement with previous studies which showed the existence of a slight, but significant increase in the number of cardiac malformations among women who began taking ADHD medication prior to the time of the birth of their child. The risk grew during the latter part of pregnancy, when many women begin to discontinue their medication.
Women who used ADHD medication in the first trimester of their pregnancies were also more likely to have caesarean sections, a low Apgar score following delivery, and a baby that required breathing assistance at birth. However the researchers of the study were unable to eliminate bias due to selection by restricting the study to women who didn't have other medical issues that could be a contributing factor to these findings.
Researchers hope that their research will provide doctors with information when they meet pregnant women. They advise that while the discussion of risks and benefits is important however, the decision to stop or maintain medication should be based on the woman's requirements and the severity of her ADHD symptoms.
The authors warn that, while stopping the medication is an option to consider, it is not recommended due to the high rate depression and other mental problems among women who are pregnant or recently gave birth. Research has also shown that women who stop taking their medications will have a difficult adjustment to life without them after the baby is born.
Nursing
It can be a stressful experience to become a mother. Women with ADHD may face a lot of challenges when they must manage their symptoms, go to doctor appointments and prepare for the birth of their child and adjust to a new routine. Many women opt to continue taking their ADHD medication during pregnancy.
The majority of stimulant medicines are absorbed through breast milk in low quantities, so the risk for breastfeeding infant is minimal. However, the frequency of exposure to medications by the newborn can vary depending on dosage, frequency it is administered, and the time of the day the medication is administered. Additionally, different medications enter the body of the baby differently through the gastrointestinal tract and breast milk, and the effect of this on a newborn infant is not well known.
Some doctors may stop taking stimulant medications during a woman's pregnancy due to the lack of research. This is a difficult decision for the patient, who must weigh the benefits of continuing her medication against the potential dangers to the fetus. Until more information becomes available, doctors may ask pregnant patients if they have a history of ADHD or if they intend to take medication in the perinatal stage.
A increasing number of studies have proven that most women can safely continue to take their ADHD medication during pregnancy and while breastfeeding. This has led to an increasing number of patients choose to do so and after consulting with their doctor, they have found that the benefits of continuing their current medication far outweigh any risks.
Women with ADHD who are planning to breastfeed should seek advice from a specialist psychiatrist prior to becoming pregnant. They should discuss the medication they are taking with their physician as well as the pros and cons for continuing treatment. This includes non-pharmacological methods. Get the facts is also required to help pregnant women suffering from ADHD be aware of the symptoms and the underlying disorder. They should also learn about treatment options and reinforce strategies for coping. This should involve a multidisciplinary approach, which includes the GP as well as obstetricians, psychiatry and obstetricians. Counselling for pregnancy should include the discussion of a plan for management for both the mother and child, and monitoring for signs of deterioration, and the need for adjustments to the medication regimen.