ADHD Medication During Pregnancy and Breastfeeding

Women with ADHD must make a difficult decision about whether to continue or stop taking ADHD medication during pregnancy and breastfeeding. Little data exists about how long-term exposure to these medications may affect the fetus.

A recent study published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological disorders such as impaired hearing or vision, febrile seizures or IQ impairment. The authors acknowledge that more high-quality research is needed.

Risk/Benefit Analysis

Women who are pregnant and taking ADHD medication need to weigh the benefits of taking it against the possible dangers for the foetus. The doctors don't have the information to give clear advice however they can provide information about risks and benefits to help pregnant women make an informed decision.

A study published in Molecular Psychiatry found that women who used ADHD medications during early pregnancy did not have an increased risk of fetal cardiac malformations or major structural birth defects. Researchers conducted a large, population-based case-control study to assess the risk of major structural birth defects in babies born to mothers who had taken stimulants in early pregnancy, as well as those who had not. Pediatric cardiologists, clinical geneticists and other experts examined the cases to ensure that the classification was correct and to minimize any bias.

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

The study revealed that infants whose mother had taken ADHD medication during pregnancy had a higher chance of being admitted to the neonatal care unit (NICU) in comparison to those whose mothers did not take any medication during pregnancy, or had discontinued taking their medication prior to or during pregnancy. This was due to central nervous system disorders. The higher risk of admission was not influenced by the stimulant medication used during pregnancy.

Women who were taking stimulant ADHD medications during pregnancy also had a higher likelihood of having to have an emergency caesarean section or having one whose baby scored low on the Apgar scale (less than 7). These increases appeared to be unrelated to the type of medication used during pregnancy.

Researchers suggest that the minor risk of using ADHD medications in early pregnancies can be offset by greater benefits to both baby and mother of continued treatment for the woman's condition. Physicians should discuss the issue with their patients and, if they are able, assist them in developing strategies to improve coping skills that can lessen the impact of her disorder on her daily life and relationships.

Medication Interactions

Doctors are increasingly faced with the decision of whether to maintain treatment or stop during pregnancy as more women are diagnosed with ADHD. These decisions are often taken without clear and authoritative evidence. Instead, physicians must weigh their own knowledge, the experience of other doctors and the research that has been conducted on the subject.

Particularly, the issue of potential risks to the infant can be difficult. The research that has been conducted on this topic is based on observation rather than controlled studies, and the results are conflicting. Furthermore, most studies restrict their analysis to live births, which may underestimate the severity of teratogenic effects that could result in abortion or termination of the pregnancy. The study that is discussed in the journal club addresses these limitations by analyzing data on live and deceased births.

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 found no connection and the majority of studies have a neutral or slightly negative effect. In the end an accurate risk-benefit analysis must be conducted in every case.

It isn't easy, but not impossible for women suffering from 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 patients with ADHD. A loss of medication may affect the ability to safely drive and perform work-related tasks, which are essential aspects of everyday life for those with ADHD.

She suggests that women who are unsure whether to continue taking the medication or stop it due to their pregnancy, educate their family members, coworkers and friends about the condition, its impact on daily functioning and the advantages of staying on the current treatment. It can also help the woman feel supported as she struggles with 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 passed on to her baby.

Risk of Birth Defects

As the use and abuse of ADHD drugs to treat symptoms of attention deficit disorder hyperactivity disorder (ADHD) increases, so does concern about the possible effects of the drugs on the fetuses. A recent study published in the journal Molecular Psychiatry adds to the body of knowledge click here on this subject. Researchers used two massive data sets to study over 4.3 million pregnant women and determine whether stimulant medications increased birth defects. While the overall risk remains low, the researchers found that exposure in the first trimester to ADHD medications was linked to an increase in the risk of certain heart defects, such as ventriculoseptal defect (VSD).

The authors of the study didn't find any association between early use of medication and other congenital anomalies such as facial deformities or club feet. The results are in line with previous studies that have shown an insignificant, but small increase in cardiac malformations for women who began taking ADHD medication before the birth of their child. The risk increased in the latter part of pregnancy when many women began to stop taking their medication.

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

Researchers hope that their study will inform physicians when they see pregnant women. The researchers recommend that while discussing risks and benefits are important, the decision regarding whether or not to stop medication should be in light of the severity of each woman's ADHD symptoms and her requirements.

The authors warn that, although stopping the medication is an option to look into, it is not advised due to the high rate depression and other mental problems among women who are pregnant or have recently given birth. Research has also shown that women who stop taking their medications will have a harder adjustment to life without them after the baby is born.

Nursing

It can be a challenge becoming a mother. Women who suffer from ADHD can face severe challenges when they have to manage their symptoms, attend doctor appointments, prepare for the birth of a child and adjust to a new routine. Many women choose to continue taking their ADHD medication during pregnancy.

The risk to a breastfeeding infant is not too high since the majority of stimulant medications is absorbed through breast milk in low amounts. The amount of exposure to medications will vary based on the dosage and frequency of administration as well as the time of the day. 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 is not yet fully known.

Some doctors may decide to stop stimulant medications during a woman's pregnancy due to the absence of research. It is a difficult decision for the woman who must weigh the advantages of continuing her medication against the risk to the fetus. Until more information is available, GPs should ask all pregnant patients about their experience with ADHD and if they are taking or planning to take medication during the perinatal period.

A increasing number of studies have shown that most women can safely continue taking their ADHD medication during pregnancy and breastfeeding. In the end, more and more patients choose to do so, and in consultation with their doctor they have discovered that the benefits of keeping their current medication far outweigh any risks.

It is essential for women with ADHD who are contemplating breastfeeding to seek out a specialist psychiatrist's advice prior becoming pregnant. They should discuss the medication they are taking with their physician as well as the pros and cons of continuing treatment. This includes non-pharmacological methods. Psychoeducation should also be provided to help pregnant women suffering from ADHD understand their symptoms and the underlying disorder and learn about treatment options and reinforce existing strategies for managing. This should include a multidisciplinary approach with the GP doctors, obstetricians and psychiatrists. Pregnancy counseling should consist of a discussion of a treatment plan for the mother and the child, and monitoring for indicators of deterioration, and, if necessary adjustments to the medication regimen.