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ADHD Medication During Pregnancy and Breastfeeding

The decision to stop or keep ADHD medications during pregnancy and nursing is a challenge for women suffering from the condition. There aren't enough data on how long-term exposure may affect a foetus.

A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus do not develop neurological developmental disorders like hearing or vision impairment seizures, febrile seizures, or IQ impairment. The authors acknowledge the need for more high-quality research.

Risk/Benefit Analysis

Women who are pregnant and take ADHD medication must consider the benefits of taking it against the possible risks for the foetus. Physicians do not have the necessary data to make unequivocal recommendations but they can provide information about the risks and benefits to help pregnant women make informed decisions.

A study published in Molecular Psychiatry found that women who were taking adhd medication not working medications in early pregnancy did not have a significantly higher risk of fetal cardiac malformations or major structural birth defects. Researchers conducted a large population-based study of case-control to evaluate the incidence of major structural birth defects in babies born to mothers who had taken stimulants during early pregnancy and those who had not. Pediatric cardiologists, clinical geneticists and other experts looked over the cases to confirm that the classification was accurate and to reduce any bias.

However, the researchers' study had its limitations. The researchers were unable, in the first place, to separate the effects of the medication from the disorder. That limitation makes it difficult to determine whether the limited associations observed in the groups that were exposed result from medication use or confounding by comorbidities. The researchers also did not look at long-term outcomes for offspring.

The study found that babies whose mothers took ADHD medication during pregnancy had a slightly greater risk of being admitted to the neonatal care unit (NICU), compared to mothers who did not use any medication during pregnancy or stopped taking their medication before or during pregnancy. This was due to central nervous system disorders. The increased risk of admission was not affected by the stimulant medications used during pregnancy.

Women who were taking stimulant ADHD medications during pregnancy also had a higher risk of having to have a caesarean section or a baby that scored low estrogen and adhd medication on the Apgar scale (less than 7). These increases appeared to be independent of the type of medication used during pregnancy.

Researchers suggest that the small risk of using ADHD medications in early pregnancies could be offset by the greater benefits for baby and mother of continued treatment for the woman’s disorder. Doctors should discuss with their patients about this issue and as much as possible, assist them develop coping skills that can lessen 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 or not to stop treatment during pregnancy is one that more and more physicians confront. Most of the time, these decisions are made without solid and reliable evidence either way, so physicians must weigh what they know about their experiences, the experiences of other doctors, and what the research suggests about the subject as well as their own judgments for each individual patient.

Particularly, the issue of potential risks for the baby can be tricky. Many studies on this topic are based on observations rather than controlled research, and their findings are often contradictory. Most studies focus on live births, which can underestimate the severity of teratogenic effects which can cause terminations or abortions of pregnancy. The study discussed in this journal club addresses these issues by analyzing data on live and deceased births.

The conclusion: While some studies have found a positive association between ADHD medications and the possibility of certain birth defects, other studies have not found any evidence of a link and the majority of studies have a neutral or slight negative effect. Therefore, a careful risk/benefit analysis must be done in each instance.

For women suffering from ADHD, the decision to stop medication is difficult, if not impossible. In a recent article published in Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can increase depression and feelings of isolation. The loss of medication can also affect the ability to drive safely and complete work-related tasks, which are vital aspects of daily life for those with ADHD.

She recommends women who are unsure about whether to continue or stop medication in light of their pregnancy consider informing family members, friends and colleagues on the condition, its impact on daily functioning, and on the advantages of staying on the current treatment regimen. It will also help a woman feel confident about her decision. It is important to remember that certain medications can pass through the placenta so if the patient decides to stop taking her adhd medication pregnancy medication during pregnancy and breastfeeding, she must be aware that the effects of the medication could be passed on to the baby.

Risk of Birth Defects

As the use and misuse of ADHD medications to treat the symptoms of attention deficit hyperactivity disorder (ADHD) is increasing, so does concern about the potential adverse effects of the drugs on foetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge regarding this issue. Using two massive data sets researchers were able look at more than 4.3 million pregnancies and see whether stimulant medications increased the risk of birth defects. Researchers discovered that although the overall risk is low, first-trimester ADHD medication use was associated with slightly higher risk of certain heart defects, such as ventriculoseptal defect.

The authors of the study did not discover any link between early use of medication and other congenital anomalies like facial deformities, or club feet. The results are in the same vein as previous studies that showed the existence of a slight, but significant increase in cardiac malformations for women who started taking ADHD medication prior to pregnancy. The risk grew 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 their pregnancies were also more likely to experience caesarean section, low Apgar score following delivery, and a baby who needed breathing assistance at birth. The researchers of the study were unable to eliminate bias due to selection because they restricted the study to women who did not have any other medical conditions that might 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 the risks and benefits are important, the decision on whether to continue or stop medication should be made according to the severity of each woman's ADHD symptoms and her needs.

The authors also caution that even though stopping the medication is an option, it is not an option to consider due to the high prevalence of depression and other mental health issues in women who are pregnant or who are recently post-partum. Research has also shown that women who stop taking their medication will have a difficult adjustment to life without them after the baby is born.

Nursing

It can be a stressful experience to become a mom. Women with ADHD can face severe challenges when they must manage their symptoms, go to doctor appointments, prepare for the birth of a baby 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 medication passes through breast milk at low levels. The rate of exposure to medication will differ based on dosage, frequency of administration and time of day. Additionally, different medications enter the baby's system differently through the gastrointestinal tract as well as breast milk. The impact of this on a newborn isn't fully known.

Because of the lack of research, some physicians may recommend stopping stimulant medication during the course of pregnancy. It's a difficult choice for the mother, who must weigh the benefits of taking her medication as well as the potential risks to the embryo. As long as there is no more information, GPs should ask all pregnant patients about their history of ADHD and whether they plan or are taking to take medication during the perinatal time.

Many studies have shown that women can continue to take their ADHD medication without risk during pregnancy and breast-feeding. In response, a rising number of patients are choosing to continue their medication. They have concluded, in consultation with their physicians that the benefits of retaining their current medication outweigh risk.

Women who suffer from ADHD who are planning to nurse should seek advice from an expert psychiatrist prior to becoming pregnant. They should discuss their medication with their prescriber and discuss the advantages and disadvantages of continued treatment, including non stimulant adhd medications for adults-pharmacological management strategies. Psychoeducation is also needed to help pregnant women with ADHD recognize the signs and underlying disorder. They should also be informed about treatment options and strengthen strategies for coping. This should be a multidisciplinary process including obstetricians, GPs and psychiatry. The pregnancy counselling should consist of discussion of a management plan for both the mother as well as the child, and monitoring for signs of deterioration, and when necessary, making adjustments to the medication regimen.