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ADHD Medication During Pregnancy and Breastfeeding

Women suffering from ADHD face a difficult decision regarding whether or not to stop taking ADHD medication during pregnancy and breastfeeding. Little data exists about how long-term exposure to these drugs may affect the foetus.

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

Risk/Benefit Analysis

Women who are pregnant and take ADHD medication should evaluate the benefits of using it against the potential dangers for the fetus. 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 informed decisions.

A study published in Molecular Psychiatry found that women who used ADHD medications during early pregnancy did not face an increased risk of fetal cardiac malformations or major birth defects that are structural. Researchers conducted 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 did not. Pediatric cardiologists and clinical geneticists examined the cases to ensure accurate case classification and to limit the possibility of bias.

The study of the researchers was not without limitations. The researchers were unable, in the first place to distinguish the effects triggered by the medication from the disorder. This limitation makes it difficult for researchers to determine if the few associations observed between the groups that were exposed to medication use, or if they were confounded by co-morbidities. In addition the study did not examine the long-term outcomes of offspring.

The study did show that babies whose mothers had taken ADHD medication during pregnancy were at slightly more risk of being admitted to the neonatal intensive care unit (NICU) than infants who were born without any medication or stopped their medications before or during pregnancy. This was due to central nervous system-related disorders, and the higher risk of admission did not appear to be influenced by the stimulant medications were used during pregnancy.

Women who used stimulant ADHD medication during pregnancy also had an elevated chance of having a caesarean birth or having a child with a low Apgar score (less than 7). These increases didn't appear to be influenced by the type of medication that was used during pregnancy.

Researchers suggest that the small risk of using ADHD medication during pregnancies in the early stages may be offset by the more beneficial outcomes for both mother and baby of continuing treatment for the woman's condition. Physicians should discuss the issue with their patients and, where they are able, assist them in developing strategies for improving their coping skills that may minimize the impact of her disorder on her daily life and relationships.

Medication Interactions

Many doctors are confronted with the dilemma of whether to maintain treatment or stop it during pregnancy as more women are diagnosed with ADHD. The majority of these decisions are taken in the absence of clear and authoritative evidence regardless, so doctors must weigh what they know about their experiences, the experiences of other doctors, and what medication is prescribed for adhd the research suggests on the subject and their own judgments for each individual patient.

Particularly, the subject of potential risks to the infant can be difficult. The research on this issue is based on observation rather than controlled studies, and the results are conflicting. Additionally, the majority of studies limit their analysis to live births, which could underestimate the severity of teratogenic effects that could cause abortion or termination of the pregnancy. The study that is discussed in the journal club addresses these limitations by analyzing information on deceased and live births.

The conclusion: While certain studies have demonstrated an association between ADHD medications and the risk of certain birth defects, others have not found any evidence of a link, and most studies demonstrate a neutral or slightly negative effect. In all cases an in-depth analysis of the benefits and risks is required.

For many women with ADHD, the decision to discontinue medication is difficult, if not impossible. In a recent article in Archives of Women's Mental Health, psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can lead to increased depression, feelings of loneliness and family conflict for these patients. Additionally, the loss of medication may affect the ability to complete work-related tasks and safely drive that are crucial aspects of daily life for many people with ADHD.

She suggests that women who aren't sure whether to take the medication or stop due to pregnancy, educate their family members, colleagues, and acquaintances about the condition, its impact on daily functioning and the benefits of keeping the current treatment regimen. In addition, educating them can aid in ensuring that the woman feels supported in her struggle with her decision. It is important to note that certain medications can pass through the placenta, therefore, if a patient decides to discontinue her ADHD medication during pregnancy and breastfeeding, she should be aware of the possibility that traces of the drug can be transferred to the infant.

Risk of Birth Defects

As the use of ADHD medication to treat the symptoms of attention deficit hyperactivity disorder (ADHD) increases as do concerns over the impact that these medications could have on fetuses. Recent research published in the journal Molecular Psychiatry has added to the body knowledge on this subject. Researchers used two massive data sets to study over 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 exposure to medication was associated with slightly higher rates of specific heart defects such as ventriculoseptal defect.

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 which showed a small, but significant increase in the number of cardiac malformations among women who began taking ADHD medication prior to pregnancy. This risk increased in the later part of pregnancy, when many women are forced to stop taking their medication.

Women who took ADHD medication in the first trimester were more likely to require a caesarean birth or have an insufficient Apgar after delivery and have a baby that needed help breathing when they were born. However the researchers of the study were not able to eliminate selection bias by restricting the study to women who didn't have any other medical issues that could have contributed to the findings.

Researchers hope their research will help doctors when they see pregnant women. They recommend that, while a discussion of the benefits and risks is important but the decision to stop or continue medication should be based on each woman's requirements and the severity of her ADHD symptoms.

The authors also warn that while discontinuing the medications is an option, it is not an option to consider due to the high incidence of depression and other mental health issues in women who are pregnant or postpartum. Furthermore, research suggests that women who choose to stop taking their medication are more likely to experience a difficult time getting used to life without them following the birth of their baby.

Nursing

The responsibilities of being a new mother can be overwhelming. Women who suffer from ADHD are often faced with a number of difficulties when they have to manage their symptoms, attend doctor appointments and prepare for the birth of their child and adjust to new routines. As such, many women elect to continue taking their ADHD medications throughout the course of pregnancy.

The majority of stimulant medications are absorbed by breast milk in low amounts, therefore the risk to infant who is breastfeeding is low. The rate of medication exposure will differ based on dosage the medication is administered, its frequency and the time of day. In addition, individual medications enter the body of the baby differently through the gastrointestinal tract and breast milk. The impact of this on a newborn infant is not fully known.

Due to the absence of research, some physicians may be inclined to discontinue stimulant medication during the course of pregnancy. This is a difficult choice for the patient, who must weigh the benefits of continuing her best medication for inattentive adhd against the possible risks to the foetus. In the meantime, until more information is available, GPs should ask all pregnant patients about their history of adhd and anxiety medication and if they are taking or planning to take medication during the perinatal time.

A increasing number of studies have shown that most women can safely continue to take their ADHD medication while they are pregnant and nursing. In response, a rising number of patients are choosing to do this. They have discovered through consultation with their doctor, that the benefits of continuing their current medication far outweigh any risk.

It is essential for women with ADHD who are considering breastfeeding to seek a specialist psychiatrist's advice prior to becoming pregnant. They should discuss their medication with their physician and discuss the pros and cons of continued treatment, including non-pharmacological strategies. Psychoeducation is also required to help pregnant women with ADHD understand the symptoms and underlying disorder. They should also learn about treatment options and reinforce the coping mechanisms. This should be a multidisciplinary approach with the GPs, obstetricians and psychiatrists. Pregnancy counseling should include discussion of a treatment plan for the mother and child, as well as monitoring for indicators types of adhd medication deterioration, and, if needed, adjustments to the medication regimen.