ADHD Medication During Pregnancy and Breastfeeding

The decision to stop or keep ADHD medication during pregnancy and nursing is a difficult decision for women suffering from the condition. There are few data on how exposure to ADHD for a long time could affect the fetus.

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

Risk/Benefit Analysis

Women who are expecting and taking ADHD medication should consider the benefits of taking it versus the risks to the baby. Physicians do not have the information needed to provide clear recommendations however they can provide information regarding risks and benefits that assist pregnant women in making informed choices.

A study published in Molecular Psychiatry concluded that women who were taking ADHD medication in early pregnancy did not have a higher risk of fetal malformations or structural birth defects. Researchers used a large population-based case control study to examine the prevalence of structural defects that were major in infants who were born to mothers who were taking stimulants during pregnancy. Pediatric cardiologists and clinical geneticists examined the cases to ensure correct classification of the cases and to reduce the possibility of bias.

However, the researchers' study was not without its flaws. The researchers were not able, in the first place to differentiate the effects caused by the medication from the disorder. This makes it difficult for researchers to determine if the small associations observed among the groups that were exposed to the use of medications, or if they were affected by the presence of comorbidities. The researchers also did not examine long-term outcomes for the offspring.

The study revealed that babies whose mothers took ADHD medication during pregnancy were at a slightly higher chance of being admitted to the neonatal care unit (NICU), compared to mothers who did not take any medication during pregnancy or discontinued taking their medication prior to or during pregnancy. This increase was due to central nervous system disorders, and the increased risk for admission was not found to be influenced by which stimulant medication was used during pregnancy.

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

The research suggests that the risk of a small amount with the use of ADHD medications during the early stages of pregnancy may be offset by the greater benefit to both the mother and child of continued treatment for the woman's disorder. Physicians should discuss the issue with their patients and, where they are able, assist them in developing strategies to improve coping skills that may minimize the effects of her disorder on her daily life and relationships.

Medication Interactions

As more women than ever are being diagnosed with ADHD and being treated with medication, the issue of whether or not to stop treatment during pregnancy is one that more and more doctors have to face. Most of the time, these decisions are made in the absence of any evidence that is clear and definitive regardless, so doctors must weigh what they know about their experiences, the experiences of other doctors, and what the research suggests about the subject and their own best judgment for each individual patient.

The issue of possible risks for infants can be particularly tricky. A lot of studies on this issue are based on observational evidence rather than controlled research, and their conclusions are often contradictory. Most studies restrict their analysis to live-births, which could underestimate the severity of teratogenic effects leading to abortions or terminations of pregnancy. The study discussed in this journal club addresses these shortcomings by looking at data from both live and deceased births.

Conclusion: While some studies have found an association between ADHD medications and certain birth defects however, other studies haven't established a link. Most studies show a neutral, or even slight negative impact. In each case, a careful study of the potential risks and benefits is required.

For a lot of women with ADHD who suffer from ADHD, the decision to stop taking medication can be 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 loneliness. Additionally, the loss of medication can affect the ability to complete job-related tasks and drive safely, which are important aspects of daily life for many people suffering from ADHD.

She suggests that women who are not sure whether to continue taking the medication or stop due to pregnancy, educate their family members, coworkers and friends about the condition, its effects on daily functioning, and the advantages of staying on the current treatment. It can also help women feel more confident in her decision. Certain medications can pass through the placenta. If the patient decides to not take her ADHD medication while pregnant and breastfeeding, it is crucial to be aware that the drug could be transferred to the baby.

Birth Defects and Risk of

As the use and abuse of ADHD medications to treat the symptoms of attention deficit hyperactivity disorder (ADHD) is increasing as does the concern about the potential adverse effects of the drugs on fetuses. A study that was published in the journal Molecular Psychiatry adds to the body of knowledge about this subject. Researchers utilized two massive datasets to analyze over 4.3 million pregnancies and determine whether stimulant medications caused birth defects. Researchers found that while the risk overall is low, the first trimester ADHD medication exposure was associated with slightly higher risk of certain heart defects, like ventriculoseptal defect.

The authors of the study did not discover any connection between the use of early medications and other congenital anomalies such as facial deformities or club feet. The results are in the same vein as previous studies that have shown the existence of a slight, but significant increase in cardiac malformations for women who began taking ADHD medication before pregnancy. The risk was higher during the latter part of pregnancy, when a lot of women begin to discontinue their ADHD medications.

Women who used ADHD medications in the first trimester of pregnancy were also more likely to experience caesarean section, low Apgar score after delivery and a baby that required breathing assistance during birth. The authors of the study could not remove bias in selection since they restricted the study to women who did not have any other medical conditions that could have contributed to the findings.

Researchers hope that their study will provide doctors with information when they encounter pregnant women. The researchers recommend that, while discussing benefits and risks are crucial, the decision about whether to continue or stop medication should be in light of the severity of each woman's ADHD symptoms and the needs of the woman.

The authors also caution that, while stopping the medication 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 recently postpartum. Further, the research suggests that women who decide to stop their medications are more likely to experience a difficult time getting used to life without them following the baby's arrival.

Nursing

The responsibilities of being a new mother can be overwhelming. Women with ADHD can face severe challenges when they must deal with their symptoms, go to doctor appointments, prepare for the birth of a baby and adjust to new routines. Therefore, many women elect to continue taking their ADHD medications throughout pregnancy.

The risk to a nursing infant is low because the majority of stimulant medications passes through breast milk at a low level. However, the rate of exposure to medication by the newborn may differ based on dosage, how often it is administered and the time of the day the medication is administered. Additionally, individual medications enter the baby's system differently through the gastrointestinal tract and breast milk and the impact of this on a newborn is not yet fully known.

Due to the absence of research, some physicians may recommend stopping stimulant medication during the pregnancy of a woman. This is a complicated decision for the patient, who must weigh the benefit of continuing her medication against the potential risks to the fetus. As long as more information is available, GPs may inquire about pregnant patients if they have a background of ADHD or if they are planning to take medication in the perinatal period.

Numerous studies have demonstrated that women can continue taking their ADHD medication safely during pregnancy and breast-feeding. As a result, more and more patients opt to do this, and after consulting with their doctor, they have discovered that the benefits of maintaining their current medication far outweigh any potential risks.

It's important for women with ADHD who are thinking of breastfeeding to seek out a specialist psychiatrist's guidance prior to becoming pregnant. They should discuss their medication with their doctor and discuss the advantages and disadvantages of continued treatment, including non-pharmacological management strategies. Psychoeducation is also needed to help pregnant women suffering from ADHD be aware of the symptoms and the underlying disorder. They should also be informed about treatment options and build coping mechanisms. This should be a multidisciplinary approach with the GP doctors, obstetricians and psychiatrists. Pregnancy counseling should include discussion of a treatment plan for the mother and child, monitoring of indicators types of adhd medication deterioration, and, if needed modifications to the medication regime.