ADHD Medication During Pregnancy and Breastfeeding

Women suffering from ADHD face a difficult decision about whether to continue or stop taking ADHD medication for odd and adhd during pregnancy and breast-feeding. There are few data on how long-term exposure may affect the foetus.

A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological issues like hearing loss or vision, febrile seizures or IQ impairment. The authors acknowledge that more high quality research is needed.

Risk/Benefit Analysis

Women who are expecting and taking ADHD medication should consider the benefits of taking it against the possible risks for the fetus. Physicians do not have the information needed to give clear guidelines however they can provide information about risks and benefits that help pregnant women make informed decisions.

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

However, the study had its limitations. Researchers were unable in the beginning to distinguish the effects caused by the medication from the disorder. This limitation makes it difficult for researchers to determine if the small associations observed among the groups that were exposed to the use of medication or if they were confounded by co-morbidities. The researchers did not examine the long-term effects for the offspring.

The study did reveal that infants whose mothers took adhd focus medication medications during pregnancy were at a higher risk of being admitted to the neonatal intensive care unit (NICU) than infants who were born without any medication or taken off their medication prior to or during pregnancy. This increase was caused by central nervous system disorders. The higher risk of admission was not affected by the stimulant medication 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 baby born with a low Apgar score (less than 7). These increases didn't appear to be affected by the kind of medication used during pregnancy.

Researchers suggest that the minor risks associated with the use ADHD medication during pregnancies in the early stages 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 try to help them develop coping strategies that may reduce the impact of her disorder in her daily functioning and her relationships.

Interactions with Medication

Many doctors are confronted with the dilemma of whether to maintain treatment or stop as more women are diagnosed with ADHD. These decisions are usually made without clear and authoritative evidence. Instead, doctors have to weigh their own knowledge and experience, as well as the experiences of other doctors and the research on the topic.

The issue of risk to the infant can be extremely difficult. The research on this subject is based on observations rather than controlled studies and the results are conflicting. Additionally, the majority of studies limit their analysis to live births, which can undervalue the serious teratogenic effects that can result in abortion or termination of the pregnancy. The study presented in this journal club addresses these issues by examining data on both live and deceased births.

Conclusion: While some studies have shown a positive correlation between ADHD medications and certain birth defects, other studies have not established a link. The majority of studies show an unintended, or somewhat negative, effect. In each case an in-depth study of the risks and benefits must be performed.

For women suffering from ADHD, the decision to stop taking 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 being isolated. A loss of medication may affect the ability to safely drive and to perform work-related tasks which are crucial aspects of daily life for those with ADHD.

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

Risk of Birth Defects

As the use and abuse of adhd without medication medications to treat the symptoms of attention deficit hyperactivity disorder (ADHD) increases, so does concern about the potential effects of these drugs on foetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge on this subject. Researchers used two huge data sets to study more than 4.3 million pregnancies and determine if the use of stimulant medications increased birth defects. Researchers discovered that although the overall risk is low, first-trimester ADHD exposure to medication was associated with slightly higher risk of specific heart defects such as ventriculoseptal defect.

The authors of the study did not discover any connection between early medication usage and other congenital anomalies, like facial deformities, or club feet. The results are in line with previous studies revealing an increase, but not significant, in the risk of developing cardiac malformations among women who started taking adhd medication private prescription medications prior to the time of pregnancy. This risk increased during the latter half of pregnancy when a large number of women decided to stop taking their medication.

Women who were taking ADHD medication during the first trimester were more likely to need a caesarean or have a low Apgar after birth and have a baby that needed help breathing when they were born. However the researchers of the study were unable to eliminate selection bias by restricting the study to women who didn't have any other medical issues that could have contributed to these findings.

The researchers hope their research will help inform the clinical decisions of physicians who treat pregnant women. They advise that while a discussion of risks and benefits is important, the decision to stop or keep medication must be based on each woman's requirements and the severity of her ADHD symptoms.

The authors also advise that while discontinuing the medications is an option, it isn't 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 choose to stop taking their medications are more likely to experience a difficult time adjusting to life without them after the birth of their baby.

Nursing

The responsibilities that come with being a new mom can be overwhelming. Women suffering from ADHD can face severe challenges when they must deal with their symptoms, attend doctor appointments and prepare for the birth of a child and adjust to a new routine. Many women opt to continue taking their ADHD medication during pregnancy.

The majority of stimulant drugs pass through breast milk in small amounts, therefore the risk to the breastfeeding infant is minimal. The rate of exposure to medication will differ based on dosage, frequency of administration and time of day. In addition, individual medications enter the body of the baby differently through the gastrointestinal tract as well as breast milk. The impact of this on a newborn infant is not fully known.

Some physicians may discontinue stimulant medications during a woman's pregnancy due to the absence of research. It's a difficult choice for the woman who must weigh the advantages of her medication against the potential risks to the foetus. In the meantime, until more information is available, doctors may inquire about pregnant patients whether they have a background of ADHD or if they intend to take medication in the perinatal period.

A increasing number of studies have proven that most women can safely continue taking their ADHD medication during pregnancy and breastfeeding. As a result, an increasing number of patients opt to do this and in consultation with their physician, 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 contemplating breastfeeding to seek out a specialist psychiatrist's advice prior to becoming pregnant. They should discuss their medication with their doctor and discuss the pros and cons of continued treatment, including non-pharmacological strategies. Psychoeducation is also necessary to help pregnant women with ADHD recognize the signs and the underlying disorder. They should also be informed about treatment options and strengthen strategies for coping. This should be a multidisciplinary process together with obstetricians, GPs and psychiatrists. Counselling for pregnancy should include discussion of a management plan for both the mother as well as the child, monitoring for signs of deterioration, and when necessary, making adjustments to the medication regimen.