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 aren't enough data regarding how exposure over time may affect the foetus.
A recent study published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological issues such as impaired hearing or vision, febrile seizures, or IQ impairment. The authors acknowledge the need for higher-quality research.
Risk/Benefit Analysis
Women who are pregnant and take ADHD medication need to evaluate the benefits of using it against the possible risks for the baby. Physicians do not have the data needed to provide clear recommendations but they can provide information regarding benefits and risks that can aid pregnant women in making informed decisions.
A study published in Molecular Psychiatry concluded that women who were taking ADHD medication during their early pregnancy were not at a higher risk of fetal malformations, or structural birth defects. Researchers conducted a massive sample-based case control study to assess the frequency of major structural defects in infants born to mothers who took stimulants during pregnancy. Clinical geneticists and pediatric cardiologists examined the cases to ensure accurate case classification and to limit the possibility of bias.
However, the researchers' study was not without its flaws. Most important, they were unable to separate the effects of the medication from those of the disorder at hand. This limitation makes it difficult for researchers to establish whether the small associations observed among the groups that were exposed to medication use or if they were caused by the presence of comorbidities. In addition, the researchers did not examine the long-term effects of offspring on their parents.
The study revealed that infants whose mother had taken ADHD medication during pregnancy were at a slightly higher chance of being admitted to the neonatal care unit (NICU) in comparison to those whose mothers didn't take any medication during pregnancy or had discontinued taking their medication prior to or during pregnancy. This was due to central nervous system-related disorders and the increased risk for admission did not appear to be influenced by the stimulant medications were taken 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 did not seem to be influenced by the type of medication that was used during pregnancy.
Researchers suggest that the small risks associated with the use ADHD medications during early pregnancies could be offset by the greater benefits to both mother and baby of continuing treatment for the woman's condition. Physicians should discuss this with their patients and, if possible, assist them in developing strategies for improving their coping skills that may minimize the negative impact of her condition on her daily life and relationships.
Medication Interactions
More and more doctors
are adhd meds covered by ohip faced with the decision of whether to continue treatment or stop as more women are diagnosed with ADHD. These decisions are frequently taken without clear and authoritative evidence. Instead, doctors must consider their own expertise, the experience of other physicians and the research on the subject.
The issue of risk to the infant can be particularly tricky. Many studies on this subject are based on observational evidence instead of controlled research and their conclusions are often contradictory. In addition, most studies limit 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 this journal club addresses these limitations by analyzing data on live and deceased births.
Conclusion: While some studies have found a positive correlation between ADHD medications and certain birth defects however, other studies haven't established a link. Most studies show a neutral, or even slightly negative, effect. In the end an accurate risk-benefit analysis must be done in each case.
For a lot of women with ADHD, the decision to discontinue medication is difficult if not impossible. In fact, in an article recently published in the Archives of Women's Mental Health psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can increase depression, feelings of loneliness, and family conflict for these patients. In addition, a decrease in medication can interfere with the ability to perform job-related tasks and drive safely which are essential aspects of daily life for many people with ADHD.
She suggests that women who are unsure whether to continue taking the medication or stop it due to their pregnancy educate family members, colleagues, and friends about the condition, the effects on daily functioning, and the benefits of continuing the current treatment plan. It can also aid in ensuring that the woman feels supported as she struggles with her decision. It is also worth noting that some drugs can be absorbed through the placenta therefore, if a patient decides to stop her ADHD medication during pregnancy and breastfeeding, she should be aware that traces of the drug can be passed on to the baby.
Birth Defects and Risk of
As the use of ADHD medications to treat symptoms of attention deficit hyperactivity disorder (
best adhd medication for adults) increases, so do concerns about the effects that the drugs might have on fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge regarding this topic. Researchers used two massive data sets to study more than 4.3 million pregnancies and determine if stimulant medication use caused birth defects. Although the risk overall is low, the researchers did find that first-trimester exposure to ADHD medications was linked to an increased risk of certain heart defects, like ventriculo-septal defects (VSD).
The researchers of the study found no link between early medication use and congenital abnormalities like facial clefting, or club foot. The results are in line with previous studies that have shown an insignificant, but small increase in the number of cardiac malformations among women who began taking ADHD medication prior to the time of pregnancy. This risk increased during the latter part of pregnancy, when a lot of women decided to stop taking their medication.
Women who were taking ADHD medication during the first trimester were more likely to require a caesarean birth and also have an insufficient Apgar after birth and have a baby that needed breathing assistance at birth. The researchers of the study were not able to eliminate bias due to selection because they restricted the study to women who did not have any other medical conditions that could have contributed to the findings.
The researchers hope their study will help inform the clinical decisions of doctors who encounter pregnant women. The researchers advise that while discussing risks and benefits are crucial, the decision regarding whether or not to stop
medication for adhd should be based on the severity of each woman's ADHD symptoms and the needs of the woman.
The authors also caution that even though stopping the medication is an option, it isn't a recommended practice because of the high rate of depression and other mental health issues in women who are pregnant or post-partum. Furthermore, research suggests that women who decide to stop taking their medications are more likely to experience difficulties adjusting to life without them following the birth of their baby.
Nursing
The responsibilities of a new mother can be overwhelming. Women suffering from ADHD may face a lot of challenges when they have to manage their symptoms, go to doctor appointments, prepare for the birth of their child and adjust to a new routine. This is why many women decide to continue taking their ADHD medications throughout the course of pregnancy.
The majority of stimulant medicines are absorbed by breast milk in small amounts, so the risk to breastfeeding infant is minimal. However, the rate of exposure to medication by the newborn can vary depending on dosage, how often it is administered, and the time of the day the medication is administered. In addition, 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 fully understood.
Because of the lack of evidence, some doctors may recommend
stopping adhd medication weekends adults stimulant drugs during the course of pregnancy. It is a difficult decision for the mother, who must weigh the advantages
types of adhd medication taking her medication as well as the potential risks 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 time.
Numerous studies have proven that women can continue to take their ADHD medication without risk during pregnancy and while breast-feeding. In the end, many patients choose to do so and, after consulting with their doctor, they have found that the benefits of keeping their current medication outweigh any risks.
It is essential for women with ADHD who are thinking of breastfeeding to seek out a specialist psychiatrist's advice prior to becoming pregnant. They should review their medications with their prescriber and discuss the advantages and disadvantages of continued treatment, including
non medication treatment for adhd-pharmacological management strategies. Psychoeducation is also needed to help pregnant women with ADHD recognize the signs and underlying disorder. They should also learn about treatment options and strengthen coping mechanisms. This should be a multidisciplinary process together with obstetricians, GPs, and psychiatrists. The pregnancy counselling should consist of the discussion of a treatment plan for both mother and child, and monitoring for signs of deterioration, and when necessary, making adjustments to the medication regimen.
