ADHD Medication During Pregnancy and Breastfeeding

Women suffering from ADHD have to make a difficult choice regarding whether or not to stop taking ADHD medication during pregnancy and breastfeeding. Little data exists about how long-term exposure to these medications may affect the fetus.

A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus don't develop neurological developmental disorders such as hearing or vision impairment, febrile seizures, or IQ impairment. The authors acknowledge the need for more high-quality studies.

Risk/Benefit Analysis

Pregnant women who take ADHD medications must weigh the advantages of using them against the risks to the foetus. Physicians do not have the data needed to make unequivocal recommendations but they can provide information regarding the risks and benefits to assist pregnant women in making informed decisions.

A study published in Molecular Psychiatry concluded that women who were taking ADHD medication in early pregnancy were not at higher risk of fetal malformations, or 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 did not. Clinical geneticists, pediatric cardiologists and other experts reviewed the cases in order to make sure that the classification was correct and to eliminate any bias.

The study of the researchers was not without limitations. Researchers were unable in the beginning, to separate the effects caused by the medication from the disorder. This makes it difficult for researchers to determine if the few associations observed between the groups exposed were due to medication use, or if they were caused by co-morbidities. In addition the researchers did not look at the long-term effects of offspring on their parents.

The study did find that infants whose mothers took ADHD medication during pregnancy were at slightly greater risk of being admitted to the neonatal intensive care unit (NICU) than infants whose mothers had not taken any medication or stopped their medications before or during pregnancy. This increase was caused by central nervous system disorders. The higher risk of admission was not influenced by the stimulant medication that was used during pregnancy.

Women who took 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 appeared to be independent of the type of medication taken during pregnancy.

Researchers suggest that the minor risks posed by the use of Adhd Medication Without Diagnosis Uk (Http://Www.Stes.Tyc.Edu.Tw/Xoops/Modules/Profile/Userinfo.Php?Uid=1237799) medication during pregnancies in the early stages can be offset by greater benefits for baby and mother of continued treatment for the woman’s disorder. Physicians should talk to their patients about this issue and, if possible, help them develop coping skills that may reduce the effects of her disorder on her daily life and relationships.

Medication Interactions

As more women than ever are being diagnosed with ADHD and treated with medication, the question of whether to keep or end treatment during pregnancy is a question that more and more physicians have to face. These decisions are usually made without clear and reliable evidence. Instead, physicians must weigh their own knowledge in conjunction with the experiences of other physicians and the research on the subject.

Particularly, the issue of possible risks to the infant can be difficult. The research on this subject is based on observation instead of controlled studies and many of the findings are contradictory. Most studies limit their analysis to live births, which can underestimate the severity of teratogenic effects that can lead to abortions or terminations of pregnancy. The study presented in the journal club addresses these shortcomings by analyzing data on live and deceased births.

The conclusion The conclusion: While some studies have found that there is a positive correlation between ADHD medications and the risk of certain birth defects, other studies have found no connection and the majority of studies have a neutral or slightly negative impact. In the end, a careful risk/benefit assessment is required in every situation.

It can be difficult, if not impossible for women suffering from ADHD to stop taking their medication. 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 isolation, and family conflict for these patients. A loss of medication may also impact the ability to drive safely and to perform work-related tasks which are crucial aspects of daily life for those suffering from ADHD.

She recommends women who are unsure about whether or not to stop medication in light of their pregnancy, consider the possibility of educating friends, family members and colleagues on the condition, its impact on daily functioning, and the advantages of staying on the current treatment plan. It can also help a woman feel confident about her decision. Some medications can pass through the placenta. If a patient decides not to take her ADHD medication while pregnant and breastfeeding, it's important to be aware that the medication could be transferred to the infant.

Risk of Birth Defects

As the use of ADHD medications to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases as do concerns over the impact that these drugs might have on foetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge regarding this topic. Utilizing two huge data sets researchers were able look at more than 4.3 million pregnancies and see whether stimulant medications increased the risk of birth defects. Although the risk overall is low, the researchers found that exposure in the first trimester to ADHD medications was associated with an increased risk of specific heart defects, like ventriculo-septal defects (VSD).

The researchers of the study did not find any association between the use of early medications and 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 in women who started taking ADHD medications prior to the time of pregnancy. The risk was higher during the latter part of pregnancy, when a lot of women begin to discontinue their ADHD medications.

Women who took adhd stimulant medication medication in the first trimester of their pregnancy were also more likely to have caesarean sections, a low Apgar score after delivery and a baby who needed help breathing at birth. The researchers of the study could not eliminate bias due to selection because they limited the study to women with no other medical conditions that could have contributed to the findings.

Researchers hope their research will provide doctors with information when they encounter pregnant women. They advise that while a discussion of the benefits and risks is important however, the decision to stop or keep treatment must be based on each woman's needs and the severity of her ADHD symptoms.

The authors also caution that, while stopping the medication is an option, it isn't an option that is recommended due to the high incidence of depression and other mental health problems in women who are pregnant or post-partum. Furthermore, research suggests that women who decide to stop taking their medications are more likely to have a difficult time adjusting to life without them after the birth of their baby.

Nursing

It can be a challenge becoming a mother. Women who suffer from ADHD who have to manage their symptoms while attending physician appointments as well as getting ready for the arrival of a baby and getting used to new routines at home are often faced with a number of difficulties. As such, many women choose to continue taking their ADHD medication throughout the pregnancy.

The risk to breastfeeding infant is minimal because the majority of stimulant medications is absorbed through breast milk at a low level. However, the rate of exposure to medication by the infant can differ based on dosage, frequency it is administered and the time of day it is administered. Additionally, different medications enter the body of the baby differently through the gastrointestinal tract and breast milk, and the effect of this on a newborn isn't yet fully known.

Some doctors may stop taking stimulant medication during a woman’s pregnancy due to the absence of research. This is a complicated decision for the patient, who must weigh the benefits of continuing her medication with the potential dangers to the foetus. In the meantime, until more information is available, doctors may inquire about pregnant patients whether they have an background of ADHD or if they intend to take medication in the perinatal stage.

A increasing number of studies have shown that most women can safely continue to take their treating adhd without medication medication while they are pregnant and nursing. In the end, more and more patients opt to do this, and in consultation with their doctor they have found that the benefits of continuing their current medication exceed any risk.

Women with inattentive adhd medication who plan to breastfeed should seek the advice of a specialist psychiatrist before becoming pregnant. They should discuss their medication with their prescriber and discuss the pros and cons of continued treatment, including non-pharmacological management strategies. Psychoeducation should also be provided to help women with ADHD recognize their symptoms and the root cause, learn about available treatment options and strengthen existing coping strategies. This should involve an approach that is multidisciplinary, including the GP as well as obstetricians, psychiatry and obstetricians. Pregnancy counselling should include discussion of a management plan for both the mother as well as the child, monitoring for signs of deterioration and the need for adjustments to the medication regimen.