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ADHD Medication During Pregnancy and Breastfeeding

The choice of whether to stop or continue ADHD medications during pregnancy and breastfeeding is a challenge for women suffering from the condition. Little data exists about how long-term exposure to these medications may affect the foetus.

A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus don't develop neurological conditions like hearing or vision impairment seizures, febrile seizures, or IQ impairment. The authors acknowledge that more high quality studies are required.

Risk/Benefit Analysis

Women who are pregnant and take ADHD medication need to evaluate the benefits of using it versus the dangers for the baby. Physicians don't have the data to give clear advice, but can provide information on the risks and benefits to help pregnant women make informed decisions.

A study published in Molecular Psychiatry concluded that women who took ADHD medication during early pregnancy were not at greater risk of fetal malformations or structural birth defects. Researchers used a large population-based study of case control to assess the frequency of structural defects that were major in infants born to mothers who took stimulants during pregnancy. Clinical geneticists and pediatric cardiologists looked over the cases to ensure correct case classification and to limit the chance of bias.

The research conducted by the researchers had some limitations. In particular, they were unable to separate the effects of the medication from the effects of the underlying disorder. This limitation makes it difficult to determine whether the small differences observed in the groups that were exposed result from medication use or comorbidities that cause confusion. In addition the study did not look at long-term offspring outcomes.

The study did reveal that infants whose mothers took prescribe adhd medication medication during pregnancy were at slightly higher risk of being admitted to the neonatal intensive care unit (NICU) than those whose mothers had not taken any medication or taken off their medication prior to or during pregnancy. This increase was due to central nervous system-related disorders and the higher risk of admission was not found to be influenced by the stimulant medication was used during pregnancy.

Women who were taking stimulant ADHD medications during pregnancy also had a higher likelihood of having to have a caesarean section or one whose baby scored low on the Apgar scale (less than 7). These increases did appear to be independent of the type of medication taken during pregnancy.

Researchers suggest that the small risk of using ADHD medications in early pregnancies may be offset by the more beneficial outcomes for both baby and mother of continued treatment for the woman's condition. Doctors should discuss with their patients about this issue and try to help them develop coping skills that could reduce the impact of her disorder in her daily life and relationships.

Medication Interactions

More and more doctors are confronted with the dilemma of whether to keep treatment or stop as more women are diagnosed with ADHD. These decisions are often made without clear and reliable evidence. Instead, physicians must weigh their own knowledge in conjunction with the experiences of other physicians and the research that has been conducted on the subject.

Particularly, the subject of potential risks for the baby can be tricky. The research on this subject is based on observations rather than controlled studies, and the results are in conflict. Furthermore, most studies restrict their analysis to live births, which may undervalue the serious teratogenic effects that can cause abortion or termination of the pregnancy. The study presented in the journal club addresses these issues by analyzing information on deceased and live births.

The conclusion: While certain studies have demonstrated that there is a positive correlation between ADHD medications and the risk of certain birth defects, other studies have found no such relationship and the majority of studies have a neutral or slightly negative impact. In every case an in-depth study of the benefits and risks must be performed.

For women suffering from ADHD, the decision to discontinue medication is difficult, if not impossible. In a recent piece published in the Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can lead to depression and feelings of being isolated. The loss of medication can also affect the ability to safely drive and complete work-related tasks, which are vital aspects of everyday life for those suffering from ADHD.

She suggests that women who are not sure whether to continue taking medication or discontinue it due to pregnancy, educate their family members, coworkers, and their friends about the condition, the effects on daily functioning, and the benefits of continuing the current treatment plan. It can also make the woman feel more comfortable when she is struggling with her decision. Some medications can pass through the placenta. If a woman decides not to take her ADHD medication while breastfeeding, it is crucial to be aware that the drug may be transferred to her baby.

Birth Defects and Risk of

As the use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases as do concerns about what impact the drugs could have on the fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge on this issue. Utilizing two huge data sets researchers were able to look at more than 4.3 million pregnancies and determine whether the use of stimulant medications increased the risk of birth defects. Although the risk overall remains low, the researchers found that exposure in the first trimester to ADHD medications was associated with an increased risk of specific heart defects, such as ventriculoseptal defect (VSD).

The researchers of the study didn't discover any connection between the use of early medications and other congenital anomalies, such as facial deformities or club feet. The results are in agreement with previous studies that showed a small, but significant increase in the number of cardiac malformations among women who started taking ADHD medication prior to the time of pregnancy. The risk increased in the latter stages of pregnancy when many women stopped taking their medication.

Women who were taking ADHD medication in the first trimester were more likely require a caesarean birth, have a low Apgar after delivery, and had a baby that required breathing assistance after birth. However the researchers of the study were not able to eliminate selection bias by limiting the study to women who didn't have other medical issues that could be a contributing factor to these findings.

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

The authors caution that, even though stopping the medication is an option to consider, it is not recommended due to the high rate depression and mental health issues for women who are pregnant or who have recently given birth. Further, research shows that women who stop taking their medications will have a tough time adjusting to a life without them once the baby is born.

Nursing

The responsibilities of a new mom can be overwhelming. Women who suffer from ADHD can face severe challenges when they must deal with their symptoms, attend doctor appointments and prepare for the birth of their child and adjust to new routines. Many women choose to continue taking their prescribe adhd medication medication during pregnancy.

The risk for nursing infant is low because the majority of stimulant medications is absorbed through breast milk at a low level. However, the amount of exposure to medication by the infant can differ based on dosage, frequency it is administered, and the time of day it is administered. 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.

Due to the absence of evidence, some doctors might be tempted to stop taking stimulant medication during the course of pregnancy. It is a difficult decision for the woman who must weigh the benefits of taking her medication as well as the potential risks to the foetus. Until more information is available, GPs should ask all pregnant patients about their history of adhd treatment medication and if they are planning or taking to take Medication for odd and adhd during the perinatal time.

Many studies have shown that women can continue taking their ADHD medication safely during pregnancy and while breast-feeding. In response, a growing number of patients are opting to do so. They have found through consultation with their doctors, that the benefits of continuing their current medication far outweigh any potential risks.

Women with ADHD who plan to breastfeed should seek advice from an expert psychiatrist prior to becoming pregnant. They should discuss the medication they are taking with their physician, and the pros and cons of continuing treatment. This includes non-pharmacological methods. Psychoeducation should also be offered to help women with ADHD understand their symptoms and the root cause, learn about available treatment options and strengthen existing coping strategies. This should be a multidisciplinary effort including obstetricians, GPs and psychiatry. Pregnancy counseling should include a discussion of a treatment plan for the mother as well as the child, as well as monitoring for indicators of deterioration, and, if needed modifications to the medication regime.