our website During Pregnancy and Breastfeeding
Women suffering from ADHD have to make a difficult choice about whether to continue or stop taking ADHD medication during pregnancy and breast-feeding. Little data exists about how long-term exposure to these medications may affect the fetus.
A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus don't develop neurological disorders such as hearing loss or impaired vision seizures, febrile seizures, or IQ impairment. The authors acknowledge that more high quality research is needed.
Risk/Benefit Analysis
Women who are pregnant and taking ADHD medication should consider the benefits of taking it against the possible risks to the fetus. Doctors don't have enough data to make unambiguous recommendations however they can provide information about risks and benefits to assist pregnant women to make informed choices.
A study published in Molecular Psychiatry found that women who took ADHD medications during early pregnancy did not face an higher risk of fetal cardiac malformations or major birth defects that are structural. Researchers conducted a large population-based study of case control to compare the incidence of major structural defects in infants who were born to mothers who used stimulants during pregnancy. Pediatric cardiologists and clinical geneticists looked over the cases to ensure correct classification of the cases and to reduce the chance of bias.
However, the researchers' study was not without its flaws. In particular, they were not able to differentiate the effects of the medication from those of the disorder that is underlying. That limitation makes it difficult to know whether the small associations observed in the groups that were exposed are due to the use of medication or the confounding effect of comorbidities. In addition, the researchers did not look at the long-term outcomes of offspring.
The study found that infants whose mother had taken ADHD medication during pregnancy had a greater risk of being admitted to the neonatal care unit (NICU) as compared to those whose mothers didn't 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 of admission was not found to be influenced by which stimulant medication was used during pregnancy.
Women who used stimulant ADHD medication during pregnancy were also at an increased risk of having a caesarean section or having a baby born with an low Apgar score (less than 7). These increases didn't appear to be affected by the kind of medication used during pregnancy.
The researchers suggest that the risk of a small amount with the use of ADHD medications during the early stages of pregnancy may be offset by the higher benefit to both mother and child of continued treatment for the woman's condition. Physicians should talk to their patients about this issue and, if possible, help them develop coping skills that could reduce the effects of her disorder on her daily functioning and her relationships.
Medication Interactions
Doctors are increasingly confronted with the dilemma of whether to continue treatment or stop during pregnancy as more women are diagnosed with ADHD. The majority of these decisions are made in the absence of any evidence that is clear and definitive either way, so physicians must weigh what they know about their experiences, the experiences of other doctors, and what the research says on the topic as well as their own judgments for each patient.
Particularly, the issue of potential risks for the baby can be a challenge. The research that has been conducted on this topic is based on observation rather than controlled studies, and the results are in conflict. The majority of studies focus on live births, which may underestimate the severity of teratogenic effects that can lead to terminations or abortions of pregnancy. The study discussed in this journal club addresses these limitations by examining data on both live and deceased births.
Conclusion A few studies have revealed a positive correlation between ADHD medications and certain birth defects However, other studies haven't established a link. Most studies have shown that there is a neutral, or slightly negative, effect. In each case it is imperative to conduct a thorough study of the potential risks and benefits should be conducted.
It can be difficult, if not impossible for women suffering from ADHD to stop taking their medication. In a recent article 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. A loss of medication may also impact the ability to drive safely and perform work-related tasks, which are vital aspects of everyday life for people with ADHD.
She suggests that women who are unsure whether to continue taking medication or discontinue it due to pregnancy educate family members, coworkers, and their friends about the condition, its effects on daily functioning, and the benefits of continuing the current treatment. In addition, educating them can aid in ensuring that the woman feels supported when she is struggling with her decision. Certain medications can be passed through the placenta. If a woman decides to stop taking her ADHD medication while pregnant and breastfeeding, it's important to be aware that the drug may be transferred to her infant.
Birth Defects and Risk of
As the use and use of ADHD medications to treat the symptoms of attention deficit disorder hyperactivity disorder (ADHD), increases as does the concern about the possible effects of the drugs on foetuses. A study that was published in the journal Molecular Psychiatry adds to the existing knowledge about this subject. Researchers used two huge datasets to analyze more than 4.3 million pregnancies and determine if the use of stimulant medications increased birth defects. Researchers discovered that, while the risk overall is low, first-trimester ADHD exposure to medication was associated with slightly higher risk of certain heart defects, like ventriculoseptal defect.
The researchers of the study found no link between early use of medication and other congenital abnormalities, such as facial clefting or club foot. The results are in line with previous studies showing an increase, but not significant, in the risk of heart malformations in women who started taking ADHD medications prior to the birth of their child. The risk was higher in the latter half of pregnancy, as many women decide to stop taking their medication.
Women who took ADHD medication in the first trimester were more likely need a caesarean and also have an insufficient Apgar after delivery and have a baby that needed breathing assistance after birth. The authors of the study were not able to eliminate selection bias because they limited their study to women who did not have any other medical conditions that might have contributed to the findings.
Researchers hope that their study will provide doctors with information when they encounter pregnant women. They advise that while a discussion of risks and benefits is important but the decision to stop or continue medication should be based on each woman's requirements and the severity of her ADHD symptoms.
The authors caution that, even though stopping the medication is a possibility to consider, it is not recommended due to the high rate depression and other mental problems in women who are expecting or who have recently given birth. Furthermore, research suggests that women who choose to stop taking their medications are more likely to have difficulties 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, making preparations for the arrival of a baby and getting used to new routines at home can experience severe challenges. As such, many women elect to continue taking their ADHD medication throughout the pregnancy.
The risk for breastfeeding infant is minimal because the majority of stimulant medications is absorbed through breast milk at low levels. However, the frequency of exposure to medications by the infant can differ based on dosage, frequency it is taken and the time of day it is administered. In addition, various medications are introduced into the baby's system through the gastrointestinal tract or breast milk. The effect on the health of a newborn isn't completely known.
Because of the lack of research, some physicians might be tempted to stop taking stimulant medication during the pregnancy of a woman. It's a difficult choice for the woman who must weigh the benefits of her medication against the risk to the embryo. Until more information becomes available, doctors can inquire about pregnant patients whether they have any background of ADHD or if they are planning to take medication in the perinatal period.
Numerous studies have proven that women can continue to take their ADHD medication in a safe manner during pregnancy and breast-feeding. In response, a rising number of patients are choosing to continue their medication. They have found through consultation with their doctors that the benefits of keeping their current medication outweigh any possible risks.
Women who suffer from ADHD who plan to breastfeed should seek the advice of a specialist psychiatrist before becoming pregnant. They should review their medications with their physician and discuss the advantages and disadvantages of continued treatment, including non-pharmacological strategies. Psychoeducation should also be offered to help pregnant people with ADHD be aware of their symptoms and the root cause Learn about the available treatment options and strengthen existing coping strategies. This should be a multidisciplinary process with the GPs, obstetricians, and psychiatrists. adult attention deficit hyperactivity disorder medication counselling should include the discussion of a treatment plan for both the mother and child, and monitoring for signs of deterioration, and, if necessary, adjustments to the medication regimen.