What Is The Heck Is ADHD Medication Pregnancy?
ADHD Medication During Pregnancy and BreastfeedingThe decision to stop or keep ADHD medication during pregnancy and nursing is challenging for women with the condition. There aren't enough data on how long-term exposure may affect a pregnant fetus.
A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication during the uterus don't develop neurological disorders such as hearing or vision impairment seizures, febrile seizures, or IQ impairment. The authors acknowledge that further high-quality studies are needed.
Risk/Benefit Analysis
Pregnant women who take ADHD medications need to balance the benefits of taking them against the potential risks to the fetus. Physicians do not have the information needed to provide clear recommendations, but they can provide information regarding benefits and risks that can aid pregnant women in making informed choices.
A study published in Molecular Psychiatry found that women who used ADHD medications in early pregnancy did not face a significantly increased risk of fetal cardiac malformations or major birth defects that are structural. The researchers used a large population-based case-control study to determine the prevalence of major structural birth defects in babies born to mothers who had taken stimulants during early pregnancy, and those who did not. Clinical geneticists, pediatric cardiologists and other experts reviewed the cases in order to ensure that the classification was accurate and to reduce any bias.
However, the study had its limitations. Most important, they were unable to distinguish the effects of the medication from the disorder that is underlying. This limitation makes it difficult to determine whether the limited associations observed in the exposed groups are due to the use of medication or comorbidities that cause confusion. The researchers did not study long-term outcomes for the offspring.
The study did find that infants whose mothers took ADHD medication 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 stopped their medications before or during pregnancy. This increase was caused by central nervous system disorders. The increased risk of admission was not influenced by the stimulant medication used during pregnancy.
Women who took stimulant ADHD medications during pregnancy also had a higher chance of having an emergency caesarean section or having the baby was not scoring well on the Apgar scale (less than 7). These increases did not appear to be influenced by the type of medication that was used during pregnancy.
Researchers suggest that the small risk of using ADHD medication during pregnancies in the early stages can be offset by more beneficial outcomes for both mother and baby of continuing treatment for the woman's disorder. Physicians should speak with their patients about this issue and as much as possible, assist them develop coping strategies that could reduce the impact of her disorder in her daily life and relationships.
Medication Interactions
More and more doctors are faced with the decision of whether to maintain treatment or stop it during pregnancy as more women are diagnosed with ADHD. These decisions are usually made without clear and authoritative evidence. Instead, physicians must consider their own expertise, the experience of other doctors, and the research on the subject.
The issue of risk to infants is particularly tricky. A lot of studies on this issue are based on observational evidence instead of controlled research and their conclusions are often contradictory. Furthermore, most studies restrict their analysis to live births, which can underestimate severe teratogenic effects that cause abortion or termination of the pregnancy. The study presented in this journal club addresses these limitations by looking at data from both live and deceased births.
The conclusion The conclusion: While certain studies have demonstrated a positive association between ADHD medications and the possibility of certain birth defects, other studies have found no connection, and most studies show a neutral or even slightly negative impact. In the end, a careful risk/benefit analysis must be conducted in every instance.
It can be difficult, if not impossible for women with 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 cause depression and feelings of loneliness. Furthermore, a loss of medication can interfere with the ability to do jobs and drive safely, which are important aspects of daily life for many people suffering from ADHD.
She suggests that women who are not sure whether to continue taking the medication or get more info discontinue it due to pregnancy educate family members, colleagues, and acquaintances about the condition, its effects on daily functioning, and the benefits of keeping the current treatment. In addition, educating them can make the woman feel more comfortable when she is struggling with her decision. It is also worth noting that certain medications can pass through the placenta, so if a woman decides to stop taking her ADHD medication during pregnancy and breastfeeding, she should be aware that traces of the drug 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 subject. Researchers used two massive datasets to analyze over 4.3 million pregnant women and determine if stimulant medication use increased birth defects. Although the risk overall is low, the researchers discovered that the first-trimester exposure to ADHD medicines was associated with an increased risk of specific heart defects, such as ventriculoseptal defect (VSD).
The authors of the study found no association between the use of early medications and other congenital abnormalities, such as facial clefting or club foot. The results are in the same vein as previous studies that have shown the existence of a slight, but significant increase in the number of cardiac malformations among women who started taking ADHD medication prior to the time of the birth of their child. The risk increased in the latter half of pregnancy, when a lot of women stopped taking their medication.
Women who took ADHD medication in the first trimester were more likely to require a caesarean birth and also have a low Apgar after delivery, and had a baby that required breathing assistance at birth. However the researchers of the study were not able to eliminate bias due to selection by limiting the study to women who didn't have any other medical issues that could have contributed to the findings.
The researchers hope that their research will aid in the clinical decisions of doctors who treat pregnant women. The researchers suggest that, while discussing risks and benefits are important, the choice regarding whether or not to stop medication should be made based on the severity of each woman's ADHD symptoms and her requirements.
The authors caution that, while stopping the medication is an option to consider, it is not recommended due to the high rate depression and mental health issues in women who are expecting or recently gave birth. Research has also shown that women who stop taking their medications will have a harder transitioning to life without them after the baby is born.
Nursing
It can be a stressful experience to become a mother. Women who suffer from ADHD may face a lot of challenges when they have to manage their symptoms, go to doctor appointments, prepare for the birth of a baby and adjust to new routines. As such, many women decide to continue taking their ADHD medication throughout the pregnancy.
The majority of stimulant medicines are absorbed through breast milk in very small amounts, therefore the risk to breastfeeding infant is minimal. However, the rate of exposure to medications by the newborn may differ based on the dosage, frequency it is administered, and the time of day the medication is administered. In addition, different medications enter the baby’s system via the gastrointestinal tract or breast milk. The effect on a newborn's health is not completely known.
Some doctors may stop taking stimulant medications during a woman's pregnancy due to the absence of research. It is a difficult decision for the woman, who must weigh the benefits of continuing her medication against the risks to the foetus. Until more information becomes available, GPs may ask pregnant patients if they have any history of ADHD or if they are planning to take medication in the perinatal period.
A growing number of studies have shown that women can continue their ADHD medication while they are pregnant and nursing. In the end, more and more patients are choosing to do so, and in consultation with their physician, they have found that the benefits of continuing their current medication far outweigh any risks.
It is essential for women with ADHD who are thinking of breastfeeding to seek out a specialist psychiatrist's guidance prior to becoming pregnant. They should discuss the medication they are taking with their physician and discuss the pros and cons for continuing treatment. This includes non-pharmacological methods. Psychoeducation is also necessary to help pregnant women suffering from ADHD be aware of the symptoms and the underlying disorder. They should also be educated about treatment options and build strategies for coping. This should be a multidisciplinary approach, which includes the GP doctors, obstetricians and psychiatrists. Pregnancy counselling should include the discussion of a treatment plan for both the mother as well as the child, and monitoring for signs of deterioration, and, if necessary, adjustments to the medication regimen.