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ADHD Medication During Pregnancy and Breastfeeding
The decision to stop or keep ADHD medications during breastfeeding and pregnancy is a difficult decision for women suffering from the condition. There are few data on how long-term exposure may affect the foetus.
A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological problems such as impaired hearing or vision, febrile seizures, or IQ impairment. The authors acknowledge that further high-quality research is needed.
Risk/Benefit Analysis
Women who are expecting and taking ADHD medication must weigh the benefits of taking it against the potential dangers for the fetus. medication adhd adults don't have the data to make unambiguous recommendations, but can provide information on the risks and benefits to help pregnant women make informed decisions.
A study published in Molecular Psychiatry found that women who used ADHD medications during early pregnancy did not face a significantly increased risk of fetal heart malformations or major birth defects that are structural. Researchers used a large population-based study of case control to examine the prevalence of structural defects that were major in infants born to mothers who were taking stimulants during pregnancy. Clinical geneticists, pediatric cardiologists and other experts examined the cases to make sure that the classification was correct and to eliminate any bias.
However, the study had its limitations. Most important, they were not able to differentiate the effects of the medication from the effects of the disorder at hand. This limitation makes it difficult for researchers to establish whether the few associations observed between the groups exposed were due to the use of medications or if they were caused by co-morbidities. The researchers also did not look at long-term outcomes for offspring.
The study showed that infants whose mother had taken ADHD medication during pregnancy had a slightly higher chance of being admitted to the neonatal care unit (NICU) as compared to mothers who did not take any medication during pregnancy, or had quit taking the medication prior to or during pregnancy. This was due to central nervous system disorders. The higher risk of admission was not affected by the stimulant medication used during pregnancy.
Women who were taking stimulant ADHD medication during pregnancy were also at an increased chance of having a caesarean birth or having a baby with low Apgar score (less than 7). These risks did not appear to be influenced by the kind of medication used during pregnancy.
Researchers suggest that the small risks posed by the use of ADHD medications in early pregnancies could be offset by the greater benefits to both mother and baby from continuing treatment for the woman’s disorder. Physicians should discuss the issue with their patients and, where they are able, 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.
Interactions with Medication
Many doctors are confronted with the dilemma of whether to keep treatment or stop as more women are diagnosed with ADHD. These decisions are usually made without clear and reliable evidence. Instead, doctors must consider their own expertise, the experience of other doctors and the research that has been conducted on the subject.
The issue of possible risks for infants can be extremely difficult. Many of the studies on this topic are based on observations instead of controlled research and their findings are often contradictory. Furthermore, most studies restrict their analysis to live births, which could undervalue the serious teratogenic effects that can lead to abortion or termination of the pregnancy. The study discussed in this journal club addresses these shortcomings by looking at data from both live and deceased births.
The conclusion: While some studies have found an association between ADHD medications and the risk of certain birth defects, other studies have found no connection, and most studies demonstrate a neutral or slightly negative impact. As a result, a careful risk/benefit assessment must be done in each case.
It can be challenging, if not impossible for women suffering from ADHD to stop taking their medication. In an article published in Archives of Women's Mental Health, psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can lead to increased depression, feelings of loneliness, and family conflict for these patients. A decrease in medication could also impact the ability to drive safely and perform work-related tasks, which are crucial aspects of daily life for people with ADHD.
medication for adhd uk recommends women who are unsure about whether to continue or stop taking medication because of their pregnancy, consider educating family members, friends and colleagues on the condition, its impact on daily functioning, and the benefits of keeping the current treatment regimen. It will also help a woman feel supported in her decision. It is important to note that certain medications are able to pass through the placenta, therefore, if a patient decides to discontinue her ADHD medication during pregnancy and breastfeeding, she should be aware of the possibility that traces of the drug can be transferred to the infant.
Birth Defects and Risk of
As the use of ADHD medication to treat the symptoms of attention deficit hyperactivity disorder (ADHD) increases there are concerns about what impact the medications could have on fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge regarding this subject. Using two massive data sets researchers were able analyze more than 4.3 million pregnancies to determine whether stimulant medications increased the risk of birth defects. Researchers discovered that, while the risk overall is low, first-trimester ADHD medication use was associated with slightly higher rates of specific heart defects like ventriculoseptal defect.
The researchers of the study found no link between early use of medication and congenital abnormalities such as facial clefting or club foot. The results are in the same vein as previous studies which showed 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 pregnancy. This risk increased during the latter part of pregnancy when many women decided to stop taking their medication.
Women who used ADHD medications during the first trimester of pregnancy were also more likely to undergo a caesarean section, a low Apgar score after delivery and a baby that required breathing assistance at birth. The researchers of the study could not remove bias in selection since they limited their study to women who did not have any other medical conditions that might have contributed to the findings.
The researchers hope their research will serve to inform the clinical decisions of doctors who encounter pregnant women. The researchers recommend that while discussing risks and benefits are important, the choice regarding whether or not to stop medication should be based on the severity of each woman's ADHD symptoms and the needs of the woman.
The authors also caution that while discontinuing the medications is an option, it is not a recommended practice because of the high incidence of depression and other mental health issues in women who are pregnant or who are recently post-partum. Furthermore, research suggests that women who decide to stop their medications are more likely to experience a difficult time getting used to life without them following the baby's arrival.
Nursing
It can be a stressful experience to become 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 their child and adjusting to new household routines are often faced with a number of difficulties. Many women opt to continue taking their ADHD medication during pregnancy.
The risk for nursing infant is low because the majority of stimulant medication is absorbed through breast milk at a low level. The rate of exposure to medication can vary depending upon the dosage and frequency of administration as well as the time of day. Additionally, different medications are introduced into the baby's system through the gastrointestinal tract, or through breast milk. The effect on the health of a newborn isn't completely understood.
Because of the lack of evidence, some doctors might be tempted to stop taking stimulant drugs during the course of pregnancy. This is a difficult choice for the patient, who must balance the benefits of continuing her medication with the potential dangers to the embryo. Until more information is available, doctors should inquire with all pregnant patients about their history of ADHD and if they plan or are taking to take medication during the perinatal period.
Numerous studies have proven that women can continue taking their ADHD medication in a safe manner while breastfeeding and during pregnancy. In the end, an increasing number of patients opt to do this and, after consulting with their doctor, they have discovered that the benefits of continuing their current medication far exceed any risk.
Women with ADHD who are planning to breastfeed should seek advice from a specialist psychiatrist before becoming pregnant. They should discuss their medication with their prescriber as well as the pros and cons of continuing treatment. This includes non-pharmacological methods. Psychoeducation should also be provided to help women with ADHD recognize their symptoms and the underlying disorder, learn about available treatment options and reinforce existing strategies for coping. This should be a multidisciplinary approach with the GP doctors, obstetricians and psychiatrists. The pregnancy counselling should consist of discussion of a management plan for both the mother and child, and monitoring for signs of deterioration and the need for adjustments to the medication regimen.
