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ADHD Medication During Pregnancy and Breastfeeding
Women with ADHD have to make a difficult choice about whether to continue or stop taking ADHD medication during pregnancy and breastfeeding. There isn't much information on how long-term exposure to these drugs could affect the foetus.
A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus do not develop neurological developmental disorders such as hearing loss or impaired vision seizures, febrile seizures or IQ impairment. The authors acknowledge the need for higher-quality studies.
Risk/Benefit Analysis
Pregnant women who use ADHD medications must weigh the benefits of taking them against potential risks to the fetus. Doctors don't have enough data to make unambiguous recommendations but they can provide information on risks and benefits to help pregnant women make informed choices.
A study published in Molecular Psychiatry concluded that women who were taking ADHD medication during their early pregnancy were not at a 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 babies born to mothers who took stimulants during early pregnancy, as well as those who had not. Clinical geneticists, pediatric cardiologists and other experts examined the cases to make sure that the classification was correct and to eliminate any bias.
The research conducted by the researchers was not without limitations. The researchers were not able, in the first place, to separate the effects caused by the medication from the disorder. This limitation makes it difficult for researchers to determine whether the small associations observed among the exposed groups were due to medication use, or if they were caused by comorbidities. The researchers did not examine long-term outcomes for the offspring.
The study found that babies whose mothers took ADHD medication during pregnancy were at a slightly greater risk of being admitted to the neonatal care unit (NICU) in comparison to mothers who did not use any medication during pregnancy or discontinued taking their medication prior to or during pregnancy. This was due to central nervous system disorders. The increased risk of admission was not influenced by the stimulant medications used during pregnancy.
Women who were taking stimulant ADHD medication during pregnancy were also at an increased risk of having a caesarean delivery or having a child with a low Apgar score (less than 7). These increases did appear to be independent of the type of medication taken during pregnancy.
Researchers suggest that the minor risks posed by the use of ADHD medication during pregnancies in the early stages can be offset by greater benefits to both mother and baby of continuing treatment for the woman's disorder. Physicians should discuss the issue with their patients and, if possible, help them develop strategies to improve their coping abilities that may minimize the negative impact of her condition on her daily functioning and relationships.
Medication Interactions
As more women than ever before are being diagnosed with ADHD and being treated with medication, the dilemma of whether to continue or discontinue treatment during pregnancy is one that doctors are having to have to face. Often, these decisions are made in the absence of clear and authoritative evidence in either case, which means that doctors have to weigh their experience about their experiences, the experiences of other doctors, and what the research suggests on the subject as well as their own best judgment for each patient.
The issue of potential risks to the infant can be extremely difficult. A lot of studies on this topic are based on observational evidence rather than controlled research, and their findings are often contradictory. Additionally, the majority of studies limit their analysis to live births, which can undervalue the serious teratogenic effects that can cause abortion or termination of the pregnancy. The study discussed in this journal club addresses these limitations by analyzing data on live and deceased births.
The conclusion is that while some studies have found a positive association between ADHD medications and the risk of certain birth defects, others have found no such relationship and the majority of studies show a neutral or even slightly negative effect. In every case, a careful analysis of the benefits and risks should be conducted.
For a lot of women with ADHD, the decision to stop medication can be difficult, if not impossible. In fact, 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 isolation, and family conflict for those suffering from the disorder. The loss of medication can also affect the ability to drive safely and complete work-related tasks, which are vital aspects of daily life for those with ADHD.
She suggests that women who are unsure whether to continue taking medication or stop due to pregnancy should educate family members, coworkers and friends about the condition, the effects on daily functioning, and the benefits of continuing the current treatment regimen. It can also help a woman feel supported in her decision. It is also worth noting that some medications can be absorbed through the placenta therefore, if a patient decides to discontinue her ADHD medication during pregnancy and breastfeeding, she must be aware of the possibility that traces of the medication could be transferred to the child.
Risk of Birth Defects
As the use of ADHD medication to treat the symptoms of attention deficit hyperactivity disorder (ADHD) increases there are concerns about the effects that the medications could have on fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge on this issue. Researchers used two massive data sets to examine more than 4.3 million pregnancies and determine if the use of stimulant medications caused birth defects. Researchers discovered that, while the overall risk is low, first-trimester ADHD medication use was associated with slightly higher risk of specific heart defects like ventriculoseptal defects.
The researchers behind the study found no link between early use of medication and other congenital abnormalities, like facial clefting, or club foot. The results are in agreement with previous studies that have shown a small, but significant increase in cardiac malformations for women who began taking ADHD medication prior to pregnancy. The risk increased in the latter half of pregnancy when many women began to stop taking their medication.
Women who were taking ADHD medication in the first trimester were more likely to need a caesarean, have a low Apgar after birth and have a baby who needed breathing assistance when they were born. The researchers of the study could not eliminate selection bias because they restricted the study to women with no other medical conditions that could have contributed to the findings.
The researchers hope their study will serve to inform the clinical decisions of doctors who encounter pregnant women. The researchers suggest that, while discussing risks and benefits are important, the decision about whether to continue or stop medication should be made based on the severity of each woman's ADHD symptoms and her needs.
The authors caution that, although stopping the medication is a possibility to think about, it isn't advised due to the high rate depression and mental health issues among women who are pregnant or who have recently given birth. Furthermore, research suggests that women who decide to stop their medications are more likely to have difficulties getting used to life without them following the birth of their baby.
Nursing
It can be a stressful experience to become a mother. Women with ADHD who have to deal with their symptoms while attending doctor appointments and getting ready for the arrival of a baby and adapting to new routines in the home may face a lot of challenges. Many women opt to continue taking their ADHD medication during pregnancy.
The risk to breastfeeding infant is not too high since the majority of stimulant medications passes through breast milk at a low level. However, the rate of medication exposure to the infant can differ based on dosage, frequency it is administered and the time of the day it is administered. In addition, individual medications enter the body of the baby differently through the gastrointestinal tract and breast milk. medication for adhd in adults of this on a newborn infant is not fully understood.
Some doctors may stop taking stimulant medications during a woman's pregnancy due to the lack of research. It is a difficult decision for the mother, who must weigh the benefits of her medication against the potential risks to the fetus. As long as there is no more information, doctors should ask all pregnant patients about their history of ADHD and whether they plan or are taking to take medication during the perinatal period.
A increasing number of studies have proven that women can continue taking their ADHD medication while they are pregnant and nursing. In response, an increasing number of patients are opting to do this. They have found after consulting with their doctor that the benefits of keeping their current medication far outweigh any possible risks.
It is crucial for women suffering from ADHD who are thinking of breastfeeding to seek out a specialist psychiatrist's advice prior becoming pregnant. They should discuss their medication with their doctor and discuss the pros and cons for continuing treatment. This includes non-pharmacological strategies. Psychoeducation should also be offered to help pregnant women suffering from ADHD recognize their symptoms and underlying disorder Learn about the available treatment options and strengthen existing strategies for managing. This should be a multidisciplinary approach including obstetricians, GPs, and psychiatry. Pregnancy counseling should include a discussion of a treatment plan for the mother as well as the child, monitoring of signs of deterioration and, if necessary adjustments to the medication regimen.
