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ADHD Medication During Pregnancy and Breastfeeding
Women with ADHD face a difficult decision regarding whether or not to stop taking ADHD medication during pregnancy and breastfeeding. Little data exists about how long-term exposure to these drugs can affect the fetus.
A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological issues like hearing loss or vision, febrile seizures, or IQ impairment. The authors acknowledge the need for higher-quality research.
Risk/Benefit Analysis
Pregnant women who take ADHD medications must weigh the advantages of using them against the risks to the fetus. Doctors don't have the data needed to give clear guidelines however they can provide information about the risks and benefits to assist pregnant women in making informed decisions.
A study published in Molecular Psychiatry found that women who were taking ADHD medications in early pregnancy did not have a significantly increased risk of fetal heart malformations or major structural birth defects. Researchers conducted a massive population-based case control study to assess the frequency 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 accurate case classification and to limit the chance of bias.
The study conducted by the researchers was not without its limitations. In particular, they were unable to separate the effects of the medication from those of the underlying disorder. This limitation makes it difficult for researchers to establish whether the small associations observed among the groups that were exposed to the use of medications or confounded by comorbidities. Additionally, the researchers did not study long-term offspring outcomes.
The study did show that babies whose mothers had taken ADHD medication during pregnancy were at slightly more risk of being admitted to the neonatal intensive care unit (NICU) than infants who were born without any medication or taken off their medication prior to or during pregnancy. This was due to central nervous system-related disorders and the increased risk for admission was not found to be influenced by which stimulant medication was used during pregnancy.
Women who were taking stimulant ADHD medications during pregnancy also had a higher risk of having to have a caesarean section or a baby that scored low on the Apgar scale (less than 7). These increases appear to be unrelated to the type of medication used during pregnancy.
The research suggests that the low risk associated with the use of ADHD medications during early pregnancy may be offset by the greater benefits to both the mother and child from continued treatment for the woman's condition. Physicians should talk to their patients about this and try to help them develop coping skills that can lessen the effects of her disorder on her daily life and relationships.
Medication Interactions
Doctors are increasingly faced with the decision of whether to keep treatment or stop during pregnancy as more women are diagnosed with ADHD. These decisions are frequently taken without clear and authoritative evidence. Instead, physicians must weigh their own knowledge, the experience of other physicians and the research on the subject.
The issue of potential risks to the infant can be difficult to determine. The research that has been conducted on this topic is based on observation rather than controlled studies, and many of the findings are conflicting. Furthermore, most studies restrict their analysis to live births, which could underestimate the severity of teratogenic effects that could lead to abortion or termination of the pregnancy. The study discussed in the journal club addresses these shortcomings by analyzing both the data from deceased and live births.
Conclusion A few studies have revealed a positive correlation between ADHD medications and certain birth defects However, other studies haven't found a correlation. Most studies have shown a neutral, or even slightly negative, effect. In all cases it is imperative to conduct a thorough evaluation of the benefits and risks should be conducted.
For women suffering from ADHD who suffer from ADHD, the decision to stop medication is difficult if not impossible. In a recent article in 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 loneliness. In addition, a decrease in medication may affect the ability to perform jobs and drive safely, which are important aspects of a normal life for many people suffering from ADHD.
She suggests that women who are not sure whether to take the medication or stop it due to their pregnancy should educate family members, coworkers, and acquaintances about the condition, its impact on daily functioning and the benefits of keeping the current treatment plan. It can also make the woman feel more comfortable when she is struggling with her decision. It is important to remember that certain drugs can be absorbed through the placenta so if a woman decides to discontinue her ADHD medication during pregnancy and breastfeeding, she should be aware that the effects of the drug can be transferred to the child.
Risk of Birth Defects
As the use and abuse of ADHD medications to treat the symptoms of attention deficit hyperactivity disorder (ADHD) increases as does the concern about the possible effects of the drugs on the fetuses. A recent study published in the journal Molecular Psychiatry adds to the existing information on this topic. Utilizing two huge data sets, researchers were able to analyze more than 4.3 million pregnancies to determine whether stimulant medication use increased the risk of birth defects. Researchers discovered that although the overall risk is low, the first trimester ADHD medication use was associated with slightly higher risk of specific heart defects like ventriculoseptal defect.
The authors of the study didn't discover any connection between early use of medication and other congenital anomalies like facial deformities, or club feet. The results are in agreement with previous studies which showed a small, but significant increase in the number of cardiac malformations among women who began taking ADHD medication before the time of pregnancy. The risk grew during the latter part of pregnancy, when many women begin to discontinue their ADHD medication.
Women who were taking ADHD medication during the first trimester were more likely require a caesarean birth, have a low Apgar after birth and have a baby who needed breathing assistance after birth. adhd medication for adults of the study were not able to remove bias in selection since they restricted the study to women who did not have any other medical conditions that could have contributed to the findings.
Researchers hope their research will help doctors when they meet pregnant women. They recommend that, while the discussion of risks and benefits is important but the decision to stop or keep treatment should be based on each woman's requirements and the severity of her ADHD symptoms.
The authors also warn that even though stopping the medication is an option, it isn't a recommended practice because of the high prevalence of depression and other mental health issues in women who are pregnant or recently postpartum. Additionally, the research suggests that women who choose to stop taking their medications are more likely to have a difficult time getting used to life without them after the baby's arrival.
Nursing
The responsibilities of being a new mother can be overwhelming. Women with ADHD are often faced with a number of difficulties when they have to manage their symptoms, attend doctor appointments, prepare for the birth of their child and adjust to a new routine. Many women choose to continue taking their ADHD medication during pregnancy.
The majority of stimulant drugs pass through breast milk in low amounts, therefore the risk for breastfeeding infant is minimal. 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. Additionally, different drugs enter the infant's system via the gastrointestinal tract or breast milk. The impact on the health of a newborn is not completely understood.
Some doctors may decide to stop stimulant medications during a woman's pregnancy due to the absence of research. This is a difficult decision for the patient, who must balance the benefits of keeping her medication against the potential dangers to the embryo. As long as there is no more information, GPs should ask all pregnant patients about their experience with ADHD and whether they are planning or taking to take medication during the perinatal time.
Many studies have shown that women can continue taking their ADHD medication safely during pregnancy and breast-feeding. In response, a growing number of patients are choosing to do so. They have concluded through consultation with their doctor that the benefits of keeping their current medication outweigh any risk.
It is crucial for women suffering from ADHD who are contemplating 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 should also be offered to help pregnant women suffering from ADHD understand their symptoms and the underlying disorder and learn about treatment options and reinforce existing coping strategies. This should include an approach that is multidisciplinary, including the GP doctors, obstetricians and psychiatrists. Pregnancy counselling should include the discussion of a plan for management for both mother and child, and monitoring for signs of deterioration, and, if necessary, adjustments to the medication regimen.
