ADHD Medication Pregnancy: 10 Things I'd Love To Have Known In The Past
ADHD Medication Pregnancy: 10 Things I'd Love To Have Known In The Past
Blog Article
ADHD Medication During Pregnancy and Breastfeeding
The decision to stop or continue ADHD medication during pregnancy and nursing is a challenge for women suffering from the condition. There is a lack of information about how long-term exposure to these medications can affect the foetus.
A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication in utero do not develop neurological developmental disorders such as impaired vision or hearing seizures, febrile seizures, or IQ impairment. The authors acknowledge the need for more high-quality research.
Risk/Benefit Analysis
Pregnant women who use ADHD medications must weigh the advantages of using them against the risks to the fetus. Doctors don't have enough data to make unambiguous recommendations, but can provide information on the risks and benefits to assist pregnant women to make informed choices.
A study published in Molecular Psychiatry found that women who used ADHD medications in early pregnancy did not have an increased risk of fetal heart malformations or major structural birth defects. Researchers conducted a massive population-based case control study to compare the incidence of structural defects that were major in infants born to mothers who used stimulants during pregnancy. Clinical geneticists, pediatric cardiologists and other experts looked over the cases to confirm that the classification was correct and to reduce any bias.
The research conducted by the researchers was not without limitations. In particular, they were unable to distinguish the effects of the medication from those of the underlying disorder. That limitation makes it difficult to know whether the limited associations observed in the exposed groups are due to the use of medication or the confounding effect of comorbidities. The researchers did not look at long-term outcomes for the offspring.
The study found that babies whose mothers had taken ADHD medication during pregnancy were at a slightly greater risk of being admitted to the neonatal care unit (NICU) as compared to those whose mothers did not take 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 affected by the stimulant medications used during pregnancy.
Women who were taking stimulant ADHD medication during pregnancy were also at an increased chance of having a caesarean delivery or having a baby with an low Apgar score (less than 7). These increases appeared to be independent of the type of medication used during pregnancy.
Researchers suggest that the minor risks posed by the use of ADHD medications during early pregnancies can be offset by greater benefits for mother and baby from continuing treatment for the woman’s disorder. Physicians should talk to their patients about this issue and try to help them improve coping skills which could reduce the impact of her disorder in her daily functioning and her relationships.
Medication Interactions
As more women than ever are being diagnosed with ADHD and being treated with medication, the issue of whether to continue or stop treatment during pregnancy is one that more and more physicians face. The majority of these decisions are made without solid and reliable evidence regardless, so doctors must weigh what they know from their own experiences, those of other doctors, and what the research suggests on the subject and their own judgments for each patient.
The issue of potential risks to the infant can be extremely difficult. The research on this subject is based on observation rather than controlled studies, and a lot of the results are conflicting. Additionally, the majority of studies limit their analysis to live births, which could underestimate the severity of teratogenic effects that could cause abortion or termination of the pregnancy. The study that is discussed in this journal club addresses these shortcomings by looking at data from both live and deceased births.
Conclusion Some studies have shown an association between ADHD medications and certain birth defects However, other studies haven't established a link. Most studies show an unintended, or slightly negative, impact. As a result an accurate risk-benefit analysis must be done in each case.
For a lot of women with ADHD who suffer from ADHD, the decision to discontinue medication is difficult if not impossible. In a recent piece 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 affect the ability to safely drive and to perform work-related tasks which are essential aspects of everyday life for those with ADHD.
She recommends women who are uncertain about whether to continue or stop medication in light of their pregnancy, consider the possibility of educating friends, family members, and coworkers on the condition, its impact on daily functioning, and on the benefits of keeping the current treatment plan. It can also help a woman feel supported in her decision. It is important to remember that some drugs can pass through the placenta, so if the patient decides to discontinue her ADHD medication during pregnancy and breastfeeding, she must be aware that the effects of the drug can be transferred to the child.
Risk of Birth Defects
As the use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) grows, so do concerns about the effects that the medications could have on fetuses. A recent study published in the journal Molecular Psychiatry adds to the existing information on this topic. Researchers used two huge data sets to study over 4.3 million pregnancies and determine if the use of stimulant medications increased birth defects. Researchers found that while the overall risk is low, the first trimester ADHD exposure to medication was associated with slightly higher risk of certain heart defects, like ventriculoseptal defect.
The researchers behind the study found no connection between early medication use and congenital abnormalities like facial clefting, or club foot. The results are in line with previous studies showing a small but significant increase in the risk of developing cardiac malformations among women who started taking ADHD medications prior to the time of the birth of their child. The risk increased in the latter part of pregnancy when many women decided to stop taking their medication.
Women who used ADHD medication in the first trimester of their pregnancies were also more likely to undergo a caesarean section, a low Apgar score following delivery, and a baby who required help breathing at birth. However the researchers of the study were unable to eliminate bias due to selection by limiting the study to women who didn't have other medical issues that could be a contributing factor to these findings.
Researchers hope that their study will help doctors when they encounter pregnant women. They advise that while discussing the benefits and risks is important, the decision to stop or maintain medication must be based on each woman's requirements and the severity of her ADHD symptoms.
The authors warn that, while stopping the medication is an option to consider, it is not recommended because of the high incidence of depression and other mental problems for women who are pregnant or have recently given birth. Furthermore, research suggests that women who choose to stop taking their medication are more likely to experience a difficult time getting used to life without them after the birth of their baby.
Nursing
It can be a challenge to become a mother. Women who suffer from ADHD are often faced with a number of difficulties when they must deal with their symptoms, go to doctor appointments, prepare for the birth of a baby and adjust to a new routine. Many women decide to continue taking their ADHD medication during pregnancy.
The majority of stimulant medications are absorbed through breast milk in very small amounts, therefore the risk to nursing infant is very low. However, the frequency of exposure to medication by the infant can differ based on dosage, how often it is administered and the time of day the medication is administered. Additionally, individual medications enter the infant's system differently through the gastrointestinal tract and breast milk and the impact of this on a newborn isn't yet fully known.
Because of the lack of research, some doctors may be inclined to discontinue stimulant drugs during the course of here pregnancy. This is a difficult decision for the mother, who must weigh the advantages of continuing her medication against the potential risks to the embryo. As long as more information is available, GPs may ask pregnant patients if they have any history of ADHD or if they intend to take medication in the perinatal period.
A increasing number of studies have revealed that most women can safely continue to take their ADHD medication during pregnancy and while breastfeeding. This has led to an increasing number of patients choose to do so and in consultation with their doctor they have found that the benefits of continuing their current medication far outweigh any risks.
It's important for women with ADHD who are considering breastfeeding to seek a specialist psychiatrist's advice prior becoming pregnant. They should discuss their medication with their prescriber and discuss the pros and cons for continuing treatment. This includes non-pharmacological methods. Psychoeducation is also needed to help pregnant women suffering from ADHD be aware of the symptoms and the underlying disorder. They should also be informed about treatment options and build strategies for coping. This should involve an approach that is multidisciplinary, including the GP doctors, obstetricians and psychiatrists. Pregnancy counselling should include discussion of a management plan for both mother and child, as well as monitoring for signs of deterioration and, if necessary, adjustments to the medication regimen.