ADHD Medication During Pregnancy and Breastfeeding
Women suffering from ADHD face a difficult decision regarding whether or not to stop taking ADHD medication during pregnancy and breast-feeding. Little data exists about how long-term exposure to these drugs can affect the foetus.
A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication in utero do not develop neurological disorders such as hearing loss or impaired vision seizures, febrile seizures or IQ impairment. The authors acknowledge that more high-quality studies are required.
Risk/Benefit Analysis
Women who are expecting and taking ADHD medication need to evaluate the benefits of using it versus the risks for the baby. Doctors don't have enough data to make unambiguous recommendations however they can provide information on the risks and benefits to aid pregnant women in making informed choices.
A study published in Molecular Psychiatry concluded that women who took ADHD medication during early pregnancy did not have a higher risk of fetal malformations, or structural birth defects. 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 in the early stages of pregnancy and those who had not. Clinical geneticists, pediatric cardiologists and other experts examined the cases to make sure that the classification was correct and to reduce any bias.
However, the researchers' study had its limitations. The researchers were not able to, in the first place, to separate the effects caused by the medication from the disorder. This makes it difficult for researchers to determine if the small associations observed among the groups that were exposed to the use of medication, or if they were affected by co-morbidities. The researchers also did not examine the long-term effects for the offspring.
The study revealed that infants whose mother took ADHD medication during pregnancy had a slightly greater risk of being admitted to the neonatal care unit (NICU) as compared to those whose mothers did not use any medication during pregnancy or stopped taking their medication before or during pregnancy. This was due to central nervous system disorders, and the increased risk of admission was not found to be influenced by which stimulant medications were used during pregnancy.
Women who took stimulant ADHD medications during pregnancy also had a higher chance of having to have caesarean sections or the baby was not scoring well on the Apgar scale (less than 7). These increases didn't appear to be affected by the kind of medication used during pregnancy.
Researchers suggest that the minor risks posed by the use of ADHD medication during pregnancies in the early stages could be offset by the more beneficial outcomes for both mother and baby of continuing treatment for the woman’s disorder. Physicians should discuss this with their patients and, when possible, help them develop strategies to improve their coping abilities that may minimize the effects of her disorder on her daily life and relationships.
Medication Interactions
Many doctors are confronted with the dilemma of whether to keep treatment or stop it during pregnancy as more women are diagnosed with ADHD. These decisions are usually made without clear and reliable evidence. Instead, doctors must weigh their own knowledge, the experience of other physicians and the research on the topic.
Particularly, the subject of possible risks to the infant can be difficult. Many of the studies on this issue are based on observations rather than controlled research, and their findings are often contradictory. The majority of studies restrict their analysis to live births, which can underestimate the severity of teratogenic effects that can lead to abortions or terminations of pregnancy. The study discussed in this journal club addresses these limitations by looking at data from both live and deceased births.
The conclusion The conclusion: While some studies have found an association between ADHD medications and the possibility of certain birth defects, others have not found any evidence of a link, and most studies show a neutral or even slight negative effect. In every case it is imperative to conduct a thorough study of the risks and benefits is required.
For many women with ADHD who suffer from ADHD, the decision to stop taking medication is difficult, if not impossible. In fact, in a recent article 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. Furthermore, a loss of medication can interfere with the ability to perform work-related tasks and safely drive that are crucial aspects of daily life for many people with ADHD.
She suggests that women who aren't sure whether to take the medication or here discontinue it due to pregnancy should educate family members, colleagues, and acquaintances about the condition, its effects on daily functioning, and the benefits of keeping the current treatment plan. In addition, educating them can aid in ensuring that the woman feels supported as she struggles with her decision. Some medications can pass through the placenta. If a patient decides not to take her ADHD medication while breastfeeding, it is important to be aware that the medication could be transferred to the baby.
Risk of Birth Defects
As the use and misuse of ADHD medication to treat symptoms of attention deficit disorder hyperactivity disorder (ADHD), increases the concern over the potential adverse effects of the drugs on the fetuses. A recent study published in the journal Molecular Psychiatry adds to the body of information on this topic. 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. While the overall risk remains low, the researchers did find that first-trimester exposure to ADHD medications was associated with a slightly higher rate of certain heart defects, such as ventriculo-septal defect (VSD).
The authors of the study found no connection between early use of medication and other congenital anomalies, such as facial clefting or club foot. The results are in agreement with previous studies which showed an insignificant, but small increase in cardiac malformations for women who began taking ADHD medication before pregnancy. The risk was higher in the latter half of pregnancy, as many women decide to stop taking their ADHD medications.
Women who were taking ADHD medication in the first trimester were more likely to require a caesarean birth or have an insufficient Apgar after delivery, and have a baby who needed breathing assistance when they were born. The researchers of the study were not able to eliminate bias due to selection because they limited their study to women who did not have any other medical conditions that might have contributed to the findings.
The researchers hope that their research will aid in the clinical decisions of doctors who treat pregnant women. They suggest that although a discussion of the benefits and risks is important, the decision to stop or keep medication should be based on each woman's needs and the severity of her ADHD symptoms.
The authors also warn that even though stopping the medication is an option, it is not an option that is recommended due to the high rate of depression and other mental health problems among women who are pregnant or post-partum. Research has also shown that women who stop taking their medication will have a harder time adjusting to a life without them once the baby is born.
Nursing
The responsibilities of a new mother can be overwhelming. Women with ADHD may face a lot of challenges when they must deal with their symptoms, go to 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 medicines are absorbed through breast milk in very small amounts, therefore the risk for breastfeeding infant is minimal. The amount of exposure to medications will vary based on the dosage the medication is administered, its frequency and the time of day. In addition, individual medications enter the body of the baby differently through the gastrointestinal tract and breast milk, and the effect of this on a newborn infant is not yet fully known.
Some doctors may stop taking stimulant medications during a woman's pregnancy due to the absence of research. This is a complicated decision for the patient, who must balance the benefits of keeping her medication with the potential risks to the fetus. In the meantime, until more information is available, doctors may inquire about pregnant patients whether they have any background of ADHD or if they intend to take medication in the perinatal phase.
Numerous studies have proven that women can continue taking their ADHD medication safely while breastfeeding and during pregnancy. In the end, more and more patients opt to do this and, in consultation with their physician, they have found that the benefits of keeping their current medication exceed any risk.
Women who suffer from ADHD who are planning to breastfeed should seek the advice of a specialist psychiatrist before becoming pregnant. They should review their medications with their physician and discuss the pros and cons of continued treatment, including non-pharmacological management strategies. Psychoeducation is also necessary to help pregnant women with ADHD recognize the signs and the underlying disorder. They should also be informed about treatment options and reinforce strategies for coping. This should be an approach that is multidisciplinary, including the GP doctors, obstetricians and psychiatrists. Pregnancy counseling should include discussion of a treatment plan for the mother and child, monitoring of signs of deterioration, and, if needed, adjustments to the medication regimen.