ADHD Medication During Pregnancy and Breastfeeding

Women suffering from ADHD have to make a difficult choice on whether to keep or stop taking ADHD medication during pregnancy and breastfeeding. There is a lack of information about how long-term exposure to these medications can affect the fetus.

A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication in utero do not develop neurological disorders such as impaired vision or hearing, febrile seizures, or IQ impairment. The authors acknowledge the need for higher-quality studies.

Risk/Benefit Analysis

Women who are pregnant and taking ADHD medication should evaluate the benefits of using it against the possible risks for the baby. Physicians don't have the data to give clear advice however they can provide information on the risks and benefits to help pregnant women make informed choices.

A study published in Molecular Psychiatry found that women who took ADHD medications in early pregnancy did not have a significantly increased risk of fetal heart malformations or major birth defects that are structural. Researchers used a vast, population-based case-control study to evaluate the incidence of major structural birth defects in babies born to mothers who took stimulants during the early stages of pregnancy, as well as those who had not. Clinical geneticists and pediatric cardiologists 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 limitations. Researchers were unable in the beginning to distinguish the effects caused by the medication from the disorder. This limitation makes it difficult for researchers to determine whether the small differences observed between the groups exposed were due to medication use or if they were caused by co-morbidities. Additionally, the researchers did not look at long-term offspring outcomes.

The study found that infants whose mother had taken ADHD medication during pregnancy had a slightly greater risk of being admitted to the neonatal care unit (NICU), compared to mothers who didn't take any medication during pregnancy or discontinued taking their medication prior to or during pregnancy. The reason for this was central nervous system disorders. The increased risk of admission was not affected by the stimulant medication used during pregnancy.

Women who took stimulant ADHD medications during pregnancy also had a higher likelihood of having to have caesarean sections or the baby was not scoring well on the Apgar scale (less than 7). These increases appeared to be unrelated to the type of medication taken during pregnancy.

The research suggests that the risk of a small amount with the use of ADHD medications during early pregnancy may be offset by the greater benefit for both mother and child of continuing treatment for the woman's condition. Physicians should talk to their patients about this issue and as much as possible, assist them develop coping skills that can lessen the effects of her disorder on her daily life and relationships.

Medication Interactions

As more women than ever are diagnosed with ADHD and treated with medication, the issue of whether or not to stop treatment during pregnancy is a question that doctors are having to face. The majority of these decisions are made without solid and reliable evidence in either case, which means that doctors must weigh their knowledge, the experiences of other doctors, and what research suggests about the subject, along with their own best judgment for each patient.

Particularly, the subject of possible risks to the baby can be tricky. The research on this subject is based on observation rather than controlled studies and the results are in conflict. The majority of studies limit their analysis to live-births, which could underestimate the severity of teratogenic effects which can cause terminations or abortions of pregnancy. The study that is discussed in the journal club addresses these limitations, by examining both the data from deceased and live births.

Conclusion Some studies have revealed a positive correlation between ADHD medications and certain birth defects, other studies have not shown such a relationship. The majority of studies show an unintended, or slightly negative, impact. Therefore, a careful risk/benefit analysis must be done in each situation.

It can be difficult, if not impossible, for women with ADHD to stop taking their medication. In a recent article 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 loneliness. Furthermore, a loss of medication can adhd medication help with memory affect the ability to complete jobs and drive safely, which are important aspects of a normal life for many people suffering from ADHD.

She suggests that women who are unsure about whether to keep or discontinue medication due to their pregnancy consider informing family members, friends and colleagues about the condition, its impact on daily functioning, and the advantages of staying on the current treatment plan. In addition, educating them can aid in ensuring that the woman feels supported when she is struggling with her decision. Certain medications can pass through the placenta. If a patient decides not to take her ADHD medication while pregnant and breastfeeding, it is crucial to be aware that the drug may be transferred to her baby.

Birth Defects Risk

As the use of most popular adhd medication medication to treat the symptoms of attention deficit hyperactivity disorder (ADHD) increases there are concerns over the impact that these medications could have on fetuses. A study that was published in the journal Molecular Psychiatry adds to the existing knowledge on this subject. With two massive data sets researchers were able to look at more than 4.3 million pregnancies and see whether stimulant medications increased the risk of birth defects. While the overall risk is low, the researchers discovered that the first-trimester exposure to common adhd medications uk medications was associated with an increased risk of specific heart defects, such as ventriculoseptal defect (VSD).

The authors of the study could not discover any link between early medication usage and congenital anomalies such as facial deformities or club feet. The results are in the same vein as previous studies which showed a small, but significant increase in the number of cardiac malformations among women who started taking ADHD medication prior to the time of the time of pregnancy. This risk increased during the latter part of pregnancy when a large number of women stopped taking their medication.

Women who used ADHD medication in the first trimester of their pregnancy were also more likely to undergo caesarean section, low Apgar score following delivery, and a baby who required breathing assistance during birth. However the researchers of the study were not able to eliminate selection bias by restricting the study to women who did not have other medical issues that could have contributed to the findings.

The researchers hope their research will aid in the clinical decisions of physicians who treat pregnant women. They suggest that although the discussion of the benefits and risks is important however, the decision to stop or keep treatment should be based on each woman's needs and the severity of her ADHD symptoms.

The authors caution that, while stopping the medication is an option to look into, it is not advised because of the high incidence of depression and other mental problems in women who are expecting or have recently given birth. Further, the research suggests that women who decide to stop their medications are more likely to have a difficult time adapting to life without them following the birth of their baby.

Nursing

The responsibilities of being a new mom can be overwhelming. Women with treating adhd without medication who have to deal with their symptoms while attending doctor appointments, preparing for the arrival of their child and adapting to new routines in the home are often faced with a number of difficulties. Many women choose to continue taking their ADHD medication during pregnancy.

The majority of stimulant medicines are absorbed by breast milk in very small amounts, so the risk to the breastfeeding infant is minimal. The rate of exposure to medication will vary based on the dosage and frequency of administration as well as the time of the day. In addition, 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 understood.

Some doctors may decide to stop stimulant medications during a woman's pregnancy due to the lack of research. This is a difficult choice for the patient, who must weigh the benefits of continuing her medication against the possible risks to the fetus. Until more information becomes available, GPs can ask pregnant patients whether they have an background of ADHD or if they intend to take medication during the perinatal stage.

Many studies have shown that women can continue taking their ADHD medication without risk during pregnancy and while breast-feeding. In response, a rising number of patients are opting to continue their medication. They have concluded through consultation with their doctor, that the benefits of retaining their current medication outweigh any risk.

Women who suffer from ADHD who plan to breastfeed should seek the advice of a specialist psychiatrist prior to becoming pregnant. They should review their medications with their prescriber and discuss the pros and cons of continued treatment, including non-pharmacological management strategies. Psychoeducation should also be offered to help women with ADHD recognize their symptoms and underlying disorder, learn about available treatment options and reinforce existing strategies for coping. This should be a multidisciplinary approach including obstetricians, GPs and psychiatry. Pregnancy counseling should include a discussion of a treatment plan for the mother and child, as well as monitoring for signs of deterioration and, if necessary adjustments to the medication regime.