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 breast-feeding. There aren't enough data on how exposure to ADHD for a long time could affect the fetus.

A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological disorders like hearing loss or vision, febrile seizures, or IQ impairment. The authors acknowledge the need for more high-quality research.

Risk/Benefit Analysis

Women who are pregnant and take ADHD medication should consider the benefits of taking it versus the risks to the foetus. Physicians don't have the data to provide clear recommendations, but can provide information on the risks and benefits to assist pregnant women to make an informed decision.

A study published in Molecular Psychiatry concluded that women who took ADHD medication during their early pregnancy were not at a greater risk of fetal malformations, or structural birth defects. Researchers conducted a large sample-based case control study to assess the frequency of major structural defects in infants born to mothers who were taking stimulants during pregnancy. Clinical geneticists and pediatric cardiologists reviewed the cases to ensure accurate case classification and to minimize the possibility of bias.

However, the researchers' study was not without its flaws. In particular, they were unable to separate the effects of the medication from those of the underlying disorder. This limitation makes it difficult to know whether the small differences observed in the exposed groups are due to the use of medication or the confounding effect of comorbidities. In addition, the researchers did not look at the long-term effects of offspring on their parents.

The study found that babies whose mothers took ADHD medication during pregnancy were at a slightly higher risk of admission to the neonatal care unit (NICU) as compared to mothers who didn't take any medication during pregnancy or had discontinued taking their medication prior to or during pregnancy. The reason for this was central nervous system disorders, and the increased risk for admission did not appear to be influenced by the stimulant medications were used during pregnancy.

Women who were taking stimulant ADHD medications during pregnancy also had a higher likelihood of having to have an emergency caesarean section or having a baby that scored low on the Apgar scale (less than 7). These increases did not appear to be affected by the type of medication that was used during pregnancy.

Researchers suggest that the small risks posed by the use of ADHD medications in early pregnancies can be offset by more beneficial outcomes for both mother and baby of continuing treatment for the woman's disorder. Physicians should discuss this with their patients and, where possible, assist them in developing strategies for improving their coping skills that may minimize the negative impact of her condition on her daily functioning and relationships.

Medication Interactions

More and more doctors are faced with the decision of whether to continue treatment or stop it during pregnancy as more women are diagnosed with ADHD. Often, these decisions are taken in the absence of any evidence that is clear and definitive regardless, so doctors have to weigh their experience, the experiences of other doctors, and what the research suggests about the subject, along with their own best judgment for each individual patient.

In particular, the issue of potential risks for the baby can be tricky. A lot of studies on this topic are based on observational evidence rather than controlled research, and their conclusions are often contradictory. Most popular adhd medication studies focus on live births, which can 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 analyzing both data on live and deceased births.

Conclusion A few studies have shown a positive correlation between ADHD medications and certain birth defects however, other studies haven't found a correlation. The majority of studies show a neutral, or even somewhat negative, effect. In all cases, a careful analysis of the risks and benefits is required.

It can be difficult, if not impossible for women with ADHD to stop taking their medication. In a recent article published 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 can interfere with the ability to complete job-related tasks and drive safely that are crucial aspects of daily life for many people with ADHD.

She recommends women who are uncertain about whether to keep or stop taking medication because of their pregnancy consider informing family members, friends and colleagues about the condition, its effects on daily life, and the advantages of staying on the current treatment regimen. Educating them can also help the woman feel supported when she is struggling with her decision. It is also worth noting that some drugs can be absorbed through the placenta so if a woman decides to stop her ADHD medication during pregnancy and breastfeeding, she should be aware that the effects of the drug could be transferred to the child.

Risk of Birth Defects

As the use of ADHD medications to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases, so do concerns over the impact that these drugs might have on foetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge regarding this subject. Utilizing two huge data sets, researchers were able to examine more than 4.3 million pregnancies to determine whether the use of stimulant medications increased the risk of birth defects. While the overall risk remains low, the scientists found that exposure in the first trimester to ADHD medications was linked to an increase in the risk of certain heart defects, such as ventriculo-septal defect (VSD).

The researchers behind the study found no link between the use of early medications and congenital abnormalities such as facial clefting or club foot. The results are consistent with previous studies that have shown a small but significant increase in the risk of cardiac malformations in women who started taking ADHD medications prior to pregnancy. The risk grew in the later part of pregnancy, as many women are forced to stop taking their ADHD medications.

Women who took ADHD medication in the first trimester of their pregnancy were also more likely to have caesarean sections, a low Apgar score following delivery, and a baby who required breathing assistance during birth. The authors of the study could not eliminate bias due to selection because they limited the study to women who did not have any other medical conditions that might have contributed to the findings.

Researchers hope that their research will help doctors when they encounter pregnant women. They advise that while a discussion of the benefits and risks is important, the decision to stop or keep medication must 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 think about, it isn't recommended because of the high incidence of depression and mental health issues in women who are expecting or recently gave birth. Further, the research suggests that women who choose to stop taking their medications are more likely to have a difficult time adapting to life without them after the baby's arrival.

Nursing

The responsibilities of a new mom can be overwhelming. Women who suffer from ADHD who must work through their symptoms while attending physician appointments as well as preparing for the arrival of a child and adjusting to new household routines can experience severe challenges. This is why many women choose to continue taking their ADHD medications throughout the course of pregnancy.

The risk to nursing infant is low because the majority of stimulant medications passes through breast milk in low amounts. The amount of exposure to medications will differ based on 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 as well as breast milk and the impact of this on a newborn is not yet fully understood.

Some doctors may decide to stop stimulant medication during a woman’s pregnancy due to the lack of research. This is a complicated decision for the patient, who must weigh the benefits of continuing her medication with the potential dangers to the fetus. As long as there is no more information, doctors should inquire with all pregnant patients about their history of ADHD and if they are taking or planning to take medication during the perinatal time.

A growing number of studies have shown that the majority of women are able to safely continue taking their ADHD medication during pregnancy and while breastfeeding. In response, an increasing number of patients are choosing to do this. They have concluded through consultation with their doctors that the benefits of keeping their current medication outweigh possible risks.

Women with adhd medication for women who are planning 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 medication treatment for adhd-pharmacological strategies. Psychoeducation is also needed to help pregnant women suffering from ADHD recognize the signs and the underlying disorder. They should also be informed about treatment options and reinforce coping mechanisms. This should be a multidisciplinary approach including obstetricians, GPs and psychiatry. The pregnancy counselling should consist of discussion of a management plan for both mother and child, and monitoring for signs of deterioration, and when necessary, making adjustments to the medication regimen.