ADHD Medication During Pregnancy and Breastfeeding
The decision to stop or keep ADHD medication during breastfeeding and pregnancy is a challenge for women suffering from the condition. There aren't enough data regarding how exposure over time may affect a pregnant fetus.
A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication in utero do not develop neurological developmental disorders like hearing loss or impaired vision seizures, febrile seizures or IQ impairment. The authors acknowledge the need for higher-quality research.
Risk/Benefit Analysis
Women who are pregnant and taking ADHD medication need to consider the benefits of taking it against the potential risks to the fetus. Physicians don't have the data to give clear advice however they can provide information about risks and benefits to aid pregnant women in making informed decisions.
A study published in Molecular Psychiatry found that women who took ADHD medications during 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 infants born to mothers who had taken stimulants in early pregnancy and those who had not. Clinical geneticists, pediatric cardiologists and other experts looked over the cases to ensure that the classification was correct and to reduce any bias.
The study of the researchers was not without its limitations. The researchers were not able in the beginning to distinguish the effects caused by the medication from the disorder. This makes it difficult for researchers to establish whether the small differences observed between the groups that were exposed to the use of medication, or if they were affected by comorbidities. The researchers did not examine long-term outcomes for the offspring.
The study did reveal that babies whose mothers had taken ADHD medication during pregnancy were at slightly higher risk of being admitted to the neonatal intensive care unit (NICU) than those whose mothers had not taken any medication or had cut back on their medications prior to or during pregnancy. This increase was caused by central nervous system disorders. The higher risk of admission was not influenced by the stimulant medication that was used during pregnancy.
Women who were taking stimulant ADHD medication during pregnancy were also at an elevated chance of having a caesarean birth or having a child with a low Apgar score (less than 7). These increases appeared to be independent of the type of medication taken during pregnancy.
The research suggests that the small risk associated with the use of ADHD medications during the early stages of pregnancy may be offset by the higher benefit to both mother and child of continuing treatment for the woman's condition. Physicians should discuss this with their patients and, when possible, assist them in developing strategies for improving their coping skills that can lessen the impact of her disorder on her daily functioning and relationships.
Medication Interactions
Doctors are increasingly confronted with the dilemma of whether to continue treatment or stop as more women are diagnosed with ADHD. These decisions are usually made without clear and reliable evidence. Instead, physicians must take into account their own experience, the experience of other doctors, and the research on the topic.
The issue of risk to the infant can be difficult to determine. A lot of studies on this subject are based on observational evidence instead of controlled research and their conclusions are often contradictory. Most studies focus on live-births, which could underestimate the severity of teratogenic effects that can lead to terminations or abortions of pregnancy. The study discussed in the journal club addresses these shortcomings by analyzing information on deceased and live births.
The conclusion is that while some studies have shown a positive association between ADHD medications and the possibility of certain birth defects, others have found no connection and the majority of studies show a neutral or even slightly negative impact. In all cases an in-depth evaluation of the potential risks and benefits should be conducted.
It can be difficult, if not impossible, for women suffering from ADHD to stop taking their medication. In fact, in an article published in the Archives of Women's Mental Health, psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can cause depression, feelings of loneliness and family conflict for those suffering from the disorder. A loss of medication may also impact the ability to safely drive and perform work-related tasks, which are essential aspects of daily life for those suffering from ADHD.
She suggests women who are uncertain about whether to keep or stop medication in light of 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. It can also make the woman feel more comfortable when she is struggling with her decision. Certain medications can be passed through the placenta. If the patient decides not to take her ADHD medication while pregnant and breastfeeding, it is important to be aware that the medication could be passed on to her infant.
Risk of Birth Defects
As the use and misuse of ADHD drugs to treat symptoms of attention deficit disorder hyperactivity disorder (ADHD), increases the concern over the potential adverse effects of the drugs on foetuses. 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 examine more than 4.3 million pregnancies and see whether stimulant medications increased the risk of birth defects. While the overall risk remains low, the scientists discovered that the first-trimester exposure to ADHD medications was associated with an increase in the risk of certain heart defects like ventriculo-septal defects (VSD).
The researchers of the study did not find any association between early use of medication and other congenital anomalies like facial deformities or club feet. The findings are in line with previous studies showing a small but significant increase in the risk of cardiac malformations among women who began taking ADHD medications prior to the time of pregnancy. This risk increased during the latter stages of pregnancy when a large number of women began to stop taking their medication.
Women who were taking ADHD medication during the first trimester were more likely need a caesarean or have a low Apgar after birth and had a baby that required breathing assistance when they were born. However the researchers of the study were not able to eliminate selection bias by limiting the study to women who didn't have any other medical issues that could have contributed to these findings.
The researchers hope their research will help inform the clinical decisions of doctors who treat pregnant women. They advise that while the discussion of risks and benefits is important however, the decision to stop or maintain treatment should be based on each woman's requirements and the severity of her ADHD symptoms.
The authors warn that, although stopping the medication is a possibility to look into, it is not recommended due to the high rate depression and other mental problems in women who are expecting or have recently given birth. Furthermore, research suggests that women who decide to stop taking their medication are more likely to have difficulties getting used to life without them after the birth of their baby.
Nursing
It can be a stressful experience to become a mother. Women suffering from ADHD may face a lot of challenges when they must manage their symptoms, go to doctor appointments and prepare for the birth of their child and adjust to a new routine. Many women decide to continue taking their ADHD medication during pregnancy.
The risk to a nursing infant is low because the majority of stimulant medications passes through breast milk in low amounts. The rate of medication exposure will vary based on the dosage the medication is administered, its frequency and the time of the day. Additionally, individual medications enter the infant's system differently through the gastrointestinal tract as well as breast milk. The impact of this on a newborn infant is not well understood.
Due to the absence of research, some doctors may be inclined to discontinue stimulant medications during the pregnancy of a woman. This is a difficult decision for the mother, who must weigh the benefits of her medication against the risks to the foetus. As long as there is no more information, GPs should ask all pregnant patients about their experience with ADHD and if they are taking or planning to take medication during the perinatal time.
iampsychiatry.uk growing number of studies have revealed that women can continue to take their ADHD medication while they are pregnant and nursing. This has led to an increasing number of patients are choosing to do so and, in consultation with their doctor they have found that the benefits of keeping their current medication far exceed any risk.
It's important for women with ADHD who are considering breastfeeding to seek a specialist psychiatrist's guidance prior to becoming pregnant. They should discuss their medication with their physician and discuss the advantages and disadvantages of continued treatment, including non-pharmacological management strategies. Psychoeducation should also be offered to help pregnant people with ADHD recognize their symptoms and underlying disorder and learn about treatment options and strengthen existing coping strategies. This should be a multidisciplinary approach with the GPs, obstetricians and psychiatrists. The pregnancy counselling should consist of the discussion of a treatment plan for both the mother as well as the child, and monitoring for signs of deterioration, and, if necessary, adjustments to the medication regimen.