10 Things You Learned In Preschool That'll Help You With ADHD Medication Pregnancy
ADHD Medication During Pregnancy and Breastfeeding
Women with ADHD must make 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 recent study published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological issues such as impaired hearing or vision, febrile seizures, or IQ impairment. The authors acknowledge that more high quality studies are needed.
Risk/Benefit Analysis
Women who are pregnant and take ADHD medication need to weigh the benefits of taking it versus the risks to the fetus. Doctors don't have enough data to provide clear recommendations however they can provide information about risks and benefits to help pregnant women make informed decisions.
A study published in Molecular Psychiatry found that women who took ADHD medications during their early pregnancy did not have an increased risk of fetal cardiac malformations or major birth defects that are structural. Researchers conducted a large population-based case control study to examine the prevalence of major structural defects in infants who were born to mothers who used stimulants during pregnancy. Clinical geneticists and pediatric cardiologists examined the cases to ensure an accurate classification of the cases and to reduce the possibility of bias.
The study conducted by the researchers was not without its limitations. Researchers were unable to, in the first place to distinguish the effects caused by the medication from the disorder. This limitation makes it difficult for researchers to establish whether the small associations observed among the groups that were exposed to the use of medications or affected by the presence of comorbidities. In addition, the researchers did not look at long-term offspring outcomes.
The study revealed that infants whose mothers had taken ADHD medication during pregnancy had a slightly higher chance of being admitted to the neonatal care unit (NICU), compared to mothers who did not take any medication during pregnancy or had quit taking the medication prior to or during pregnancy. This increase was due to central nervous system-related disorders and the higher risk of admission did not appear to be influenced by which stimulant medication was used during pregnancy.
Women who took stimulant ADHD medication during pregnancy were also at an increased chance of having a caesarean section or having a baby born with an low Apgar score (less than 7). These increases did appear to be unrelated to the type of medication taken during pregnancy.
The research suggests that the low risk associated with the use of ADHD medications during early pregnancy could be offset by the greater benefits for both mother and child of continued 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 life and relationships.
As more women than ever are diagnosed with ADHD and being treated with medication, the issue of whether to keep or stop treatment during pregnancy is a question that doctors are having to face. The majority of these decisions are made in the absence of solid and reliable evidence either way, so physicians must weigh their knowledge, the experiences of other doctors, and what the research suggests about the subject as well as their own best judgment for each patient.
Particularly, the subject of potential risks to the infant can be difficult. The research on this issue is based on observations instead of controlled studies and many of the findings are conflicting. Additionally, the majority of studies limit their analysis to live births, which may undervalue the serious teratogenic effects that can result in abortion or termination of the pregnancy. The study presented in this journal club addresses these limitations by analyzing data on live and deceased births.
Conclusion Some studies have found a positive correlation between ADHD medications and certain birth defects however, other studies haven't established a link. Most studies show that there is a neutral, or slight negative impact. In every case an in-depth evaluation of the benefits and risks is required.
It isn't easy, but not impossible, for women suffering from ADHD to stop taking their medication. In a recent piece published in Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can cause depression and feelings of being isolated. The loss of medication can affect the ability to drive safely and to perform work-related tasks which are essential aspects of everyday life for those suffering from ADHD.
She recommends women who are unsure about whether to continue or stop medication in light of their pregnancy, consider educating family members, friends and colleagues on the condition, its impact on daily functioning, and the benefits of keeping the current treatment regimen. It will also help a woman feel more confident in her decision. It is important to remember that some medications are able to pass through the placenta, so if the patient decides to stop her ADHD medication during pregnancy and breastfeeding, she should be aware of the possibility that traces of the drug could be transferred to the infant.
Risk of Birth Defects
As the use and abuse of ADHD medication to treat symptoms of attention deficit hyperactivity disorder (ADHD), increases the concern over the possible effects of the drugs on the fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge on this issue. Researchers used two massive datasets to analyze more than 4.3 million pregnant women and determine if the use of stimulant medications increased the risk of birth defects. While the overall risk remains low, the researchers discovered that the first-trimester exposure to ADHD medications was associated with a slightly higher rate of certain heart defects, like ventriculo-septal defects (VSD).
The researchers of the study found no association between early medication use and congenital abnormalities like facial clefting, or club foot. The results are consistent with previous studies showing the presence of a small, but significant increase in the risk of cardiac malformations in women who started taking ADHD medications before the time of pregnancy. The risk grew in the latter half of pregnancy, as many women are forced to stop taking their ADHD medication.
Women who used ADHD medications in the first trimester of pregnancy were also more likely to experience caesarean section, low Apgar score following delivery, and a baby that required breathing assistance at birth. However the authors of the study were unable to eliminate selection bias by limiting the study to women who didn't have any other medical conditions that could have contributed to these findings.
The researchers hope their study will serve to inform the clinical decisions of physicians who encounter pregnant women. The researchers recommend that, while discussing benefits and risks are important, the choice regarding whether or not to stop taking medication should be based on the severity of each woman's ADHD symptoms and her needs.
The authors also caution that even though stopping the medication is an option, it isn't a recommended practice because of the high prevalence of depression and other mental health issues for women who are expecting or who are recently postpartum. Additionally, the research suggests that women who choose to stop taking their medication are more likely to have a difficult time adjusting to life without them following the birth of their baby.
Nursing
It can be overwhelming to become a mom. Women who suffer from ADHD who must work through their symptoms while attending physician appointments and getting ready for the arrival of a baby and adjusting to new household routines are often faced with a number of difficulties. Many women opt to continue taking their ADHD medication during pregnancy.
The risk for breastfeeding infant is minimal because the majority of stimulant medication passes through breast milk at a low level. The amount of exposure to medications will differ based on dosage the medication is administered, its frequency and the time of the day. In addition, different medications are introduced into the baby's system via the gastrointestinal tract, or through breast milk. The impact of these medications on the health of a newborn is not fully understood.
Some physicians may discontinue stimulant medication during a woman's pregnancy due to the absence of research. This is a difficult choice for the patient, who must balance the benefit of continuing her medication against the possible risks to the fetus. In the meantime, until more information is available, doctors should inquire with all pregnant patients about their experience with ADHD and whether they plan or are taking to take medication during the perinatal period.
A increasing number of studies have shown that women can continue their ADHD medication while they are pregnant and nursing. In response, a growing number of patients are opting to do so. They have concluded after consulting with their doctors that the benefits of retaining their current medication outweigh any potential risks.
Women with ADHD who are planning to breastfeed should seek advice from a specialist psychiatrist before becoming pregnant. They should review their medications with their doctor and discuss the advantages and disadvantages of continuing treatment, including non-pharmacological strategies. Psychoeducation is also necessary to help pregnant women with ADHD be aware of the symptoms and underlying disorder. They should also be informed about treatment options and strengthen the coping mechanisms. This should involve an approach that is multidisciplinary, including the GP, obstetricians and psychiatry. Pregnancy counseling should include a discussion of a treatment plan for the mother and child, monitoring of indicators of deterioration, and, if needed modifications to the medication regimen.