10 Tips For Getting The Most Value From ADHD Medication Pregnancy
ADHD Medication During Pregnancy and Breastfeeding
Women suffering from ADHD have to make a difficult choice about whether to continue or stop taking ADHD medication during pregnancy and breastfeeding. There aren't many studies on how long-term exposure 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 such as impaired vision or hearing seizures, febrile seizures, or IQ impairment. The authors acknowledge that further high-quality research is needed.
Risk/Benefit Analysis
Women who are expecting and taking ADHD medication must weigh the benefits of taking it versus the dangers for the fetus. Physicians do not have the data needed to make unequivocal recommendations but they can provide information on risks and benefits that assist pregnant women in making informed decisions.
A study published in Molecular Psychiatry concluded that women who were taking ADHD medication during their early pregnancy were not at greater risk of fetal malformations, or structural birth defects. Researchers conducted a massive population-based case control study to compare the incidence of structural defects that were major in infants who were born to mothers who were taking stimulants during pregnancy. Pediatric cardiologists, clinical geneticists and other experts looked over the cases to ensure that the classification was correct and to minimize any bias.
However, the study was not without its flaws. In particular, they were unable to distinguish the effects of the medication from the effects of the underlying disorder. This limitation 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. In addition the researchers did not examine the long-term outcomes of offspring.
The study did reveal that infants whose mothers had taken ADHD medications during pregnancy were at slightly greater risk of being admitted to the neonatal intensive care unit (NICU) than infants whose mothers had not taken any medication or had cut back on their medications prior to or during pregnancy. The reason for this was central nervous system-related disorders and the increased risk for admission was not found to be influenced by which stimulant medication was used during pregnancy.
Women who used stimulant ADHD medication during pregnancy were also at an elevated risk of having a caesarean birth or having a child with low Apgar score (less than 7). These increases didn't appear to be affected by the kind of medication used during pregnancy.
Researchers suggest that the small risk of using ADHD medications in early pregnancies may be offset by the greater benefits for mother and baby from continuing treatment for the woman's disorder. Doctors should discuss with their patients about this and as much as possible, assist them improve coping skills which can lessen the effects of her disorder on her daily functioning and her relationships.
Medication Interactions
As more women than ever are being diagnosed with ADHD and treated with medication, the dilemma of whether or not to stop treatment during pregnancy is one that doctors are having to confront. Most of the time, these decisions are made in the absence of any evidence that is clear and definitive in either case, which means that doctors must weigh their knowledge from their own experiences, those of other doctors, and what research suggests on the subject as well as their own best judgment for each patient.
Particularly, the subject of potential risks for the baby can be a challenge. A lot of studies on this subject are based on observational evidence rather than controlled research and their findings are often contradictory. Most studies focus on live-births, which could underestimate the teratogenic impact leading to abortions or terminations of pregnancy. The study discussed in this journal club addresses these limitations by examining data on both live and deceased births.
The conclusion: While some studies have found a positive association between ADHD medications and the risk of certain birth defects, other studies have found no such relationship, and most studies demonstrate a neutral or slightly negative effect. Therefore, a careful risk/benefit analysis must be conducted in every case.
It can be difficult, if not impossible, for women with 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 lead to increased depression, feelings of isolation and family conflict for these patients. A loss of medication may affect the ability to drive safely and complete work-related tasks, which are essential aspects of everyday life for people with ADHD.
She suggests that women who are not sure whether to continue taking the medication or stop due to pregnancy educate family members, coworkers, and friends about the condition, its effects on daily functioning, and the benefits of continuing the current treatment plan. It can also help the woman feel supported as she struggles with her decision. It is also worth noting that some medications are able to be absorbed through the placenta so if the patient decides to stop her ADHD medication during pregnancy and breastfeeding, she should be aware that traces of the drug can be passed on to the baby.
adhd medication for adults Risk
As the use of ADHD medications to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases, so do concerns over the impact that these medications could have on fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge regarding this topic. Utilizing two huge data sets researchers were able analyze more than 4.3 million pregnancies and determine whether the use of 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 an increased risk of certain heart defects, such as ventriculo-septal defect (VSD).
The authors of the study didn't discover any link between early use of medication and other congenital anomalies, like facial deformities, or club feet. The results are consistent with previous studies that have shown an increase, but not significant, in the risk of cardiac malformations among women who started taking ADHD medications prior to the time of pregnancy. The risk increased in the latter part of pregnancy, when a lot of women began to stop taking their medication.
Women who took ADHD medication during the first trimester were more likely require a caesarean birth or have a low Apgar after birth and had a baby that required help breathing at birth. The authors of the study were unable to eliminate bias due to selection because they limited their study to women who did not have any other medical conditions that could have contributed to the findings.
Researchers hope that their research will inform physicians when they see pregnant women. They suggest that although discussing the risks and benefits is crucial, the decision to stop or continue medication should be based on each woman's needs and the severity of her ADHD symptoms.
The authors warn that, even though stopping the medication is a possibility to think about, it isn't recommended due to the high prevalence of depression and mental health issues among women who are pregnant or have recently given birth. Further, research shows that women who stop taking their medications will have a difficult transitioning to life without them once the baby is born.
Nursing
It can be overwhelming to become a mother. Women with 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 choose to continue taking their ADHD medication during pregnancy.
The majority of stimulant medications are absorbed by breast milk in small amounts, so the risk to the nursing infant is very low. The amount of exposure to medications will vary based on the dosage, frequency of administration and the time of the day. In addition, different drugs enter the infant's system through the gastrointestinal tract or through breast milk. The impact of these medications on the health of a newborn is not completely understood.
Some physicians may discontinue 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 continuing her medication against the possible risks to the embryo. In the meantime, until more information is available, doctors may inquire about pregnant patients whether they have an history of ADHD or if they intend to take medication in the perinatal phase.
Numerous studies have demonstrated that women can continue taking their ADHD medication without risk during pregnancy and breast-feeding. In response, an increasing number of patients are choosing to do so. They have discovered after consulting with their doctors that the benefits of continuing their current medication outweigh potential risks.
Women who suffer from ADHD who plan to breastfeed should seek the advice of an expert psychiatrist prior to becoming pregnant. They should discuss their medication with their prescriber, and the pros and cons of continuing treatment. This includes non-pharmacological strategies. Psychoeducation should also be provided to help women with ADHD recognize their symptoms and the root cause and learn about treatment options and reinforce existing strategies for coping. This should be a multidisciplinary approach with the GP doctors, obstetricians and psychiatrists. Pregnancy counselling should include the discussion of a treatment plan for both mother and child, monitoring for signs of deterioration and, if necessary, adjustments to the medication regimen.