5 Laws Anyone Working In ADHD Medication Pregnancy Should Know
ADHD Medication During Pregnancy and Breastfeeding
Women suffering from ADHD face a difficult decision about whether to continue or stop taking ADHD medication during pregnancy and breastfeeding. There isn' watch this video on how long-term exposure to these drugs could affect the fetus.
A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication in utero do not develop neurological developmental conditions like hearing or vision impairment, febrile seizures, or IQ impairment. The authors acknowledge that further high-quality studies are required.
Risk/Benefit Analysis
Pregnant women who use ADHD medications must weigh the benefits of taking them against potential risks to the fetus. Physicians do not have the necessary data to provide clear recommendations however they can provide information regarding risks and benefits that assist pregnant women in making informed choices.
A study published in Molecular Psychiatry found that women who used ADHD medications in early pregnancy did not face an increased risk of fetal heart malformations or major structural birth defects. Researchers conducted a large 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 examined the cases to confirm that the classification was correct and to eliminate any bias.
However, the researchers' study had its limitations. Researchers were unable in the beginning, to separate the effects of the medication from the disorder. This limitation makes it difficult to know whether the limited associations observed in the groups that were exposed result from medication use or the confounding effect of comorbidities. The researchers also did not examine long-term outcomes for the offspring.
The study did reveal that babies whose mothers had taken ADHD medications 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 was due to central nervous system disorders. The higher risk of admission was not influenced by the stimulant medications used during pregnancy.
Women who took stimulant ADHD medication during pregnancy were also at an increased risk of having a caesarean section or having a baby born with low Apgar score (less than 7). These increases appeared to be unrelated to the type of medication used during pregnancy.
The research suggests that the risk of a small amount with the use of ADHD medications during the early stages of pregnancy could be offset by the greater benefits for both mother and child from continued treatment for the woman's condition. Physicians should discuss the issue with their patients and, where possible, assist them in developing strategies to improve coping skills which can reduce the negative impact of her condition on her daily functioning and relationships.
Medication Interactions
Many doctors are confronted with the dilemma of whether to continue treatment or stop it during pregnancy as more women are diagnosed with ADHD. These decisions are often made without clear and authoritative evidence. Instead, physicians must weigh their own knowledge and experience, as well as the experiences of other physicians and the research on the topic.
In particular, the issue of possible risks to the baby can be tricky. Many of the studies on this topic are based on observational evidence rather than controlled research, and their conclusions are often contradictory. In addition, most studies limit their analysis to live births, which can underestimate the severity of teratogenic effects that could result in abortion or termination of the pregnancy. The study that is discussed in the journal club addresses these shortcomings by analyzing both data on live and deceased births.
The conclusion: While certain studies have demonstrated that there is a positive correlation between ADHD medications and the possibility of certain birth defects, other studies have found no connection, and most studies show a neutral or even slight negative effect. In every case an in-depth evaluation of the potential risks and benefits should be conducted.
For a lot of women with ADHD and ADD, the decision to stop taking medication can be difficult, if not impossible. In fact, in a recent article 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 these patients. In addition, a decrease in medication can affect the ability to perform jobs and drive safely which are essential aspects of a normal life for many people with ADHD.
She suggests that women who are unsure whether to continue taking medication or discontinue it due to pregnancy educate family members, coworkers, and their friends about the condition, the effects on daily functioning, and the benefits of keeping the current treatment regimen. It will also help a woman feel supported in her decision. Some medications can pass through the placenta. If a woman decides to not take her ADHD medication while breastfeeding, it's important to be aware that the drug may be transferred to her baby.
Risk of Birth Defects
As the use and abuse of ADHD medications to treat the symptoms of attention deficit disorder hyperactivity disorder (ADHD) increases as does the concern about the potential adverse effects of the drugs on foetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge on this issue. Using two massive data sets researchers were able look at more than 4.3 million pregnancies to determine whether stimulant medications increased the risk of birth defects. Researchers found that while the overall risk is low, the first trimester ADHD medication exposure was associated with slightly higher rates of specific heart defects like ventriculoseptal defects.
The authors of the study could not discover any link between early use of medication and other congenital anomalies, like facial deformities or club feet. The results are in the same vein as previous studies that have shown an insignificant, but small increase in the number of cardiac malformations among women who started taking ADHD medication prior to pregnancy. The risk was higher in the later part of pregnancy, when a lot of women decide to stop taking their ADHD medication.
Women who used ADHD medications in the first trimester of their pregnancy were also more likely to have caesarean section, low Apgar score following delivery, and a baby who required breathing assistance during birth. The authors of the study could not remove bias in selection since they limited their study to women who did not have any other medical conditions that might have contributed to the findings.
The researchers hope their study will aid in the clinical decisions of doctors who see pregnant women. They suggest that although the discussion of 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 also warn that even though stopping the medication is an option, it isn't an option to consider due to the high incidence of depression and other mental health problems among women who are pregnant or postpartum. Furthermore, research suggests that women who decide to stop taking their medication are more likely to have difficulties getting used to life without them following the baby's arrival.
Nursing
It can be a stressful experience to become a mother. Women who suffer from ADHD who must work through their symptoms while attending physician appointments and making preparations for the arrival of a child and adapting to new routines in the home are often faced with a number of difficulties. This is why many women choose to continue taking their ADHD medication throughout the pregnancy.
The risk to breastfeeding infant is not too high since the majority of stimulant medication passes through breast milk at low levels. The rate of medication exposure can vary depending upon the dosage, frequency of administration and time of 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 isn't yet fully understood.
Due to the absence of research, some physicians may recommend stopping stimulant medications during a woman's pregnancy. This is a difficult decision for the woman, who must weigh the advantages of taking her medication as well as the potential risks to the embryo. As long as more information is available, GPs may ask pregnant patients whether they have an history of ADHD or if they intend to take medication during the perinatal phase.
A growing number of studies have proven that most women can safely continue taking their ADHD medication during pregnancy and while breastfeeding. This has led to many patients are choosing to do so and in consultation with their physician, they have discovered that the benefits of maintaining their current medication outweigh any potential risks.
Women with ADHD who plan to breastfeed should seek advice from a specialist psychiatrist prior to becoming pregnant. They should discuss their medication with their doctor and discuss the advantages and disadvantages of continued treatment, including non-pharmacological strategies. Psychoeducation should also be provided to help pregnant people with ADHD recognize their symptoms and underlying disorder Learn about the available treatment options and strengthen existing strategies for managing. This should be a multidisciplinary process with the GPs, obstetricians and psychiatry. Pregnancy counselling should include the discussion of a plan for management for both the mother as well as the child, as well as monitoring for signs of deterioration, and when necessary, making adjustments to the medication regimen.