"Ask Me Anything," 10 Answers To Your Questions About ADHD Medication Pregnancy
ADHD Medication During Pregnancy and Breastfeeding
The choice of whether to stop or continue ADHD medications during pregnancy and nursing is a difficult decision for women suffering from the condition. There isn't much information on how long-term exposure to these medications may affect the foetus.
A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus don't develop neurological developmental disorders like hearing loss or impaired vision, febrile seizures, or IQ impairment. The authors acknowledge the need for more high-quality research.
Risk/Benefit Analysis
Women who are pregnant and taking ADHD medication must weigh the benefits of taking it versus the risks for the baby. Physicians don't have the data to provide clear recommendations however they can provide information on the risks and benefits to assist pregnant women to make informed decisions.
A study published in Molecular Psychiatry found that women who used ADHD medications in early pregnancy did not have a significantly higher risk of fetal cardiac malformations or major birth defects that are structural. Researchers conducted a large sample-based case control study to assess the frequency of major structural defects in infants who were born to mothers who used stimulants during pregnancy. Clinical geneticists, pediatric cardiologists and other experts looked over the cases to confirm that the classification was correct and to minimize any bias.
The study conducted by the researchers was not without its limitations. Researchers were unable to, in the first place, to separate the effects triggered by the medication from the disorder. This makes it difficult for researchers to determine whether the small differences observed between the exposed groups were due to medication use or affected by comorbidities. In addition the study did not look at the long-term effects of offspring on their parents.
The study found that babies whose mothers had taken ADHD medication during pregnancy had a slightly higher risk of admission to the neonatal care unit (NICU) in comparison to those whose mothers didn't take any medication during pregnancy, or had discontinued taking their medication prior to or during pregnancy. This increase was caused by central nervous system disorders. The increased risk of admission was not affected by the stimulant medication that was used during pregnancy.
Women who took stimulant ADHD medications during pregnancy also had a higher chance of having caesarean sections or one whose baby scored low on the Apgar scale (less than 7). These risks did not seem to be influenced by the type of medication that was used during pregnancy.
Researchers suggest that the minor risks posed by the use of ADHD medications during early pregnancies could be offset by the more beneficial outcomes for both mother and baby from continuing treatment for the woman's condition. Physicians should discuss the issue with their patients and, if they are able, assist them in developing strategies to improve their coping abilities which can reduce the negative impact of her condition on her daily life and relationships.
Interactions with Medication
As more women than ever are being diagnosed with ADHD and treated with medication, the dilemma of whether to keep or stop treatment during pregnancy is a question that doctors are having to confront. These decisions are often made without clear and authoritative evidence. Instead, doctors have to consider their own expertise in conjunction with the experiences of other physicians and the research on the topic.
The issue of risk for infants can be extremely difficult. A lot of studies on this topic are based on observational data rather than controlled research and their findings are often contradictory. The majority of studies limit their analysis to live births, which can underestimate the teratogenic impact leading to terminations or abortions of pregnancy. The study presented in this journal club addresses these limitations by looking at data from both live and deceased births.
Conclusion: While some studies have found a positive correlation between ADHD medications and certain birth defects However, other studies haven't found a correlation. Most studies show that there is a neutral, or slight negative effect. In all cases an in-depth evaluation of the potential risks and benefits is required.
It isn't easy, but not impossible, for women suffering from 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 increase depression and feelings of loneliness. A loss of medication may affect the ability to safely drive and complete work-related tasks, which are essential aspects of daily life for those suffering from ADHD.
She recommends women who are uncertain about whether to keep or discontinue medication due to their pregnancy should consider informing family members, friends, and coworkers on the condition, its effects on daily functioning, and on the advantages of continuing the current treatment regimen. It can also help a woman feel confident about her decision. Certain medications can be passed through the placenta. If a woman decides to not take her ADHD medication while breastfeeding, it's important to be aware that the medication may be transferred to her baby.
Risk of Birth Defects
As the use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) grows as do concerns about what impact the drugs might have on foetuses. 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 to look at more than 4.3 million pregnancies and see whether stimulant medication use increased the risk of birth defects. Researchers found that while the risk overall is low, the first trimester ADHD medication exposure was associated with slightly higher rates of certain heart defects, like ventriculoseptal defects.
The authors of the study found no link between the use of early medications and other congenital anomalies, such as facial clefting or club foot. most effective adhd medication for adults are in line with previous studies that showed the existence of a slight, but significant increase in cardiac malformations for women who started taking ADHD medication prior to the time of the time of pregnancy. This risk increased during the latter half of pregnancy when a large number of women decided 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 have a baby who needed help breathing at birth. 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 conditions that could be a contributing factor to these findings.
Researchers hope that their research will inform physicians when they see pregnant women. They recommend that, while the discussion of risks and benefits is important but the decision to stop or continue treatment should be based on each woman's needs and the severity of her ADHD symptoms.
The authors also caution that, while stopping the medication is an alternative, it is not an option to consider due to the high incidence of depression and other mental health issues for women who are expecting or post-partum. Furthermore, research suggests that women who decide to stop taking their medications are more likely to experience difficulties adjusting to life without them following the baby's arrival.
Nursing
The responsibilities of a new mom can be overwhelming. Women suffering from ADHD may face a lot of challenges when they must manage their symptoms, attend doctor appointments and prepare for the birth of a baby and adjust to a new routine. Therefore, many women decide to continue taking their ADHD medication throughout the pregnancy.
The risk to nursing infant is low because the majority of stimulant medications is absorbed through breast milk at a low level. However, the rate of exposure to medication by the newborn may differ based on the dosage, frequency it is taken and the time of the day the medication is administered. Additionally, individual medications enter the infant's system differently through the gastrointestinal tract and breast milk, and the effect of this on a newborn infant is not yet fully understood.
Due to the absence of research, some doctors might be tempted to stop taking stimulant medication during the course of pregnancy. This is a difficult choice for the patient, who must balance the benefits of continuing her medication against the potential 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.
Many studies have shown that women can continue to take their ADHD medication without risk while breastfeeding and during pregnancy. As a result, many patients are choosing to do so, and in consultation with their doctor they have found that the benefits of keeping their current medication far outweigh any potential risks.
Women with ADHD who plan to breastfeed should seek advice from a specialist psychiatrist before becoming pregnant. They should discuss their medication with their prescriber and discuss the pros and cons of continued treatment, including non-pharmacological strategies. Psychoeducation is also required to help women with ADHD understand their symptoms and the underlying disorder, learn about available treatments and to reinforce existing strategies for coping. This should be an approach that is multidisciplinary, including the GP as well as obstetricians, psychiatry and obstetricians. Pregnancy counseling should consist of a discussion of a treatment plan for the mother and child, and monitoring for signs of deterioration, and, if necessary adjustments to the medication regimen.