New And Innovative Concepts That Are Happening With ADHD Medication Pregnancy
ADHD Medication During Pregnancy and Breastfeeding
The decision to stop or keep ADHD medication during pregnancy and breastfeeding is a difficult decision for women suffering from the condition. There are few data regarding how exposure over time may affect a fetus.
A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication during the uterus do not develop neurological disorders such as hearing or vision impairment seizures, febrile seizures or IQ impairment. The authors acknowledge that further high-quality studies are needed.
Risk/Benefit Analysis
Women who are pregnant and taking ADHD medication must consider the benefits of taking it versus the risks for the baby. Doctors don't have enough data to provide clear recommendations however they can provide information about 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 increased risk of fetal cardiac malformations or major birth defects that are structural. Researchers conducted a massive population-based study of case control to assess the frequency of structural defects that were major in infants who were born to mothers who used stimulants during pregnancy. Pediatric cardiologists and clinical geneticists reviewed the cases to ensure an accurate case classification and to minimize the possibility of bias.
However, the study was not without its flaws. The researchers were unable in the beginning to distinguish the effects triggered by the medication from the disorder. That limitation makes it difficult to determine whether the small differences observed in the exposed groups are due to the use of medication or confounding by comorbidities. The researchers did not study the long-term effects for the offspring.
The study did find that infants whose mothers took ADHD medication during pregnancy were at a greater risk of being admitted to the neonatal intensive care unit (NICU) than those who whose mothers did not take any medication or had cut back on their medications 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.
adhd medication adults who used stimulant ADHD medication during pregnancy were also at an elevated chance of having a caesarean delivery or having a baby with an low Apgar score (less than 7). These risks did not appear to be affected by the kind of medication used 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 greater benefit to both mother and child of continuing treatment for the woman's disorder. Doctors should discuss with their patients about this and as much as possible, assist them develop coping skills that can lessen the impact of her disorder in her daily life and relationships.
Interactions with Medication
As more women than ever are being diagnosed with ADHD and being treated with medication, the dilemma of whether to continue or stop treatment during pregnancy is one that doctors are having to have to face. The majority of these decisions are taken in the absence of clear and authoritative evidence either way, so physicians must weigh their knowledge about their experiences, the experiences of other doctors, and what the research says on the topic as well as their own judgments for each patient.
Particularly, the subject of potential risks to the baby can be tricky. A lot of studies on this issue are based on observational evidence rather than controlled research, and their conclusions are often contradictory. The majority of studies limit their analysis to live births, which can underestimate the severity of teratogenic effects which can cause terminations or abortions of pregnancy. The study presented in the journal club addresses these shortcomings, by examining both the data from deceased and live births.
Conclusion: While some studies have shown an association between ADHD medications and certain birth defects however, other studies haven't established a link. Most studies have shown a neutral, or even slightly negative, effect. In the end, a careful risk/benefit analysis must be done in each case.
It can be challenging, if not impossible, for women suffering from ADHD to stop taking their medication. In a recent article 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 isolation. In addition, a decrease in medication can affect the ability to do work-related tasks and safely drive which are essential aspects of a normal life for a lot of people with ADHD.
She suggests women who are uncertain about whether to continue or stop medication in light of their pregnancy, consider the possibility of educating friends, family members and colleagues on the condition, its effects on daily functioning, and on the advantages of staying on the current treatment regimen. In addition, educating them can aid in ensuring that the woman feels supported in her struggle with her decision. It is important to remember that certain medications can pass through the placenta so if the patient decides to stop taking her ADHD medication during pregnancy and breastfeeding, she must be aware of the possibility that traces of the medication could be transferred to the child.
Risk of Birth Defects
As the use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases as do concerns about what impact the drugs could have on foetuses. Recent research published in the journal Molecular Psychiatry has added to the body knowledge on this topic. With two massive data sets researchers were able to examine more than 4.3 million pregnancies and determine whether the use of stimulant medications increased the risk of birth defects. Researchers discovered that although the risk overall is low, the first trimester ADHD exposure to medication was associated with slightly higher risk of certain heart defects, like ventriculoseptal defect.
The authors of the study didn't discover any link between early medication usage and other congenital anomalies, like facial deformities or club feet. The results are in line with previous studies showing the presence of a small, but significant increase in the risk of heart malformations among women who began taking ADHD medications prior to the time of the time of pregnancy. This risk increased in the later part of pregnancy, when a lot of women are forced to stop taking their ADHD medications.
Women who were taking ADHD medication during the first trimester were more likely require a caesarean birth or have an insufficient Apgar after birth and have a baby who needed breathing assistance at birth. The researchers of the study were unable to eliminate bias due to selection because they limited the study to women with no other medical conditions that might have contributed to the findings.
The researchers hope that their research will aid in the clinical decisions of doctors who treat pregnant women. They suggest that although a discussion of the risks and benefits is crucial but the decision to stop or maintain treatment should be based on the woman's needs and the severity of her ADHD symptoms.
The authors caution that, although stopping the medication is a possibility to look into, it is not advised because of the high incidence of depression and other mental disorders for women who are pregnant or recently gave birth. Additionally, the research suggests that women who decide to stop their medications are more likely to have a difficult time adjusting to life without them following the birth of their baby.
Nursing
It can be a challenge becoming a mother. Women with ADHD who must work through their symptoms while attending doctor appointments as well as making preparations for the arrival of a child and adapting to new routines in the home may face a lot of challenges. Therefore, many women choose to continue taking their ADHD medications throughout the course of pregnancy.
The risk to nursing infant is low because the majority of stimulant medication is absorbed through breast milk at a low level. The rate of exposure to medication will vary based on the dosage the medication is administered, its frequency and the time of day. Additionally, individual medications enter the body of the baby differently through the gastrointestinal tract and breast milk and the impact of this on a newborn is not fully known.
Some doctors may stop taking 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 keeping her medication against the possible dangers to the foetus. As long as more information is available, GPs may inquire about pregnant patients if they have any background of ADHD or if they intend to take medication in the perinatal stage.
A increasing number of studies have shown that most women can safely continue taking their ADHD medication while they are pregnant and nursing. In response, a rising number of patients are choosing to do so. They have concluded, in consultation with their doctors, that the benefits of continuing their current medication outweigh any risk.
Women who suffer from ADHD who plan to breastfeed should seek the advice of a specialist psychiatrist before becoming pregnant. They should review their medications with their prescriber and discuss the pros and cons of continued treatment, including non-pharmacological management strategies. Psychoeducation is also needed to help pregnant women suffering from ADHD recognize the signs and underlying disorder. They should also be informed about treatment options and strengthen coping mechanisms. This should involve a multidisciplinary approach with the GP as well as obstetricians, psychiatry and obstetricians. The pregnancy counselling should consist of the discussion of a plan for management for both the mother as well as the child, monitoring for signs of deterioration, and, if necessary, adjustments to the medication regimen.