Why No One Cares About ADHD Medication Pregnancy
My Site During Pregnancy and Breastfeeding
Women suffering from ADHD face a difficult decision on whether to keep or stop taking ADHD medication during pregnancy and breastfeeding. There aren't many studies regarding how exposure over time may 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 further high-quality studies are needed.
Risk/Benefit Analysis
Women who are expecting and taking ADHD medication must evaluate the benefits of using it against the possible risks to the baby. The doctors don't have the information to provide clear recommendations however they can provide information on risks and benefits to help pregnant women make an informed decision.
A study published in Molecular Psychiatry concluded that women who took ADHD medication during their early pregnancy did not have a greater risk of fetal malformations or structural birth defects. The researchers used a large population-based case-control study to evaluate the incidence of major structural birth defects in babies born to mothers who took stimulants during early pregnancy and those who had not. Pediatric cardiologists, clinical geneticists and other experts examined the cases to ensure that the classification was correct and to reduce any bias.
The study of the researchers was not without limitations. The researchers were not able in the beginning to differentiate the effects caused by the medication from the disorder. This limitation makes it difficult for researchers to establish whether the few associations observed between the groups that were exposed to medication use, or if they were caused by comorbidities. Researchers also did not look at long-term outcomes for the offspring.
The study did show that infants whose mothers had taken ADHD medications during pregnancy were at a slightly higher risk of being admitted to the neonatal intensive care unit (NICU) than those who were born without any medication or had stopped their medications before 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 medications were used during pregnancy.
Women who took stimulant ADHD medication during pregnancy also had an increased risk of having a caesarean delivery or having a child with low Apgar score (less than 7). These increases did not seem to be influenced by the kind of medication used during pregnancy.
Researchers suggest that the small risk of using ADHD medication during pregnancies in the early stages may be offset by the more beneficial outcomes for both mother and baby of continuing treatment for the woman’s disorder. Physicians should discuss this with their patients and, when possible, help them develop strategies for improving their coping skills that can lessen the impact of her disorder on her daily functioning and relationships.
Medication Interactions
As more women than ever are diagnosed with ADHD and being treated with medication, the issue of whether or not to discontinue treatment during pregnancy is a question that doctors are having to confront. These decisions are often made without clear and reliable evidence. Instead, physicians must take into account their own experience in conjunction with the experiences of other doctors and the research on the subject.
The issue of potential risks to infants is difficult to determine. Many studies on this topic are based on observational evidence rather than controlled research, and their findings are often contradictory. The majority of studies restrict their analysis to live births, which can underestimate the teratogenic impact which can cause abortions or terminations of pregnancy. The study that is discussed in the journal club addresses these issues by analyzing both the data from deceased and live births.
Conclusion Some studies have found a positive correlation between ADHD medications and certain birth defects, other studies have not shown such a relationship. The majority of studies show a neutral, or even slightly negative, effect. As a result an accurate risk-benefit analysis is required in every instance.
For women suffering from ADHD and ADD, the decision to discontinue medication can be difficult, if not impossible. 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 loneliness. A decrease in medication could also impact the ability to safely drive and complete work-related tasks, which are vital aspects of daily life for people with ADHD.
She recommends women who are unsure about whether or not to stop medication in light of their pregnancy, consider the possibility of educating friends, family members and colleagues about the condition, its effects on daily life, and the advantages of staying on the current treatment plan. It will also help a woman feel confident about her decision. It is important to remember that some medications are able to pass through the placenta so if the patient decides to stop taking her ADHD medication during pregnancy and breastfeeding, she should be aware that the effects of the medication could be transferred to the child.
Birth Defects and Risk of
As the use and use of ADHD medications to treat the symptoms of attention deficit hyperactivity disorder (ADHD) increases as does the concern about the potential adverse effects of the drugs on the fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge on this subject. Using two massive data sets, researchers were able to examine more than 4.3 million pregnancies and determine whether stimulant medications increased the risk of birth defects. Researchers found that while the risk overall is low, the first trimester ADHD exposure to medication was associated with slightly higher risk of specific heart defects such as ventriculoseptal defect.
The researchers behind the study found no connection between the use of early medications and other congenital anomalies, like facial clefting, or club foot. The results are in line with previous studies revealing the presence of a small, but significant increase in the risk of cardiac malformations among women who started taking ADHD medications before pregnancy. The risk increased in the latter half of pregnancy, when a lot of women decided to stop taking their medication.
Women who took ADHD medication in the first trimester of pregnancy were also more likely to undergo caesarean section, low Apgar score after delivery and a baby that required breathing assistance at birth. The researchers of the study could not eliminate bias due to selection because they limited the study to women without other medical conditions that could have contributed to the findings.
The researchers hope that their research will serve to inform the clinical decisions of physicians who treat pregnant women. The researchers recommend that, while discussing risks and benefits are crucial, the decision on whether to continue or stop medication should be based on the severity of each woman's ADHD symptoms and her requirements.
The authors also caution that while discontinuing the medications is an option, it is not an option that is recommended due to the high incidence of depression and other mental health problems among women who are pregnant or who are recently post-partum. Further, research shows that women who stop taking their medications will have a tough transitioning to life without them once the baby is born.
Nursing
The responsibilities that come with being a new mom can be overwhelming. Women suffering from ADHD may face a lot of challenges when they have to manage their symptoms, attend doctor appointments, prepare for the birth of a baby and adjust to new routines. As such, many women decide to continue taking their ADHD medications throughout the course of pregnancy.
The majority of stimulant medications are absorbed through breast milk in very small amounts, so the risk to the nursing infant is very low. The rate of medication exposure will vary based on the dosage and frequency of administration as well as time of day. Additionally, different medications enter the body of the baby differently through the gastrointestinal tract as well as breast milk, and the effect of this on a newborn is not yet fully understood.
Some physicians may discontinue stimulant medication during a woman's pregnancy due to the lack of research. It is a difficult decision for the mother, who must weigh the advantages of her medication against the potential risks to the fetus. Until more information is available, GPs should ask all pregnant patients about their history of ADHD and whether they are planning or taking to take medication during the perinatal time.
A growing number of studies have proven that most women can safely continue taking their ADHD medication during pregnancy and breastfeeding. This has led to an increasing number of patients opt to do this and, in consultation with their physician, they have found that the benefits of continuing their current medication far outweigh any risks.
Women who suffer from ADHD who plan to breastfeed should seek advice from an expert psychiatrist prior to becoming pregnant. They should discuss their medication with their prescriber and discuss the advantages and disadvantages of continued treatment, including non-pharmacological management strategies. Psychoeducation is also required to help pregnant women with ADHD recognize the signs and the underlying disorder. They should also be educated about treatment options and reinforce strategies for coping. This should be an approach that is multidisciplinary, including the GP, obstetricians and psychiatry. Pregnancy counseling should consist of a discussion of a treatment plan for the mother and child, and monitoring for indicators of deterioration, and, if needed, adjustments to the medication regime.