Why Nobody Cares About ADHD Medication Pregnancy
ADHD Medication During Pregnancy and Breastfeeding
The decision to stop or keep ADHD medications during breastfeeding and pregnancy is a challenge for women suffering from the condition. There isn't much information on how long-term exposure to these medications may affect the fetus.
A study recently 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 the need for more high-quality research.
Risk/Benefit Analysis
Women who are expecting and taking ADHD medication should weigh the benefits of taking it versus the dangers for the fetus. Physicians don't have the data to give clear advice, but can provide information about risks and benefits to assist pregnant women to make informed decisions.
add medication adult published in Molecular Psychiatry found that women who were taking ADHD medications during their early pregnancy did not face a significantly higher risk of fetal cardiac malformations or major birth defects that are structural. Researchers used a vast, population-based case-control study to assess the risk of major structural birth defects in babies born to mothers who had taken stimulants in the early stages of pregnancy, and those who did not. Pediatric cardiologists, clinical geneticists and other experts examined the cases to confirm that the classification was correct and to eliminate any bias.
The study of the researchers had some limitations. The most important issue was that they were not able to differentiate the effects of the medication from those of the underlying disorder. This makes it difficult for researchers to determine if the small associations observed among the groups that were exposed to medication use, or if they were affected by co-morbidities. Additionally the researchers did not examine the long-term outcomes of offspring.
The study did show that babies whose mothers had taken ADHD medications during pregnancy were at a slightly greater risk of being admitted to the neonatal intensive care unit (NICU) than those who were born without any medication or cut back on their medications prior to or during pregnancy. This increase was caused by central nervous system disorders. The higher risk of admission was not affected by the stimulant medication used during pregnancy.
Women who took stimulant ADHD medications during pregnancy also had a higher likelihood of having to have an emergency caesarean section or having one whose baby scored low on the Apgar scale (less than 7). These increases did appear to be independent of the type of medication used during pregnancy.
Researchers suggest that the minor risks posed by the use of ADHD medication during pregnancies in the early stages may be offset by the greater benefits to both mother and baby from continuing treatment for the woman’s disorder. Physicians should discuss this with their patients and, if they are able, assist them in developing strategies for improving their coping skills which can reduce the impact of her disorder on her daily life and relationships.
Interactions with Medication
As more women than ever are diagnosed with ADHD and being treated with medication, the dilemma of whether to keep or end treatment during pregnancy is one that doctors are having to face. Most of the time, these decisions are made without solid and reliable evidence in either case, which means that doctors must weigh their knowledge about their experiences, the experiences of other doctors, and what the research suggests on the subject, along with their own best judgment for each individual patient.
Particularly, the subject of possible risks to the infant can be difficult. A lot of studies on this subject are based on observational data rather than controlled research and their findings are often contradictory. The majority of studies focus on live-births, which could underestimate the severity of teratogenic effects that can lead to terminations or abortions of pregnancy. The study presented in this journal club addresses these shortcomings by analyzing data on live and deceased births.
The conclusion: While some studies have found an association between ADHD medications and the possibility of certain birth defects, other studies have found no such relationship and the majority of studies have a neutral or slightly negative effect. Therefore, a careful risk/benefit assessment must be conducted in every situation.
For a lot of women with ADHD, the decision to stop taking medication can be difficult, if not impossible. In fact, in an article recently published in 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 those suffering from the disorder. In addition, a decrease in medication can interfere with the ability to complete job-related tasks and drive safely, which are important aspects of a normal life for many people with ADHD.
She suggests that women who aren't sure whether to continue taking medication or stop it due to their pregnancy educate family members, colleagues, and their friends about the condition, its impact on daily functioning and the advantages of staying on the current treatment plan. In addition, educating them can make the woman feel more comfortable in her struggle with her decision. Certain medications can be passed through the placenta. If a patient decides not to take her ADHD medication while pregnant and breastfeeding, it is important to be aware that the medication could be passed on to her infant.
Birth Defects Risk
As the use and misuse of ADHD medications to treat the symptoms of attention deficit disorder hyperactivity disorder (ADHD) increases, so does concern about the potential effects of these drugs on foetuses. Recent research published in the journal Molecular Psychiatry has added to the body knowledge on this issue. Researchers utilized two massive data sets to examine over 4.3 million pregnant women and determine if the use of stimulant medications increased birth defects. While the overall risk is low, the researchers discovered that the first-trimester exposure to ADHD medicines was associated with an increased risk of certain heart defects, like ventriculo-septal defects (VSD).
The researchers behind the study found no link between early medication use and other congenital abnormalities, like facial clefting, or club foot. The results are in line with previous studies that have shown an insignificant, but small increase in cardiac malformations for women who started taking ADHD medication before pregnancy. This risk increased in the latter half of pregnancy, when a lot of women are forced to stop taking their ADHD medications.
Women who took ADHD medications during the first trimester of their pregnancies were also more likely to experience caesarean section, low Apgar score following delivery, and a baby who needed help breathing at birth. The authors of the study were not able to remove bias in selection since they limited the study to women who did not have any other medical conditions that could have contributed to the findings.
The researchers hope that their research will aid in the clinical decisions of doctors who see pregnant women. The researchers advise that, while discussing the 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 the needs of the woman.
The authors warn that, while stopping the medication is an option to think about, it isn't advised due to the high prevalence of depression and mental health issues among women who are pregnant or who have recently given birth. Further, the research suggests that women who decide to stop their medications are more likely to have difficulties getting used to life without them following the birth of their baby.
Nursing
It can be a challenge to become a mother. Women with ADHD who must work through their symptoms while attending doctor appointments and getting ready for the arrival of a baby and adapting to new routines in the home may face a lot of challenges. Many women opt to continue taking their ADHD medication during pregnancy.
The risk to breastfeeding infant is minimal because the majority of stimulant medications is absorbed through breast milk at a low level. However, the rate of exposure to medications by the infant can differ based on dosage, frequency it is administered, and the time of the day it is administered. Additionally, different medications enter the baby's system differently through the gastrointestinal tract and breast milk, and the effect of this on a newborn isn't yet fully known.
Due to the absence of evidence, some doctors may recommend stopping stimulant drugs during the pregnancy of a woman. It is a difficult decision for the woman, who must weigh the benefits of continuing her medication against the risk to the foetus. Until more information is available, GPs should ask all pregnant patients about their history of ADHD and whether they are taking or planning to take medication during the perinatal time.
Numerous studies have demonstrated that women can continue taking their ADHD medication safely during pregnancy and while breast-feeding. In response, a growing number of patients are opting to do so. They have concluded after consulting with their doctor, that the benefits of retaining their current medication outweigh potential risks.
Women with ADHD who are planning to breastfeed should seek advice from a specialist psychiatrist prior to becoming pregnant. They should discuss their medication with their prescriber and discuss the advantages and disadvantages of continuing treatment, including non-pharmacological management strategies. Psychoeducation is also necessary to help pregnant women suffering from ADHD recognize the signs and underlying disorder. They should also be informed about treatment options and strengthen strategies for coping. This should be a multidisciplinary effort together with obstetricians, GPs, and psychiatrists. Pregnancy counseling should include a discussion of a treatment plan for the mother and child, and monitoring for indicators of deterioration, and, if necessary modifications to the medication regimen.