ADHD Medication During Pregnancy and Breastfeeding

Women with ADHD must make a difficult decision on whether to keep or stop taking ADHD medication during pregnancy and breast-feeding. There are few data on how long-term exposure may affect a fetus.

A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological disorders such as hearing loss or vision, febrile seizures or IQ impairment. The authors acknowledge that more high quality studies are needed.

Risk/Benefit Analysis

Pregnant women who use ADHD medications need to balance the advantages of taking them against the potential risks to the fetus. Physicians don't have the data to give clear advice but they can provide information on the risks and benefits to help pregnant women make informed decisions.

A study published in Molecular Psychiatry found that women who took ADHD medications in early pregnancy did not have an higher risk of fetal cardiac malformations or major birth defects that are structural. The researchers used a large population-based study of case-control to evaluate the incidence of major structural birth defects in babies born to mothers who had taken stimulants in early pregnancy, and those who did not. Pediatric cardiologists and clinical geneticists reviewed the cases to ensure correct classification of the cases and to reduce the possibility of bias.

However, the researchers' study had its limitations. The researchers were unable in the beginning to distinguish the effects of the medication from the disorder. This limitation makes it difficult for researchers to establish whether the small differences observed between the exposed groups were due to medication use, or if they were confounded by comorbidities. The researchers did not examine long-term outcomes for the offspring.

The study found that babies whose mothers had taken ADHD medication during pregnancy were at a slightly higher risk of admission to the neonatal care unit (NICU) in comparison to those whose mothers did not take any medication during pregnancy or 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 were taking stimulant ADHD medications during pregnancy also had a higher risk of having caesarean sections or a baby that scored low on the Apgar scale (less than 7). These increases didn't appear to be influenced by the kind of medication used during pregnancy.

The research suggests that the low risk associated with the use of ADHD medications during early pregnancy could be offset by the greater benefit to both mother and child from continued treatment for the woman's condition. Physicians should discuss this with their patients and, when possible, assist them in developing strategies to improve their coping abilities which can reduce the impact of her disorder on her daily life and relationships.

Medication Interactions

Doctors are increasingly confronted with the dilemma of whether to maintain treatment or stop it during pregnancy as more women are diagnosed with ADHD. Often, these decisions are taken in the absence of any evidence that is clear and definitive regardless, so doctors must weigh what they know, the experiences of other doctors, and what the research suggests on the subject, along with their own best judgment for each patient.

The issue of possible risks for infants can be particularly tricky. Many of the studies on this topic are based on observational evidence rather than controlled research, and their conclusions are often contradictory. Additionally, the majority of studies limit their analysis to live births, which can underestimate severe teratogenic effects that lead to abortion or termination of the pregnancy. The study that is discussed in this journal club addresses these issues by analyzing data on live and deceased births.

The conclusion is that while certain studies have demonstrated an association between ADHD medications and the possibility of certain birth defects, others have found no connection and the majority of studies show a neutral or even slight negative effect. As a result, a careful risk/benefit assessment is required in every situation.

For many women with ADHD and ADD, the decision to stop medication can be difficult, if not impossible. In an article published in the Archives of Women's Mental Health psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can lead to increased depression, feelings of loneliness, and family conflict for patients with ADHD. A decrease in medication could also impact the ability to drive safely and perform work-related tasks, which are crucial aspects of normal life for people with ADHD.

She suggests that women who aren't sure whether to take the medication or stop due to pregnancy, educate their family members, coworkers, and acquaintances about the condition, the impact on daily functioning and the benefits of continuing the current treatment. It can also help a woman feel confident about her decision. Certain medications can be passed through the placenta. If the patient decides to not take her ADHD medication while breastfeeding, it's important to be aware that the medication could be passed on to her baby.

Risk of Birth Defects

As the use and misuse of ADHD medications to treat the symptoms of attention deficit hyperactivity disorder (ADHD) increases the concern over the possible effects of the drugs on fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge on this issue. Researchers used two massive data sets to study over 4.3 million pregnancies and determine if the use of stimulant medications caused birth defects. Researchers found that while the risk overall is low, the first trimester ADHD medication exposure was associated with slightly higher risk of specific heart defects like ventriculoseptal defect.

The researchers behind the study found no link between the use of early medications and other congenital abnormalities, such as facial clefting or club foot. The results are in agreement with previous studies that have shown an insignificant, but small increase in cardiac malformations for women who began taking ADHD medication prior to the time of pregnancy. The risk increased in the latter half of pregnancy when many women decided to stop taking their medication.

Women who were taking liquid adhd medication medication during the first trimester were more likely to need a caesarean and also have an insufficient Apgar after birth and had a baby that required help breathing when they were born. The authors of the study were unable to eliminate bias due to selection because they restricted the study to women with no other medical conditions that could have contributed to the findings.

Researchers hope that their study will inform physicians when they encounter pregnant women. They advise that while the discussion of the risks and benefits is crucial however, the decision to stop or keep medication must be based on each woman's requirements 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 who are recently post-partum. Additionally, research suggests that women who stop taking their medication will have a tough adjustment to life without them after the baby is born.

Nursing

It can doctors prescribe adhd medication be a stressful experience to become a mom. Women with ADHD who have to deal with their symptoms while attending doctor appointments as well as making preparations for the arrival of a child and getting used to new routines at home can experience severe challenges. As such, many women decide to continue taking their ADHD medications throughout the course of pregnancy.

The risk to breastfeeding infant is minimal because the majority of stimulant medication is absorbed through breast milk in low amounts. However, the frequency of exposure to medication by the newborn can vary depending on the dosage, frequency it is administered and the time of the day it is administered. Additionally, different medications enter the infant's system differently through the gastrointestinal tract as well as breast milk. The impact of this on a newborn is not yet fully known.

Due to the absence of research, some physicians may be inclined to discontinue stimulant medication during the course of pregnancy. It is a difficult decision for the woman who must weigh the advantages of continuing her medication against the risks to the fetus. Until more information is available, doctors should inquire with 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 general practitioners prescribe adhd medication [you can try this out] continue taking their ADHD medication in a safe manner during pregnancy and while breast-feeding. In response, a growing number of patients are choosing to do this. They have discovered through consultation with their doctor, that the benefits of keeping their current medication outweigh potential risks.

It is crucial for women suffering from ADHD who are thinking of breastfeeding to seek a specialist psychiatrist's advice prior becoming pregnant. They should discuss their medication with their doctor as well as the pros and cons of continuing treatment. This includes non stimulant adhd medication uk-pharmacological strategies. Psychoeducation is also needed to help pregnant women with ADHD recognize the signs and underlying disorder. They should also be informed about treatment options and build strategies for coping. This should be a multidisciplinary effort together with obstetricians, GPs, and psychiatry. Pregnancy counseling should consist of a discussion of a treatment plan for the mother and the child, and monitoring for signs of deterioration, and, if needed, adjustments to the medication regimen.