ADHD Medication During Pregnancy and Breastfeeding

The choice of whether to stop or continue ADHD medication during pregnancy and breastfeeding is challenging for women with the condition. There aren't many studies on how exposure to ADHD for a long time could affect the pregnant fetus.

A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus don't develop neurological developmental conditions like hearing or vision impairment seizures, febrile seizures or IQ impairment. The authors acknowledge the need for more high-quality research.

Risk/Benefit Analysis

Women who are pregnant and take ADHD medication should evaluate the benefits of using it versus the risks for the fetus. Doctors don't have the data needed to provide clear recommendations, but they can provide information about benefits and risks that can assist pregnant women in making informed decisions.

A study published in Molecular Psychiatry concluded that women who were taking ADHD medication in early pregnancy were not at a higher risk of fetal malformations, or structural birth defects. Researchers conducted a large population-based case-control study to determine the prevalence of major structural birth defects in babies born to mothers who had taken stimulants in the early stages of pregnancy, as well as those who had not. Pediatric cardiologists and clinical geneticists reviewed the cases to ensure accurate classification of the cases and to reduce the chance of bias.

However, the study had its limitations. Most important, they were unable to distinguish the effects of the medication from the effects of the underlying disorder. This limitation makes it difficult for researchers to determine whether the small associations observed among the exposed groups were due to medication use, or if they were confounded by comorbidities. The researchers also did not examine the long-term effects for the offspring.

The study revealed that infants whose mothers had taken ADHD medication during pregnancy had a greater risk of being admitted to the neonatal care unit (NICU), compared to mothers who didn't take any medication during pregnancy or had discontinued taking their medication prior to or during pregnancy. This increase was due to central nervous system-related disorders and the increased risk for admission did not appear to be affected by the type of stimulant medications were taken during pregnancy.

Women who took stimulant ADHD medication during pregnancy were also at an increased risk of having a caesarean section or having a baby with a low Apgar score (less than 7). These increases did not appear to be affected by the type of medication that was used during pregnancy.

The research suggests that the risk of a small amount with the use of ADHD medications during early pregnancy could be offset by the greater benefits to both the mother and child of continuing treatment for the woman's disorder. Physicians should talk to their patients about this issue and, if possible, help them develop coping strategies that can lessen the impact of her disorder in her daily functioning and her relationships.

Medication Interactions

As more women than ever are being diagnosed with ADHD and treated with medication, the issue of whether or not to end treatment during pregnancy is a question that doctors are having to have to face. Often, these decisions are made without any evidence that is clear and definitive in either case, which means that doctors have to weigh their experience from their own experiences, those of other doctors, and what the research suggests on the subject as well as their own judgments for each patient.

Particularly, the issue of potential risks to the baby can be tricky. The research that has been conducted on this topic is based on observations rather than controlled studies, and a lot of the results are contradictory. Most studies restrict their analysis to live births, which can underestimate the severity of teratogenic effects leading to abortions or terminations of pregnancy. The study discussed in the journal club addresses these shortcomings, by examining both the data from deceased and live births.

The conclusion is that while certain studies have demonstrated that there is a positive correlation between ADHD medications and the possibility of certain birth defects, others have found no connection, and most studies have a neutral or slightly negative impact. Therefore, a careful risk/benefit assessment must be done in each case.

For a lot of women with ADHD and ADD, the decision to stop taking medication is difficult, if not impossible. In fact, in a recent article in Archives of Women's Mental Health psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can lead to increased depression, feelings of isolation and family conflict for those suffering from the disorder. In addition, a decrease in medication can affect the ability to do work-related tasks and safely drive that are crucial aspects of a normal life for a lot of people with ADHD.

She suggests women who are uncertain about whether to keep or discontinue medication due to their pregnancy, consider the possibility of educating friends, family members and colleagues about the condition, its effects on daily functioning, and the advantages of staying on the current treatment plan. Educating them can also aid in ensuring that the woman feels supported as she struggles with her decision. Certain medications can be passed through the placenta. If a patient decides to stop taking her ADHD medication while pregnant and breastfeeding, it's important to be aware that the medication may be transferred to her infant.

Birth Defects Risk

As the use of ADHD medication to treat the symptoms of attention deficit hyperactivity disorder (ADHD) grows there are concerns about the effects that the medications could have on fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge regarding this topic. Using two massive data sets, researchers were able to examine more than 4.3 million pregnancies and see whether the use of stimulant medications increased the risk of birth defects. Although the risk overall remains low, the scientists discovered that the first-trimester exposure to ADHD medicines was associated with a slightly higher rate of certain heart defects, such as ventriculo-septal defect (VSD).

The researchers behind the study found no association between early use of medication and other congenital abnormalities, like facial clefting, or club foot. The results are in line with previous studies that showed a small, but significant increase in the number of cardiac malformations among women who began taking ADHD medication before the birth of their child. This risk increased during the latter part of pregnancy when many women stopped taking their medication.

Women who used ADHD medication in the first trimester of their pregnancies were also more likely to undergo caesarean sections, a low Apgar score following delivery, and a baby who needed help breathing at birth. However, the authors of the study were not able to eliminate bias due to selection by restricting the study to women who did not have any other medical conditions that could have contributed to these findings.

Researchers hope that their research will inform physicians when they encounter pregnant women. The researchers recommend that while discussing risks and benefits are important, the choice on whether to continue or stop medication should be made in light of the severity of each woman's ADHD symptoms and the needs of the woman.

The authors warn that, while stopping the medication is a possibility to look into, it is not recommended because of the high incidence of depression and mental health issues in women who are expecting or have recently given birth. Furthermore, research suggests that women who decide to stop taking their medication are more likely to experience difficulties adjusting to life without them following the birth of their baby.

Nursing

It can be a stressful experience becoming a mother. Women who suffer from ADHD who must work through their symptoms while attending doctor appointments, making preparations for the arrival of their child and getting used to new routines at home may face a lot of challenges. Many women choose to continue taking their ADHD medication during pregnancy.

The majority of stimulant medications are absorbed through breast milk in low amounts, so the risk to the nursing infant is very low. The rate of exposure to medication will differ based on dosage, frequency of administration and the time of day. In addition, various medications enter the baby’s system through the gastrointestinal tract or breast milk. The impact on the health of a newborn isn't completely comprehended.

Because of the lack of evidence, some doctors might be tempted to stop taking stimulant medications during a woman's pregnancy. It is a difficult decision for the woman, who must weigh the advantages of continuing her medication against the risks to the foetus. As long as there is no more information, GPs should ask all pregnant patients about their experience with ADHD and whether they plan or are taking to take medication during the perinatal time.

Numerous studies have proven that women can continue taking their ADHD medication without risk during pregnancy and while breast-feeding. In response, an increasing number of patients are choosing to do this. They have concluded after consulting with their doctor, that the benefits of keeping their current medication outweigh any potential risks.

It is crucial for women suffering from ADHD who are contemplating breastfeeding to seek out a specialist psychiatrist's guidance prior to becoming pregnant. They should discuss their medication with their doctor as well as the pros and website cons of continuing treatment. This includes non-pharmacological strategies. Psychoeducation should also be provided to help pregnant women suffering from ADHD recognize their symptoms and the underlying disorder Learn about the available treatment options and reinforce existing strategies for managing. This should be a multidisciplinary approach with the GPs, obstetricians and psychiatrists. Pregnancy counseling should include discussion of a treatment plan for the mother and child, as well as monitoring for signs of deterioration, and, if necessary modifications to the medication regime.