A Brief History Of ADHD Medication Pregnancy History Of ADHD Medication Pregnancy
ADHD Medication During Pregnancy and Breastfeeding
Women with ADHD face a difficult decision on whether to keep or stop taking ADHD medication during pregnancy and breastfeeding. There isn't much information on how long-term exposure to these drugs could affect the fetus.
A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus do not develop neurological disorders like impaired vision or hearing seizures, febrile seizures, or IQ impairment. The authors acknowledge the need for higher-quality studies.
Risk/Benefit Analysis
Pregnant women who take ADHD medications need to balance the advantages of using them against the risks to the fetus. Doctors don't have enough data to provide clear recommendations, but can provide information about risks and benefits to assist pregnant women to make informed choices.
A study published in Molecular Psychiatry found that women who took ADHD medications during their early pregnancy did not have an increased risk of fetal cardiac malformations or major birth defects that are structural. Researchers used a large population-based study of case control to assess the frequency of major structural defects in infants who were born to mothers who used stimulants during pregnancy. Pediatric cardiologists and clinical geneticists examined the cases to ensure accurate case classification and to limit the chance of bias.
The research conducted by the researchers was not without its limitations. The most important issue was that they were unable to distinguish the effects of the medication from the underlying disorder. This limitation makes it difficult for researchers to establish whether the small differences observed between the groups exposed were due to the use of medication or if they were affected by the presence of comorbidities. Additionally, the researchers did not examine long-term offspring outcomes.
The study did show that infants whose mothers had taken ADHD medications during pregnancy were at slightly more risk of being admitted to the neonatal intensive care unit (NICU) than infants who were born without any medication or cut back on their medications prior to or during pregnancy. This was due to central nervous system-related disorders and the higher risk of admission did not appear to be influenced by the stimulant medication was used during pregnancy.
Women who were taking stimulant ADHD medications during pregnancy also had a higher chance of having a caesarean section or a baby that scored low on the Apgar scale (less than 7). These increases appeared to be unrelated to the type of medication used during pregnancy.
Researchers suggest that the small risk of using ADHD medications in early pregnancies may be offset by the more beneficial outcomes for both baby and mother of continued treatment for the woman's disorder. Doctors should discuss with their patients about this issue and try to help them develop coping strategies that may reduce the effects of her disorder on her daily life and relationships.
Medication Interactions
As more women than ever are diagnosed with ADHD and treated with medication, the dilemma of whether to keep or stop treatment during pregnancy is one that doctors are having to confront. These decisions are frequently taken without clear and authoritative evidence. Instead, medications for adhd must weigh their own knowledge, the experience of other physicians and the research on the subject.
The issue of potential risks to the infant can be extremely difficult. The research that has been conducted on this topic is based on observation rather than controlled studies and the results are in conflict. Furthermore, most studies restrict their analysis to live births, which can underestimate the severity of teratogenic effects that could cause abortion or termination of the pregnancy. The study that is discussed in the journal club addresses these shortcomings by analyzing the data from deceased and live births.
The conclusion: While certain studies have demonstrated an association between ADHD medications and the possibility of certain birth defects, others have found no such relationship, and most studies show a neutral or even slightly negative impact. In every case it is imperative to conduct a thorough analysis of the risks and benefits must be performed.
It can be challenging, if not impossible for women suffering from ADHD to stop taking their medication. In an article 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 these patients. A decrease in medication could affect the ability to drive safely and to perform work-related tasks which are crucial aspects of everyday life for those suffering from ADHD.
She suggests that women who are not sure whether to take the medication or discontinue it due to pregnancy educate family members, coworkers, and acquaintances about the condition, the impact on daily functioning and the benefits of keeping the current treatment regimen. It will also help a woman feel more confident in her decision. Certain medications can be passed through the placenta. If a woman decides to not take her ADHD medication while breastfeeding, it is crucial to be aware that the drug may be transferred to her baby.
Risk of Birth Defects
As the use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) grows there are 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 subject. Utilizing two huge data sets, researchers were able to look at more than 4.3 million pregnancies and determine whether the use of stimulant medications increased the risk of birth defects. Researchers discovered that, while the risk overall is low, the first trimester ADHD medication use was associated with slightly higher rates of specific heart defects such as ventriculoseptal defect.
The authors of the study found no association between the use of early medications and congenital abnormalities such as facial clefting or club foot. The results are in line with previous studies that showed an insignificant, but small increase in cardiac malformations for women who began taking ADHD medication prior to the time of pregnancy. This risk increased during the latter part of pregnancy when a large number of women stopped taking their medication.
Women who were taking ADHD medication in the first trimester were more likely require a caesarean birth, have a low Apgar after delivery and had a baby that required help breathing after birth. The authors of the study were unable to remove bias in selection since they restricted the study to women who did not have any other medical conditions that could have contributed to the findings.
Researchers hope that their study will provide doctors with information when they see pregnant women. They recommend that, while the discussion of risks and benefits is important but the decision to stop or continue treatment should be based on each woman's requirements and the severity of her ADHD symptoms.
The authors warn that, while stopping the medication is a possibility to think about, it isn't recommended because of the high incidence of depression and mental health issues among women who are pregnant or who have recently given birth. Additionally, the research suggests that women who decide to stop taking their medication are more likely to have difficulties adjusting to life without them following the baby's arrival.
Nursing
The responsibilities of being a new mom can be overwhelming. Women with ADHD who must work through their symptoms while attending physician appointments and preparing for the arrival of a child and adjusting to new household routines may face a lot of challenges. Therefore, many women elect to continue taking their ADHD medication throughout the pregnancy.
The risk to breastfeeding infant is minimal because the majority of stimulant medication passes through breast milk at a low level. However, the rate of medication exposure to the infant can differ based on dosage, frequency it is administered and at what time the medication is administered. Additionally, individual medications enter the infant's system differently through the gastrointestinal tract as well as breast milk. The impact of this on a newborn infant is not fully known.
Some doctors may decide to stop stimulant medication during a woman's pregnancy due to the absence of research. It is a difficult decision for the mother, who must weigh the benefits of her medication against the risks to the fetus. In the meantime, until more information is available, doctors should ask all pregnant patients about their experience with ADHD and whether they are planning or taking to take medication during the perinatal time.
Numerous studies have proven that women can continue to take their ADHD medication safely while breastfeeding and during pregnancy. In response, a growing number of patients are opting to do so. They have found through consultation with their doctors that the benefits of continuing their current medication far outweigh any potential risks.
Women who suffer from ADHD who plan to breastfeed should seek the advice of an expert psychiatrist prior to becoming pregnant. They should discuss the medication they are taking with their physician, and the pros and cons of continuing treatment. This includes non-pharmacological methods. Psychoeducation is also required to help pregnant women suffering from ADHD recognize their symptoms and underlying disorder, learn about available treatment options and reinforce existing strategies for coping. This should be a multidisciplinary process with the GPs, obstetricians, and psychiatrists. The pregnancy counselling should consist of the discussion of a plan for management for both the mother and child, and monitoring for signs of deterioration and the need for adjustments to the medication regimen.