5 Laws That Anyone Working In ADHD Medication Pregnancy Should Know
ADHD Medication During Pregnancy and Breastfeeding
The decision to stop or keep ADHD medications during pregnancy and nursing is a challenge for women suffering from the condition. There aren't enough data regarding how exposure over time may affect a fetus.
A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus don't develop neurological disorders such as hearing or vision impairment, febrile seizures, or IQ impairment. The authors acknowledge the need for more high-quality studies.
Risk/Benefit Analysis
Women who are pregnant and taking ADHD medications must weigh the advantages of taking them against potential risks to the fetus. The doctors don't have the information to give clear advice however they can provide information on the risks and benefits to aid pregnant women in making an informed decision.
A study published in Molecular Psychiatry found that women who used ADHD medications in early pregnancy did not face a significantly higher risk of fetal cardiac malformations or major birth defects that are structural. Researchers used a large sample-based case control study to examine the prevalence of structural defects that were major in infants born to mothers who took stimulants during pregnancy. Clinical geneticists, pediatric cardiologists and other experts reviewed the cases in order to confirm that the classification was correct and to eliminate any bias.
The study of the researchers had some limitations. Most important, they were unable to distinguish the effects of the medication from the effects of the disorder at hand. This 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. In addition the researchers did not look at the long-term outcomes of offspring.
The study did reveal that infants whose mothers had taken ADHD medication during pregnancy were at a slightly greater risk of being admitted to the neonatal intensive care unit (NICU) than those whose mothers had not taken any medication or cut back on their medications prior to or during pregnancy. This increase was due to central nervous system-related disorders, and the increased risk of admission was not found to be influenced by the stimulant medication was used during pregnancy.
Women who took stimulant ADHD medications during pregnancy also had a higher likelihood of having caesarean sections or one whose baby scored low on the Apgar scale (less than 7). These increases appear to be unrelated to the type of medication used during pregnancy.
site web suggests that the risk of a small amount with the use of ADHD medications during early pregnancy may be offset by the higher benefit to both mother and child from continued treatment for the woman's condition. Physicians should talk to their patients about this issue and as much as possible, assist them improve coping skills which may reduce the impact of her disorder in her daily functioning and her relationships.
Medication Interactions
More and more doctors are faced with the decision of whether to continue treatment or stop during pregnancy as more women are diagnosed with ADHD. Often, these decisions are made without any evidence that is clear and definitive either way, so physicians must weigh what they know from their own experiences, those of other doctors, and what research suggests about the subject, along with their best judgment for each patient.
Particularly, the issue of possible risks to the baby can be tricky. The research on this issue is based on observations instead of controlled studies and many of the findings are in conflict. In addition, most studies limit their analysis to live births, which may underestimate severe teratogenic effects that cause abortion or termination of the pregnancy. The study that is discussed in this journal club addresses these shortcomings by examining data on both live and deceased births.
The conclusion: While some studies have shown an association between ADHD medications and the possibility of certain birth defects, other studies have found no such relationship, and most studies show a neutral or even slight negative effect. Therefore an accurate risk-benefit analysis is required in every instance.
It isn't easy, but not impossible, for women with ADHD to stop taking their medication. 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 isolation. Additionally, the loss of medication may affect the ability to perform work-related tasks and safely drive that are crucial aspects of daily life for many people suffering from ADHD.
She recommends women who are uncertain about whether to keep or stop taking medication because of their pregnancy consider educating family members, friends, and coworkers on the condition, its impact on daily functioning, and on the advantages of continuing the current treatment plan. It can also help the woman feel supported when she is struggling with 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 must be aware that traces of the medication could be passed on to the baby.
Risk of Birth Defects
As the use of ADHD medication to treat the symptoms of attention deficit hyperactivity disorder (ADHD) grows as do concerns over the impact that these drugs might have on the fetuses. A recent study published in the journal Molecular Psychiatry adds to the body of knowledge on this subject. Researchers used two massive datasets to analyze more than 4.3 million pregnancy and determine if stimulant medication use increased the risk of birth defects. Researchers discovered that although the overall risk is low, the first trimester ADHD medication exposure was associated with slightly higher rates of certain heart defects, such as ventriculoseptal defect.
The authors of the study didn't discover any link between early use of medication and congenital anomalies like facial deformities, or club feet. The results are in line with previous studies that have shown an increase, but not significant, in the risk of heart malformations among women who began taking ADHD medications prior to pregnancy. The risk was higher during the latter part of pregnancy, when a lot of women begin to discontinue their medication.
Women who were taking ADHD medication during the first trimester were more likely require a caesarean delivery and also have a low Apgar after delivery, and have a baby that needed breathing assistance at birth. The authors of the study could not eliminate bias due to selection because they limited the study to women who did not have any other medical conditions that could have contributed to the findings.
The researchers hope their research will aid in the clinical decisions of physicians who treat pregnant women. They recommend that, while discussing the benefits and risks is important however, the decision to stop or continue medication must 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 look into, it is not recommended due to the high prevalence of depression and other mental disorders among women who are pregnant or who have recently given birth. Additionally, research suggests that women who stop taking their medications will have a harder adjustment to life without them once the baby is born.
Nursing
It can be a stressful experience to become a mother. Women who suffer from ADHD are often faced with a number of difficulties when they must deal with their symptoms, go to doctor appointments and prepare for the birth of a baby and adjust to a new routine. Therefore, many women decide to continue taking their ADHD medications throughout pregnancy.
The majority of stimulant medicines are absorbed through breast milk in low amounts, so the risk for breastfeeding infant is minimal. However, the rate of exposure to medication by the newborn can vary depending on dosage, frequency it is taken and at what time the medication is administered. In addition, different medications are introduced into the baby's system via the gastrointestinal tract or breast milk. The effect on a newborn's health is not fully known.
Some doctors may stop taking stimulant medication during a woman's pregnancy due to the absence of research. This is a difficult decision for the patient, who must weigh the benefit of continuing her medication against the potential risks to the embryo. Until more information is available, doctors should ask all pregnant patients about their history of ADHD and if they plan or are taking to take medication during the perinatal time.
Numerous studies have proven that women can continue to take their ADHD medication safely during pregnancy and while breast-feeding. In response, an increasing number of patients are choosing to continue their medication. They have found after consulting with their doctor that the benefits of continuing their current medication outweigh potential risks.
It's important for women with ADHD who are contemplating breastfeeding to seek a specialist psychiatrist's advice prior becoming pregnant. They should discuss their medication with their physician and discuss the advantages and disadvantages of continued treatment, including non-pharmacological strategies. Psychoeducation is also required to help pregnant women suffering from ADHD understand their symptoms and the root cause and learn about treatment options and strengthen existing strategies for coping. This should be a multidisciplinary approach with the GPs, obstetricians and psychiatry. Pregnancy counseling should include a discussion of a treatment plan for the mother as well as the child, and monitoring for indicators of deterioration, and, if necessary adjustments to the medication regimen.