ADHD Medication During Pregnancy and Breastfeeding
The choice of whether to stop or continue ADHD medications during pregnancy and nursing is a difficult decision for women suffering from the condition. There aren't many studies on how exposure to ADHD for a long time could affect the pregnant fetus.
A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus don't develop neurological developmental disorders 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 taking ADHD medication should weigh the benefits of taking it against the potential dangers for the baby. The doctors don't have the information to make unambiguous recommendations however they can provide information about risks and benefits to assist pregnant women to make informed choices.
A study published in Molecular Psychiatry concluded that women who took ADHD medication in early pregnancy were not at higher risk of fetal malformations or structural birth defects. Researchers used a large sample-based case control study to compare the incidence of major structural defects in infants who were born to mothers who took stimulants during pregnancy. Clinical geneticists, pediatric cardiologists and other experts looked over the cases to ensure that the classification was correct and to reduce 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 disorder that is underlying. This makes it difficult for researchers to establish whether the few associations observed between the groups exposed were due to the use of medication, or if they were caused by comorbidities. In addition, the researchers did not examine long-term offspring outcomes.
The study found that infants whose mother took ADHD medication during pregnancy had a greater risk of being admitted to the neonatal care unit (NICU), compared to mothers who did not take any medication during pregnancy or had discontinued taking their medication prior to or during pregnancy. This was due to central nervous system-related disorders, and the higher risk of admission was not found to be affected by the type of stimulant medications were used during pregnancy.
Women who were taking stimulant ADHD medication during pregnancy also had an elevated chance of having a caesarean section or having a baby born with a low Apgar score (less than 7). These increases appeared to be unrelated to the type of medication taken during pregnancy.
The researchers suggest that the small risk associated with the use of ADHD medications during early pregnancy may be offset by the higher benefit to both the mother and child from continued treatment for the woman's condition. Physicians should discuss the issue with their patients and, if possible, help them develop strategies to improve their coping abilities which can reduce the effects of her disorder on her daily life and relationships.
Medication Interactions
As more women than ever before are being diagnosed with ADHD and being treated with medication, the dilemma of whether to continue or discontinue treatment during pregnancy is one that more and more doctors have to face. These decisions are frequently taken without clear and authoritative evidence. Instead, physicians must weigh their own knowledge and experience, as well as the experiences of other physicians and the research that has been conducted on the subject.
Particularly, the issue of possible risks to the infant can be difficult. Many studies on this issue 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 the severity of teratogenic effects that could cause abortion or termination of the pregnancy. The study discussed in this journal club addresses these shortcomings by looking at data from both live and deceased births.
The conclusion is that while some studies have shown an association between ADHD medications and the risk of certain birth defects, other studies have not found any evidence of a link and the majority of studies demonstrate a neutral or slightly negative effect. In the end an accurate risk-benefit analysis is required in every situation.
For a lot of women with ADHD and ADD, the decision to here discontinue medication is difficult if not impossible. In a recent article published in the Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can cause depression and feelings of being isolated. Furthermore, a loss of medication may affect the ability to do work-related tasks and safely drive that are crucial aspects of a normal life for many people with ADHD.
She recommends that women who are unsure about whether to keep or stop medication in light of their pregnancy consider educating family members, friends and colleagues on the condition, its impact on daily life, and the advantages of staying on the current treatment regimen. It can also help a woman feel more confident in her decision. Certain medications can pass through the placenta. If a woman decides not to take her ADHD medication while pregnant and breastfeeding, it is crucial to be aware that the medication may be transferred to her infant.
Risk of Birth Defects
As the use and abuse of ADHD medication to treat symptoms of attention deficit disorder hyperactivity disorder (ADHD) increases, so does concern about the possible effects of the drugs on fetuses. A recent study published in the journal Molecular Psychiatry adds to the existing information on this topic. Using two massive data sets researchers were able to examine 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, first-trimester ADHD exposure to medication was associated with slightly higher rates of certain heart defects, such as ventriculoseptal defect.
The researchers behind the study found no connection between the use of early medications and other congenital abnormalities, such as facial clefting or club foot. The results are in the same vein as previous studies that have shown an insignificant, but small increase in cardiac malformations for women who started taking ADHD medication prior to the time of pregnancy. The risk was higher in the later part of pregnancy, as many women decide to stop taking their ADHD medication.
Women who used ADHD medication in the first trimester of their pregnancy were also more likely to experience caesarean section, low Apgar score after delivery and a baby who required help breathing at birth. However the authors of the study were unable to eliminate bias due to selection by restricting the study to women who did not have other medical issues that could have contributed to the findings.
Researchers hope that their study will inform physicians when they see pregnant women. The researchers recommend that while discussing the risks and benefits are important, the decision regarding whether or not to stop medication should be according to the severity of each woman's ADHD symptoms and the needs of the woman.
The authors also caution that while discontinuing the medications is an alternative, it is not an option to consider due to the high rate of depression and other mental health problems among women who are pregnant or postpartum. Further, the research suggests that women who decide to stop taking their medications are more likely to have difficulties adapting to life without them after the birth of their baby.
Nursing
It can be overwhelming becoming a mother. Women suffering from ADHD can face severe challenges when they have to manage their symptoms, go to doctor appointments and prepare for the birth of a child and adjust to new routines. This is why many women decide to continue taking their ADHD medication throughout the pregnancy.
The risk to a breastfeeding infant is not too high since the majority of stimulant medication passes through breast milk at a low level. The amount of exposure to medications will differ based on dosage and frequency of administration as well as time of day. Additionally, different medications are introduced into the baby's system through the gastrointestinal tract or through breast milk. The impact on the health of a newborn isn't completely known.
Because of the lack of research, some doctors may recommend stopping stimulant medication during the pregnancy of a woman. This is a complicated decision for the patient, who must weigh the benefits of keeping her medication with the potential risks to the fetus. In the meantime, until more information is available, doctors can ask pregnant patients if they have a history of ADHD or if they are planning to take medication during the perinatal period.
Numerous studies have proven that women can continue taking their ADHD medication in a safe manner during pregnancy and while breast-feeding. In the end, an increasing number of patients choose to do so and, in consultation with their physician, they have found that the benefits of keeping their current medication far exceed any risk.
Women who suffer from ADHD who plan to breastfeed should seek advice from a specialist psychiatrist prior to becoming pregnant. They should discuss their medication with their prescriber as well as the pros and cons for continuing treatment. This includes non-pharmacological strategies. Psychoeducation should also be provided to help women with ADHD understand their symptoms and underlying disorder and learn about treatment options and reinforce existing strategies for coping. This should be a multidisciplinary effort together with obstetricians, GPs, and psychiatrists. Counselling for pregnancy should include discussion of a management plan for both mother and child, and monitoring for signs of deterioration and the need for adjustments to the medication regimen.