ADHD Medication During Pregnancy and Breastfeeding
Women suffering from ADHD must make a difficult decision about whether to continue or stop taking ADHD medication during pregnancy and breastfeeding. There is a lack of information about how long-term exposure to these drugs may affect the fetus.
A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological issues such as impaired hearing or vision, 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 benefits of using them against the risks to the fetus. Doctors don't have enough data to give clear advice, but can provide information on risks and benefits to help pregnant women make an informed decision.
A study published in Molecular Psychiatry concluded that women who were taking ADHD medication during early pregnancy were not at a greater risk of fetal malformations or structural birth defects. The researchers used a large, population-based case-control study to determine the prevalence of major structural birth defects in infants born to mothers who had taken stimulants in the early stages of pregnancy, as well as those who had not. Pediatric cardiologists, clinical geneticists and other experts looked over the cases to ensure that the classification was correct and to reduce any bias.
The study conducted by the researchers was not without its limitations. The most important issue was that they were not able to differentiate the effects of the medication from the effects of the disorder at hand. This limitation makes it difficult for researchers to establish whether the small differences observed between the groups that were exposed to the use of medication or affected by comorbidities. The researchers did not study long-term outcomes for offspring.
The study showed that infants whose mothers had taken ADHD medication during pregnancy had a slightly higher chance of being admitted to the neonatal care unit (NICU) as compared to those whose mothers did not take any medication during pregnancy, or had quit taking the medication prior to or during pregnancy. This was due to central nervous system-related disorders, and the increased risk for admission was not found to be influenced by the stimulant medications were used during pregnancy.
Women who were taking stimulant ADHD medications during pregnancy also had a higher chance of having a caesarean section or the baby was not scoring well on the Apgar scale (less than 7). These increases appear to be independent of the type of medication used during pregnancy.
Researchers suggest that the minor risks posed by the use of ADHD medications in early pregnancies may be offset by the greater benefits for mother and baby of continuing treatment for the woman's disorder. Doctors should discuss with their patients about this issue and try to help them develop coping skills that can lessen the effects of her disorder on her daily life and relationships.
Medication Interactions
As more women than ever are being diagnosed with ADHD and treated with medication, the issue of whether to keep or discontinue treatment during pregnancy is one that more and more doctors face. Most of the time, these decisions are taken in the absence of any evidence that is clear and definitive in either case, which means that doctors must weigh what they know, the experiences of other doctors, and what the research suggests about the subject and their best judgment for each individual patient.
The issue of possible risks to infants is extremely difficult. Many of the studies on this issue are based on observational evidence rather than controlled research, and their conclusions are often contradictory. Most studies focus on live births, which may underestimate the teratogenic impact which can cause terminations or abortions of pregnancy. The study that is discussed in this journal club addresses these limitations by analyzing data on live and deceased births.
The conclusion is that while certain studies have demonstrated a positive association between ADHD medications and the possibility of certain birth defects, other studies have not found any evidence of a link, and most studies have a neutral or slightly negative impact. In each case it is imperative to conduct a thorough study of the risks and benefits is required.
For many women with ADHD and ADD, the decision to discontinue medication is difficult, if not impossible. In an article recently published in the Archives of Women's Mental Health psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can increase depression, feelings of isolation and family conflict for those suffering from the disorder. A loss of medication may also affect the ability to safely drive and perform work-related tasks, which are vital aspects of everyday life for people with ADHD.
She recommends women who are uncertain about whether to continue or stop medication in light of their pregnancy, consider informing family members, friends, and coworkers on the condition, its impact on daily functioning, and on the advantages of staying on the current treatment plan. It 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 is important to be aware that the medication could be passed on to her baby.
Risk of Birth Defects
As the use of ADHD medications to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases, so do concerns about the effects that the drugs might have on the fetuses. A recent study published in the journal Molecular Psychiatry adds to the existing information on this topic. Researchers used two huge datasets to analyze over 4.3 million pregnant women and determine if the use of stimulant medications increased the risk website of birth defects. Researchers discovered that, while the overall risk is low, first-trimester ADHD medication use was associated with slightly higher risk of certain heart defects, such as ventriculoseptal defect.
The researchers of the study didn't discover any connection between the use of early medications and congenital anomalies such as facial deformities or club feet. The results are in agreement with previous studies that have shown an insignificant, but small increase in the number of cardiac malformations among women who started taking ADHD medication prior to the time of the birth of their child. The risk increased in the latter half of pregnancy, when a lot of women stopped taking their medication.
Women who were taking ADHD medication during the first trimester were more likely require a caesarean birth, have a low Apgar after delivery and have a baby who needed breathing assistance at birth. However the authors of the study were not able to eliminate bias due to selection by limiting 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 suggest that while discussing benefits and risks are important, the choice regarding whether or not to stop medication should be based on the severity of each woman's ADHD symptoms and her needs.
The authors also warn that even though stopping the medication is an option, it is not an option that is recommended due to the high prevalence of depression and other mental health problems in women who are pregnant or postpartum. Further, research shows that women who stop taking their medications will have a tough time adjusting to a life without them once the baby is born.
Nursing
It can be a stressful experience to become a mother. Women who suffer from ADHD can face severe challenges when they must deal with their symptoms, go to doctor appointments, prepare for the birth of a child and adjust to new routines. Therefore, many women elect to continue taking their ADHD medications throughout the course of pregnancy.
The risk to nursing infant is low because the majority of stimulant medication is absorbed through breast milk at low levels. The rate of exposure to medication will vary based on the dosage the medication is administered, its frequency and the time of day. Additionally, different medications enter the body of the baby differently through the gastrointestinal tract as well as breast milk and the impact of this on a newborn isn't well understood.
Due to the absence of research, some doctors might be tempted to stop taking stimulant medications during the course of pregnancy. It's a difficult choice for the mother, who must weigh the benefits of continuing her medication against the risk to the foetus. Until more information becomes available, GPs may ask pregnant patients if they have an background of ADHD or if they intend to take medication in the perinatal period.
A growing number of studies have shown that most women can safely continue to take their ADHD medication while they are pregnant and nursing. In the end, more and more patients are choosing to do so and, in consultation with their physician, they have found that the benefits of maintaining their current medication 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 review their medications with their physician and discuss the advantages and disadvantages of continued treatment, including non-pharmacological strategies. Psychoeducation is also needed to help pregnant women with ADHD recognize the signs and underlying disorder. They should also be educated about treatment options and strengthen the coping mechanisms. This should involve an approach that is multidisciplinary, including the GP as well as obstetricians, psychiatry and obstetricians. The pregnancy counselling should consist of discussion of a management plan for both the mother and child, monitoring for signs of deterioration and the need for adjustments to the medication regimen.