Why ADHD Medication Pregnancy Doesn't Matter To Anyone

ADHD Medication During Pregnancy and Breastfeeding

Women with ADHD must make a difficult decision about whether to continue or stop taking ADHD medication during pregnancy and breast-feeding. There aren't many studies regarding how exposure over time may affect the fetus.

A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological disorders 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 take ADHD medication should weigh the benefits of taking it against the possible risks to the baby. Doctors don't have the information needed to provide clear recommendations however they can provide information regarding risks and benefits that aid pregnant women in making informed choices.

A study published in Molecular Psychiatry found that women who used ADHD medications in early pregnancy did not have a significantly higher risk of fetal cardiac malformations or major structural birth defects. The researchers used a large population-based study of case-control to determine the prevalence of major structural birth defects in babies born to mothers who had taken stimulants in the early stages of pregnancy, and those who did not. Clinical geneticists and pediatric cardiologists looked over the cases to ensure correct case classification and to limit the possibility of bias.

However, the researchers' study was not without its flaws. Most important, they were unable to separate the effects of the medication from the effects of the underlying disorder. This makes it difficult to determine whether the small associations observed in the exposed groups are due to medication use or confounding by comorbidities. Additionally the researchers did not examine the long-term effects of offspring on their parents.

The study found that infants whose mothers took ADHD medication during pregnancy had a higher risk of admission to the neonatal care unit (NICU), compared to mothers who did not use any medication during pregnancy or had discontinued taking their medication prior to or during pregnancy. This was due to central nervous system disorders. The higher risk of admission was not influenced by the stimulant medication that was used during pregnancy.

Women who took stimulant ADHD medications during pregnancy also had a higher risk of having caesarean sections or a baby that scored low on the Apgar scale (less than 7). These increases did appear to be independent of the type of medication taken during pregnancy.

Researchers suggest that the small risks posed by the use of ADHD medications in early pregnancies can be offset by greater benefits to both baby and mother of continued treatment for the woman's disorder. Physicians should talk to their patients about this issue and try to help them develop coping skills that could reduce the impact of her disorder in her daily functioning and her relationships.

Medication Interactions

As more women than ever are diagnosed with ADHD and being treated with medication, the issue of whether to keep or discontinue treatment during pregnancy is one that more and more doctors face. The majority of these decisions are taken in the absence of any evidence that is clear and definitive either way, so physicians have to weigh their experience from their own experiences, those of other doctors, and what research suggests on the subject, along with their best judgment for each patient.

Particularly, the issue of potential risks for the infant can be difficult. Many of the studies on this issue are based on observational data rather than controlled research, and their conclusions are often contradictory. The majority of studies focus on live births, which may underestimate the teratogenic impact leading to abortions or terminations of pregnancy. The study presented in this journal club addresses these shortcomings by examining data on both live and deceased 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, other studies have found no such relationship, and most studies have a neutral or slightly negative impact. Therefore, a careful risk/benefit analysis must be done in each instance.

It can be challenging, if not impossible for women suffering from ADHD to stop taking their medication. In a recent piece published in the Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can lead to depression and feelings of isolation. Furthermore, a loss of medication can affect the ability to perform jobs and drive safely which are essential aspects of daily life for many people with ADHD.

She recommends women who are uncertain about whether to continue or stop medication in light of their pregnancy, consider educating family members, friends and colleagues on the condition, its impact on daily functioning, and the benefits of keeping the current treatment plan. Educating them can also aid in ensuring that the woman feels supported in her struggle with her decision. Certain medications can be passed through the placenta. If a patient decides to not take her ADHD medication while breastfeeding, it is important to be aware that the drug may be transferred to her baby.

Birth Defects and Risk of

As the use and abuse of ADHD medications to treat the symptoms of attention deficit hyperactivity disorder (ADHD) is increasing the concern over the possible effects of the drugs on the fetuses.  adhd in adults medication  published in the journal Molecular Psychiatry has added to the body of knowledge on this issue. With two massive data sets, researchers were able to examine more than 4.3 million pregnancies and see whether stimulant medications increased the risk of birth defects. Researchers discovered that, while the risk overall is low, first-trimester ADHD medication use was associated with slightly higher rates of specific heart defects like ventriculoseptal defects.

The researchers of the study found no connection between early use of medication and congenital abnormalities such as facial clefting or club foot. The results are in agreement with previous studies that have shown the existence of a slight, but significant increase in cardiac malformations for women who began taking ADHD medication prior to the time of the birth of their child. The risk was higher in the latter half of pregnancy, as many women begin to discontinue their medication.

Women who took ADHD medications during the first trimester of pregnancy were also more likely to have caesarean section, low Apgar score after delivery and a baby who required breathing assistance during birth. The researchers of the study were not able to remove bias in selection since they limited their study to women without other medical conditions that could have contributed to the findings.

Researchers hope that their study will inform physicians when they meet pregnant women. They recommend that, while the discussion of the benefits and risks is important but the decision to stop or keep treatment should be based on each woman's requirements and the severity of her ADHD symptoms.

The authors warn that, although stopping the medication is a possibility to consider, it is not advised due to the high rate depression and other mental problems among women who are pregnant or recently gave birth. Furthermore, research suggests that women who choose to stop taking their medication are more likely to experience difficulties adapting to life without them following the baby's arrival.

Nursing

The responsibilities of being a new mother can be overwhelming. Women with ADHD who have to deal with their symptoms while attending doctor appointments as well as preparing for the arrival of a baby and getting used to new routines at home are often faced with a number of difficulties. This is why many women elect to continue taking their ADHD medications throughout pregnancy.

The majority of stimulant medications are absorbed through breast milk in low amounts, so the risk to nursing infant is very low. The amount of exposure to medications can vary depending upon the dosage and frequency of administration as well as the time of the day. In addition, various medications enter the baby’s system via the gastrointestinal tract, or through breast milk. The impact on a newborn's health is not completely comprehended.

Because of the lack of research, some physicians might be tempted to stop taking stimulant medications during the course of pregnancy. This is a difficult choice for the patient, who must weigh the benefit of continuing her medication against the potential risks to the fetus. 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 demonstrated that women can continue taking their ADHD medication in a safe manner during pregnancy and breast-feeding. This has led to an increasing number of patients are choosing to do so, and in consultation with their physician, they have found that the benefits of maintaining their current medication far outweigh any risks.

Women with ADHD who are planning to nurse should seek the advice of a specialist psychiatrist prior to becoming pregnant. They should discuss their medication with their prescriber and discuss the advantages and disadvantages of continuing treatment, including non-pharmacological management strategies. Psychoeducation is also necessary to help pregnant women suffering from ADHD understand the symptoms and the underlying disorder. They should also be educated about treatment options and build coping mechanisms. This should be a multidisciplinary effort with the GPs, obstetricians and psychiatrists. Pregnancy counseling should include discussion of a treatment plan for the mother as well as the child, monitoring of signs of deterioration, and, if needed modifications to the medication regimen.