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ADHD Medication During Pregnancy and Breastfeeding

The decision to stop or keep ADHD medications during breastfeeding and pregnancy is a challenge for women suffering from the condition. There aren't enough data on how long-term exposure may affect a pregnant fetus.

A recent study 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 that more high quality studies are required.

Risk/Benefit Analysis

Women who are pregnant and taking ADHD medications must weigh the benefits of taking them against the potential risks to the foetus. Doctors don't have enough data to provide clear recommendations but they can provide information on risks and benefits to assist pregnant women to make an informed decision.

A study published in Molecular Psychiatry concluded that women who were taking ADHD medication during early pregnancy did not have a higher risk of fetal malformations or structural birth defects. Researchers conducted a large population-based case control study to examine the prevalence of major structural defects in infants born to mothers who were taking stimulants during pregnancy. Pediatric cardiologists and clinical geneticists looked over the cases to ensure correct case classification and to minimize the possibility of bias.

The study conducted by the researchers was not without limitations. The researchers were not able to, in the first place to distinguish the effects triggered by the medication from the disorder. This makes it difficult for researchers to determine if the few associations observed between the exposed groups were due to medication use or if they were confounded by comorbidities. The researchers did not look at long-term outcomes for the offspring.

The study did show that babies whose mothers had taken ADHD medication during pregnancy were at a slightly higher risk of being admitted to the neonatal intensive care unit (NICU) than infants whose mothers had not taken any medication or had taken off their medication prior to or during pregnancy. This was due to central nervous system disorders, and the increased risk for admission did not appear to be affected by the type of stimulant medications were taken during pregnancy.

Women who used stimulant ADHD medication during pregnancy were also at an increased chance of having a caesarean section or having a baby born with low Apgar score (less than 7). These increases appear to be unrelated to the type of medication taken during pregnancy.

Researchers suggest that the small risk of using ADHD medications during early pregnancies can be offset by greater benefits for baby and mother of continued treatment for the woman’s disorder. Doctors should discuss with their patients about this issue and as much as possible, assist them improve coping skills which can lessen the impact of her disorder in her daily life and relationships.

Medication Interactions

Many doctors are faced with the decision of whether to maintain treatment or stop as more women are diagnosed with ADHD. These decisions are frequently made without clear and reliable evidence. Instead, doctors have to consider their own expertise and experience, as well as the experiences of other physicians and the research on the subject.

In particular, the issue of potential risks for the baby can be a challenge. The research on this subject is based on observations rather than controlled studies and many of the findings are contradictory. Most studies focus on live-births, which could underestimate the severity of teratogenic effects leading to abortions or terminations of pregnancy. The study discussed in the journal club addresses these shortcomings, by examining both data on live and deceased births.

The conclusion: 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 most studies demonstrate a neutral or slight negative effect. Therefore an accurate risk-benefit analysis must be done in each situation.

For a lot of women with ADHD, the decision to stop medication can be difficult, if not impossible. 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 increase depression and feelings of loneliness. A loss of medication may also affect the ability to safely drive and complete work-related tasks, which are vital aspects of daily life for those with ADHD.

She recommends that women who are unsure about whether or not to discontinue medication due to their pregnancy consider informing family members, friends and colleagues about the condition, its effects on daily functioning, and the benefits of keeping the current treatment regimen. It can also help a woman feel supported in her decision. It is important to note that certain medications can be absorbed through the placenta so if a woman decides to stop her ADHD medication during pregnancy and breastfeeding, she must be aware that the effects of the drug can be transferred to the infant.

Birth Defects and Risk of

As the use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases as do concerns about what impact the drugs might have on fetuses.  her response  published in the journal Molecular Psychiatry has added to the body knowledge on this issue. Researchers used two massive datasets to analyze over 4.3 million pregnancy and determine whether stimulant medications increased the risk of birth defects. Although the risk overall remains low, the scientists discovered that the first-trimester exposure to ADHD medicines was associated with an increased risk of certain heart defects, like ventriculo-septal defects (VSD).

The researchers of the study found no association between early use of medication and congenital abnormalities like facial clefting, or club foot. The results are consistent with previous studies showing a small but significant increase in the risk of developing cardiac malformations among women who began taking ADHD medications prior to the time of the time of pregnancy. This risk increased in the latter half of pregnancy, when many women are forced to stop taking their ADHD medications.

Women who took ADHD medications during the first trimester of their pregnancies were also more likely to undergo caesarean section, low Apgar score following delivery, and a baby that required breathing assistance during birth. However, the authors of the study were unable to eliminate bias due to selection by limiting the study to women who didn't have any other medical conditions that could be a contributing factor to these 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 however, the decision to stop or maintain medication should be based on the woman's needs and the severity of her ADHD symptoms.

The authors caution that, although stopping the medication is a possibility to think about, it isn't advised due to the high prevalence of depression and other mental problems for women who are pregnant or who have recently given birth. Research has also shown that women who stop taking their medications will have a harder transitioning to life without them after the baby is born.

Nursing

The responsibilities of being a new mother can be overwhelming. Women with ADHD may face a lot of challenges when they must manage their symptoms, go to doctor appointments, prepare for the birth of a baby and adjust to new routines. Many women decide to continue taking their ADHD medication during pregnancy.

The risk for breastfeeding infant is minimal because the majority of stimulant medication passes through breast milk at a low level. However, the amount of medication exposure to the newborn can vary depending on the dosage, frequency it is administered and at what time the medication is administered. Additionally, different medications enter the body of the baby differently through the gastrointestinal tract as well as breast milk, and the effect of this on a newborn is not well understood.

Some physicians may discontinue stimulant medications during a woman's pregnancy due to the lack of research. It's a difficult choice for the woman who must weigh the advantages of taking her medication as well as the risks to the foetus. Until more information becomes available, GPs may ask pregnant patients whether they have a background of ADHD or if they intend to take medication in the perinatal phase.

Many studies have shown that women can continue taking their ADHD medication safely while breastfeeding and during pregnancy. In response, an increasing number of patients are opting to continue their medication. They have concluded after consulting with their doctor that the benefits of keeping their current medication far outweigh any possible risks.

Women with ADHD who plan to breastfeed should seek the advice of an expert psychiatrist prior to becoming pregnant. They should review their medications with their doctor and discuss the advantages and disadvantages of continued treatment, including non-pharmacological management strategies. Psychoeducation should also be offered to help pregnant women suffering from ADHD understand their symptoms and underlying disorder and learn about treatment options and strengthen existing strategies for managing. This should be a multidisciplinary approach, which includes the GP doctors, obstetricians and psychiatrists. Pregnancy counseling should consist of a discussion of a treatment plan for the mother as well as the child, and monitoring for signs of deterioration, and, if necessary adjustments to the medication regime.