ADHD Medication Pregnancy: The Good The Bad And The Ugly
ADHD Medication During Pregnancy and Breastfeeding
Women with ADHD have to make a difficult choice regarding whether or not to stop taking ADHD medication during pregnancy and breast-feeding. There are few data on how long-term exposure may affect a fetus.
A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication during the uterus do not develop neurological conditions like impaired vision or hearing, febrile seizures, or IQ impairment. The authors acknowledge the need for higher-quality studies.
Risk/Benefit Analysis
Women who are expecting and taking ADHD medication should consider the benefits of taking it against the possible dangers for the foetus. Physicians don't have the data needed to provide clear recommendations, but they Can you get adhd medication without a diagnosis provide information on benefits and risks that can help pregnant women make informed choices.
A study published in Molecular Psychiatry concluded that women who were taking ADHD medication during early pregnancy were not at greater risk of fetal malformations, or structural birth defects. Researchers used a vast population-based case-control study 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 reviewed the cases to ensure accurate case classification and to minimize the possibility of bias.
The research conducted by the researchers had some limitations. The researchers were unable, in the first place, to separate the effects caused by the medication from the disorder. This makes it difficult for researchers to determine if the small differences observed between the groups exposed were due to the use of medication, or if they were confounded by comorbidities. Researchers also did not examine the long-term effects for the offspring.
The study found that infants whose mothers took ADHD medication during pregnancy were at a slightly greater risk of being admitted to the neonatal care unit (NICU) in comparison to mothers who didn't take any medication during pregnancy, or had stopped taking their medication before or during pregnancy. The reason for this was central nervous system-related disorders and the increased risk of admission did not appear to be affected by the type of stimulant medication was used during pregnancy.
Women who were taking stimulant ADHD medication during pregnancy were also at an elevated risk of having a caesarean section or having a child with low Apgar score (less than 7). These increases did appear to be independent of the type of medication used during pregnancy.
The research suggests that the risk of a small amount with the use of ADHD medications during early pregnancy could be offset by the greater benefit to both the mother and child of continued treatment for the woman's disorder. Doctors should discuss with their patients about this issue and, if possible, help them develop coping skills that could reduce the impact of her disorder in her daily life and relationships.
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As more women than ever before are being diagnosed with ADHD and treated with medication, the issue of whether to keep or end treatment during pregnancy is a question that doctors are having to face. The majority of these decisions are taken in the absence of solid and reliable evidence in either case, which means that doctors must weigh what they know about their experiences, the experiences of other doctors, and what research suggests on the subject, along with their own judgments for each individual patient.
Particularly, the subject of possible risks to the infant can be difficult. The research on this subject is based on observation instead of controlled studies and many of the findings are in conflict. Most studies limit their analysis to live-births, which could underestimate the teratogenic impact which can cause terminations or abortions of pregnancy. The study presented in this journal club addresses these limitations by looking at data from both live and deceased births.
The conclusion The conclusion: While certain studies have demonstrated a positive association between ADHD medications and the risk of certain birth defects, others have not found any evidence of a link, and most studies demonstrate a neutral or slightly negative impact. In the end, a careful risk/benefit analysis is required in every situation.
It can be challenging, if not impossible, for women with ADHD to stop taking their medication. In an article recently published in Archives of Women's Mental Health psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can lead to increased depression, feelings of isolation and family conflict for patients with ADHD. The loss of medication can also impact the ability to safely drive and to perform work-related tasks which are vital aspects of daily life for people with ADHD.
She suggests women who are unsure about whether to keep or discontinue medication due to their pregnancy, consider educating family members, friends and colleagues on the condition, its impact on daily life, and the benefits of keeping the current treatment plan. It can also help women feel confident about her decision. It is important to note that certain drugs can pass through the placenta so if a woman decides to discontinue her ADHD medication during pregnancy and breastfeeding, she must be aware that traces of the drug could be transferred to the infant.
Risk of Birth Defects
As the use and use of ADHD medication to treat symptoms of attention deficit disorder hyperactivity disorder (ADHD), increases the concern over the possible effects of the drugs on the fetuses. A recent study published in the journal Molecular Psychiatry adds to the body of information on this topic. Researchers used two massive datasets to analyze over 4.3 million pregnancies and determine if stimulant medication use caused birth defects. Researchers discovered that, while the risk overall is low, the first trimester ADHD medication exposure was associated with slightly higher risk of certain heart defects, like ventriculoseptal defect.
The authors of the study found no connection between the use of early medications and congenital abnormalities such as facial clefting or club foot. The results are in agreement with previous studies which showed a small, but significant increase in the number of cardiac malformations among 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 are forced to stop taking their ADHD medications.
Women who took ADHD medication during the first trimester were more likely require a caesarean birth and also have a low Apgar after birth and have a baby who needed breathing assistance when they were born. The researchers of the study could not remove bias in selection since they limited their study to women who did not have any other medical conditions that could have contributed to the findings.
The researchers hope their research will serve to inform the clinical decisions of physicians who treat pregnant women. They recommend that, while discussing the benefits and risks is important but the decision to stop or continue medication should be based on the woman's requirements 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 rate depression and other mental disorders for women who are pregnant or who have recently given birth. Further, the research suggests that women who decide to stop their medications are more likely to have a difficult time adjusting to life without them following the birth of their baby.
Nursing
The responsibilities that come with being a new mother can be overwhelming. Women with ADHD who have to deal with their symptoms while attending physician appointments and getting ready for the arrival of their child and adapting to new routines in the home are often faced with a number of difficulties. As such, many women elect to continue taking their ADHD medications throughout pregnancy.
The risk for nursing infant is low because the majority of stimulant medications passes through breast milk in low amounts. However, the frequency of exposure to medications by the newborn may differ based on the dosage, frequency it is administered and the time of day it is administered. Additionally, individual medications enter the baby's system differently through the gastrointestinal tract as well as breast milk. The impact of this on a newborn is not yet fully understood.
Some physicians may discontinue stimulant medication during a woman's pregnancy due to the lack of research. This is a difficult choice for the patient, who must balance the benefit of continuing her medication with the potential risks to the embryo. Until more information becomes available, GPs can ask pregnant patients if they have any background of ADHD or if they plan to take medication during the perinatal period.
Numerous studies have demonstrated that women can continue to take their ADHD medication safely during pregnancy and while breast-feeding. In the end, more and more patients choose 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 are planning 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 pros and cons of continued treatment, including non-pharmacological strategies. Psychoeducation is also necessary to help pregnant women with ADHD understand the symptoms and underlying disorder. They should also learn about treatment options and build the coping mechanisms. This should include a multidisciplinary approach with the GP doctors, obstetricians and psychiatrists. Pregnancy counseling should include a discussion of a treatment plan for the mother and the child, as well as monitoring for signs of deterioration, and, if necessary, adjustments to the medication regime.