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ADHD Medication During Pregnancy and Breastfeeding

Women with ADHD face a difficult decision about whether to continue or stop taking ADHD medication during pregnancy and breastfeeding. There isn't much information on how long-term exposure to these medications may affect the fetus.

A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological problems like hearing loss or vision, febrile seizures or IQ impairment. The authors acknowledge that more high-quality studies are needed.

Risk/Benefit Analysis

Pregnant women who take ADHD medications must weigh the advantages of taking them against potential risks to the fetus. Physicians do not have the data needed to provide clear recommendations, but they can provide information about risks and benefits that assist pregnant women in making informed decisions.

A study published in Molecular Psychiatry found that women who used ADHD medications during their early pregnancy did not face a significantly higher risk of fetal cardiac malformations or major 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 used stimulants during pregnancy. Pediatric cardiologists, clinical geneticists and other experts examined the cases to confirm that the classification was accurate and to eliminate any bias.

However, the researchers' study had its limitations. The most important issue was that they were not able to differentiate the effects of the medication from the disorder that is underlying. This limitation makes it difficult for researchers to determine if the small differences observed between the exposed groups were due to medication use or if they were affected by co-morbidities. Additionally, the researchers did not examine long-term offspring outcomes.

The study did show that babies whose mothers had taken ADHD medications during pregnancy were at slightly more risk of being admitted to the neonatal intensive care unit (NICU) than those who whose mothers did not take any medication or cut back on their medications prior to or during pregnancy. The reason for this was central nervous system-related disorders and the increased risk for admission was not found to be influenced by the stimulant medications were taken during pregnancy.

Women who were taking stimulant ADHD medications during pregnancy also had a higher chance of having caesarean sections or the baby was not scoring well on the Apgar scale (less than 7). These increases did appear to be unrelated to the type of medication taken during pregnancy.

The research suggests that the small risk associated with the use of ADHD medications during early pregnancy could be offset by the greater benefits to both mother and child from continued treatment for the woman's condition. Physicians should discuss this with their patients and, if possible, assist them in developing strategies to improve their coping abilities that can lessen the effects of her disorder on her daily life and relationships.

Medication Interactions

Doctors are increasingly confronted with the dilemma of whether to maintain treatment or stop as more women are diagnosed with ADHD. The majority of these decisions are taken in the absence of solid and reliable evidence either way, so physicians must weigh their knowledge from their own experiences, those of other doctors, and what the research says on the topic as well as their own best judgment for each individual patient.

The issue of potential risks for infants can be extremely difficult. The research that has been conducted on this topic is based on observation rather than controlled studies and the results are conflicting. Most studies focus on live-births, which could underestimate the severity of teratogenic effects leading to abortions or terminations of pregnancy. The study presented in the journal club addresses these limitations by analyzing both information on deceased and live births.

Conclusion A few studies have revealed an association between ADHD medications and certain birth defects, other studies have not shown such a relationship. Most studies show a neutral, or even slightly negative, effect. Therefore, a careful risk/benefit assessment must be conducted in every situation.

For a lot of women with ADHD who suffer from ADHD, the decision to discontinue medication is difficult if not impossible. In a recent article 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 isolation. In addition, a decrease in medication can affect the ability to do job-related tasks and drive safely, which are important aspects of a normal life for a lot of people with ADHD.

She suggests that women who are unsure whether to take the medication or stop due to pregnancy, educate their family members, colleagues, and friends about the condition, the effects on daily functioning, and the benefits of keeping the current treatment regimen. It can also aid in ensuring that the woman feels supported when she is struggling with her decision. It is important to remember that certain medications are able to pass through the placenta therefore, if a patient decides to stop taking her ADHD medication during pregnancy and breastfeeding, she must be aware that the effects of the drug can be passed on to the baby.

Risk of Birth Defects

As the use and use of ADHD medication to treat symptoms of attention deficit hyperactivity disorder (ADHD) is increasing as does the concern about the potential effects of these drugs on foetuses. A recent study published in the journal Molecular Psychiatry adds to the existing knowledge on this subject. Researchers used two huge data sets to examine more than 4.3 million pregnancies and determine if stimulant medication use increased birth defects. Researchers found that while the overall risk is low, first-trimester ADHD exposure to medication was associated with slightly higher risk of specific heart defects such as ventriculoseptal defect.

The authors of the study did not discover any link between the use of early medications and other congenital anomalies, like facial deformities or club feet. The results are in line with previous studies showing a small but significant increase in the risk of heart malformations among women who began taking ADHD medications prior to the time of pregnancy. This risk increased in the latter half of pregnancy, when a lot of 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 help breathing after birth. However the researchers of the study were unable to eliminate selection bias by restricting the study to women who didn't have other medical issues that could have contributed to the findings.

Researchers hope that their study will help doctors when they meet pregnant women. They suggest that although the discussion of risks and benefits is important however, the decision to stop or continue medication should be based on each woman's needs and the severity of her ADHD symptoms.

The authors caution that, although stopping the medication is a possibility to look into, it is not advised due to the high prevalence of depression and other mental problems for women who are pregnant or recently gave birth. Further,  sources  shows that women who stop taking their medication will have a difficult time adjusting to a life without them after the baby is born.

Nursing

The responsibilities of a new mother can be overwhelming. Women who suffer from ADHD who must work through their symptoms while attending physician appointments and getting ready for the arrival of a baby and adapting to new routines in the home are often faced with a number of difficulties. Many women decide to continue taking their ADHD medication during pregnancy.

The majority of stimulant medications are absorbed by breast milk in low amounts, therefore the risk to the breastfeeding infant is minimal. However, the rate of medication exposure to the newborn can vary depending on dosage, how often it is administered and the time of the day the medication is administered. In addition, various medications are introduced into the baby's system via the gastrointestinal tract or through breast milk. The effect on the health of a newborn is not fully comprehended.

Some doctors may decide to stop stimulant medication during a woman’s pregnancy due to the lack of research. This is a complicated decision for the patient, who must weigh the benefits of keeping her medication with the potential risks to the fetus. Until more information becomes available, doctors may inquire about pregnant patients if they have any background of ADHD or if they plan to take medication during the perinatal phase.

A increasing number of studies have revealed that women can continue to take their ADHD medication during pregnancy and while breastfeeding. In response, a growing number of patients are opting to continue their medication. They have found through consultation with their physicians, that the benefits of retaining their current medication outweigh any possible risks.

It is crucial for women suffering from ADHD who are considering breastfeeding to seek a specialist psychiatrist's advice prior becoming pregnant. They should discuss their medication with their doctor and discuss the advantages and disadvantages of continuing treatment, including non-pharmacological strategies. Psychoeducation should also be provided to help pregnant women suffering from ADHD be aware of their symptoms and the underlying disorder and learn about treatments and to reinforce existing strategies for coping. This should include a multidisciplinary approach with the GP, obstetricians and psychiatry. Pregnancy counseling should include discussion of a treatment plan for the mother and the child, and monitoring for signs of deterioration, and, if necessary, adjustments to the medication regimen.