The Ugly Truth About ADHD Medication Pregnancy
ADHD Medication During Pregnancy and Breastfeeding
The decision to stop or keep ADHD medication during breastfeeding and pregnancy is a challenge for women suffering from the condition. There aren't many studies on how long-term exposure may affect a foetus.
A recent study published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological problems such as impaired hearing or vision, febrile seizures, or IQ impairment. The authors acknowledge the need for higher-quality studies.
Risk/Benefit Analysis
Women who are pregnant and taking ADHD medications must weigh the advantages of using them against the risks to the foetus. Physicians don't have the data to give clear advice, but can provide information on the risks and benefits to assist pregnant women to make informed decisions.
A study published in Molecular Psychiatry found that women who used ADHD medications prescribed for adhd in early pregnancy did not have an increased risk of fetal heart malformations or major birth defects that are structural. Researchers conducted a large 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, as well as those who had not. Clinical geneticists and pediatric cardiologists looked over the cases to ensure accurate case classification and to minimize the chance of bias.
However, the study was not without its flaws. Most important, they were unable to separate the effects of the medication from those of the underlying disorder. That limitation makes it difficult to know whether the limited associations observed in the exposed groups result from medication use or the confounding effect of comorbidities. Additionally the study did not examine the long-term effects of offspring on their parents.
The study did reveal that infants whose mothers took ADHD medications during pregnancy were at a slightly more risk of being admitted to the neonatal intensive care unit (NICU) than those whose mothers had not taken any medication or had cut back on their medications prior to or during pregnancy. This increase was caused by central nervous system disorders. The increased risk of admission was not influenced by the stimulant medications used during pregnancy.
Women who took stimulant ADHD medication during pregnancy were also at an increased risk of having a caesarean section or having a child with a low Apgar score (less than 7). These increases appeared to be independent of the type of medication taken during pregnancy.
Researchers suggest that the small risk of using ADHD medications in early pregnancies may be offset by the greater benefits for mother and baby of continuing treatment for the woman's disorder. Physicians should discuss the issue with their patients and, where possible, assist them in developing strategies for improving their coping skills that can lessen the negative impact of her condition on her daily life and relationships.
Interactions with Medication
More and more doctors are confronted with the dilemma of whether to keep treatment or stop it during pregnancy as more women are diagnosed with ADHD. These decisions are often made without clear and authoritative evidence. Instead, physicians must take into account their own experience in conjunction with the experiences of other doctors, and the research on the topic.
Particularly, the subject of potential risks to the infant can be difficult. The research that has been conducted on this topic is based on observations instead of controlled studies and the results are in conflict. In addition, most studies limit their analysis to live births, which may underestimate the severity of teratogenic effects that could cause abortion or termination of the pregnancy. The study presented in the journal club addresses these shortcomings by analyzing both the data from deceased and live births.
Conclusion Some studies have revealed an association between ADHD medications and certain birth defects however, other studies haven't established a link. Most studies have shown an unintended, or slight negative impact. As a result an accurate risk-benefit analysis must be done in each case.
For a lot of women with ADHD who suffer from adhd no medication, the decision to stop medication is difficult, if not impossible. In fact, in an article published in the 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 those suffering from the disorder. Additionally, the loss of medication may affect the ability to do job-related tasks and drive safely, which are adhd meds covered by ohip important aspects of daily life for a lot of people with ADHD.
She suggests women who are unsure about whether to keep or stop taking medication because of their pregnancy should consider educating family members, friends and colleagues on the condition, its impact on daily functioning, and on the advantages of continuing the current treatment regimen. Educating them can also make the woman feel more comfortable in her struggle with her decision. It is important to note that some 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 traces of the medication could be transferred to the child.
Birth Defects Risk
As the use and misuse of ADHD medications to treat the symptoms of attention deficit disorder hyperactivity disorder (ADHD) increases the concern over the potential effects of these drugs on the fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge regarding this subject. With two massive data sets researchers were able to examine more than 4.3 million pregnancies and determine whether stimulant medication use increased the risk of birth defects. Researchers discovered that although the overall risk is low, first-trimester generic adhd medications medication exposure was associated with slightly higher rates of specific heart defects like ventriculoseptal defects.
The researchers of the study didn't find any association between early use of medication and congenital anomalies like facial deformities, or club feet. The results are in line with previous studies that showed the existence of a slight, but significant increase in the number of cardiac malformations among women who began taking ADHD medication prior to the time of pregnancy. The risk increased in the latter stages of pregnancy when many women stopped taking their medication.
Women who used ADHD medications in the first trimester of their pregnancies were also more likely to have caesarean section, low Apgar score after delivery and a baby who needed breathing assistance during birth. However the researchers of the study were not able to eliminate bias due to selection by restricting the study to women who didn't have any other medical issues that could have contributed to these findings.
Researchers hope that their study will provide doctors with information when they encounter pregnant women. The researchers recommend that, while discussing benefits and risks are important, the decision about whether to continue or stop taking medication should be according to the severity of each woman's ADHD symptoms and her needs.
The authors caution that, while stopping the medication is an option to think about, it isn't recommended due to the high prevalence of depression and other mental disorders for women who are pregnant or recently gave birth. Research has also shown that women who stop taking their medication will have a harder adjustment to life without them after the baby is born.
Nursing
The responsibilities of being a new mother can be overwhelming. Women with ADHD can face severe challenges when they must deal with their symptoms, go to doctor appointments and prepare for the birth of a child and adjust to a new routine. Many women choose to continue taking their ADHD medication during pregnancy.
The majority of stimulant medications pass through breast milk in very small amounts, so the risk to nursing infant is very low. The rate of medication exposure will vary based on the dosage, frequency of administration and time of day. In addition, individual 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 isn't fully known.
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 weigh the benefits of continuing her medication against the potential risks to the fetus. In the meantime, until more information is available, GPs can inquire about pregnant patients if they have an history of ADHD or if they plan to take medication in the perinatal period.
Many studies have shown that women can continue taking their ADHD medication without risk during pregnancy and breast-feeding. In response, a growing number of patients are opting to do this. They have found through consultation with their physicians that the benefits of retaining their current medication outweigh possible risks.
It is crucial for women suffering from ADHD who are contemplating breastfeeding to seek out a specialist psychiatrist's advice prior to becoming pregnant. They should discuss their medication with their doctor and discuss the pros and cons of continued treatment, including non stimulant adhd medications for adults-pharmacological strategies. Psychoeducation should also be provided to help pregnant people with ADHD be aware of their symptoms and underlying disorder and learn about treatment options and strengthen existing coping strategies. This should be a multidisciplinary approach with the GP as well as obstetricians, psychiatry and obstetricians. Counselling for pregnancy should include the discussion of a treatment plan for both mother and child, and monitoring for signs of deterioration, and when necessary, making adjustments to the medication regimen.