The Most Pervasive Issues In ADHD Medication Pregnancy
ADHD Medication During Pregnancy and Breastfeeding
The decision to stop or keep ADHD medication during breastfeeding and pregnancy is challenging for women with the condition. There aren't enough data on how long-term exposure may affect a foetus.
A recent study 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 that more high quality studies are required.
Risk/Benefit Analysis
Pregnant women who use ADHD medications need to balance the advantages of taking them against the potential risks to the foetus. Physicians don't have the data needed to give clear guidelines, but they can provide information on the risks and benefits to aid pregnant women in making informed decisions.
A study published in Molecular Psychiatry found that women who took ADHD medications in early pregnancy did not have an increased risk of fetal cardiac malformations or major birth defects that are structural. Researchers used a vast, population-based case-control study to assess the risk of major structural birth defects in infants born to mothers who had taken stimulants during the early stages of pregnancy and those who had not. Pediatric cardiologists and clinical geneticists examined the cases to ensure an accurate case classification and to minimize the possibility of bias.
However, the study had its limitations. Most important, they were not able to differentiate the effects of the medication from those of the disorder at hand. This limitation makes it difficult to know whether the small associations observed in the groups that were exposed are due to medication use or comorbidities that cause confusion. The researchers did not examine long-term outcomes for the offspring.
The study found that babies whose mothers had taken ADHD medication during pregnancy were at a slightly higher risk of admission to the neonatal care unit (NICU) in comparison to those whose mothers didn't take any medication for adhd and bipolar during pregnancy, or had stopped taking their medication before or during pregnancy. The reason for this was central nervous system disorders. The higher risk of admission was not affected by the stimulant medications used during pregnancy.
Women who were taking 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 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 during early pregnancies could be offset by the more beneficial outcomes for both baby and mother of continued treatment for the woman's condition. Physicians should speak with 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 treated with medication, the issue of whether to continue or stop treatment during pregnancy is a question that more and more doctors confront. The majority of these decisions are made without clear and authoritative evidence in either case, which means that doctors have to weigh their experience from their own experiences, those of other doctors, and what research says on the topic as well as their own judgments for each individual patient.
Particularly, the subject of possible risks to the infant can a doctor prescribe adhd medication without a diagnosis be difficult. Many of the studies on this issue are based on observations rather than controlled research and their conclusions are often contradictory. Most studies focus on live births, which may underestimate the severity of teratogenic effects which can cause abortions or terminations of pregnancy. The study presented in this journal club addresses these shortcomings by analyzing data on live and deceased births.
Conclusion A few studies have found a positive correlation between adhd medication weight loss uk medications and certain birth defects However, other studies haven't established a link. Most studies have shown that there is a neutral, or slight negative effect. In every case an in-depth evaluation of the benefits and risks must be performed.
It can be difficult, if not impossible for women with ADHD to stop taking their medication. In fact, in an article recently published in Archives of Women's Mental Health psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can cause depression, feelings of loneliness and family conflict for those suffering from the disorder. Additionally, the loss of medication may affect the ability to complete job-related tasks and drive safely which are essential aspects of daily life for many people suffering from ADHD.
She suggests women who are unsure about whether or not to discontinue medication due to their pregnancy consider the possibility of educating friends, family members and colleagues about the condition, its effects on daily life, and the benefits of keeping the current treatment plan. It can also help women feel supported in her decision. Certain medications can be passed through the placenta. If a woman decides to stop taking her ADHD medication while breastfeeding, it's important to be aware that the drug could be passed on to her baby.
Risk of Birth Defects
As the use and misuse of ADHD medication to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases as does the concern about the potential effects of these drugs on fetuses. A study that was published in the journal Molecular Psychiatry adds to the existing information on this topic. Researchers used two huge data sets to study over 4.3 million pregnant women and determine if the use of stimulant medications increased birth defects. Researchers discovered 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 found no association between early medication use and other congenital abnormalities, like facial clefting, or club foot. The results are in the same vein as previous studies which showed the existence of a slight, but significant increase in cardiac malformations for women who started taking adhd medication prescription uk medication before the birth of their child. This risk increased during the latter part of pregnancy when a large number of women decided to stop taking their medication.
Women who used adhd medication for women medications during the first trimester of pregnancy were also more likely to experience caesarean sections, a low Apgar score after delivery and a baby that required help breathing at birth. However the researchers of the study were not able to eliminate selection bias by restricting the study to women who didn't have any other medical conditions that could have contributed to these findings.
The researchers hope that their research will serve to inform the clinical decisions of doctors who see pregnant women. They suggest that although discussing risks and benefits is important but the decision to stop or maintain medication must be based on each woman's requirements and the severity of her ADHD symptoms.
The authors also advise that even though stopping the medication is an option, it isn't a recommended practice because of the high prevalence of depression and other mental health problems in women who are pregnant or who are recently post-partum. Furthermore, research suggests that women who decide to stop their medications are more likely to have a difficult time adapting to life without them after the baby's arrival.
Nursing
The responsibilities of a new mother can be overwhelming. Women who suffer from ADHD can face severe challenges when they have to manage their symptoms, attend doctor appointments and prepare for the birth of their child and adjust to a new routine. This is why many women choose to continue taking their ADHD medication throughout the pregnancy.
The majority of stimulant medications pass through breast milk in very small amounts, therefore the risk to nursing infant is very low. The rate of medication exposure can vary depending upon the dosage and frequency of administration as well as 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 impact of this on a newborn isn't yet fully understood.
Some doctors may stop taking stimulant medications during a woman's pregnancy due to the lack of research. It is a difficult decision for the mother, who must weigh the benefits of taking her medication as well as the risk to the fetus. Until more information is available, doctors should ask all pregnant patients about their history of ADHD and whether they are planning or taking to take medication during the perinatal time.
Numerous studies have demonstrated that women can continue to take their ADHD medication safely while breastfeeding and during pregnancy. In response, a rising number of patients are opting to do so. They have concluded, in consultation with their doctor, that the benefits of continuing their current medication outweigh any potential risks.
Women with ADHD who plan to breastfeed should seek advice from an expert psychiatrist prior to becoming pregnant. They should review their medications with their physician and discuss the advantages and disadvantages of continued treatment, including non-pharmacological strategies. Psychoeducation is also needed to help pregnant women with ADHD understand the symptoms and underlying disorder. They should also be educated about treatment options and reinforce the coping mechanisms. This should be a multidisciplinary approach including obstetricians, GPs and psychiatrists. Counselling for pregnancy should include the discussion of a treatment plan for both the mother as well as the child, as well as monitoring for signs of deterioration, and the need for adjustments to the medication regimen.