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ADHD Medication During Pregnancy and Breastfeeding

Women suffering from ADHD face a difficult decision about whether to continue or stop taking ADHD medication during pregnancy and breast-feeding. There are few data regarding how exposure over time may affect a fetus.

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

Risk/Benefit Analysis

Pregnant women who use ADHD medications must weigh the advantages of taking them against the potential risks to the foetus. The doctors don't have the information to give clear advice but they can provide information on risks and benefits to aid pregnant women in making informed choices.

A study published in Molecular Psychiatry found that women who were taking ADHD medications during their early pregnancy did not have a significantly increased risk of fetal cardiac malformations or major birth defects that are structural. Researchers conducted a massive 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 reviewed the cases to ensure an accurate case classification and to minimize the chance of bias.

The research conducted by the researchers was not without its limitations. The researchers were not able in the beginning to distinguish the effects triggered by the medication from the disorder. This makes it difficult for researchers to establish whether the small differences observed between the groups exposed were due to the use of medication or caused by the presence of comorbidities. The researchers also did not study long-term outcomes for offspring.

The study showed that infants whose mothers took ADHD medication during pregnancy had a slightly higher chance of being admitted to the neonatal care unit (NICU) as compared to mothers who did not take any medication during pregnancy or had discontinued taking their medication prior to or during pregnancy. This was due to central nervous system-related disorders and the increased risk of admission did not appear to be influenced by which stimulant medications were used during pregnancy.

Women who took stimulant ADHD medications during pregnancy also had a higher chance of having to have caesarean sections or a baby that scored low on the Apgar scale (less than 7). These increases did not seem to be influenced by the type of medication that was used during pregnancy.

Researchers suggest that the minor risk of using ADHD medication during pregnancies in the early stages can be offset by greater benefits to both mother and baby of continuing treatment for the woman’s disorder. Physicians should speak with their patients about this and try to help them develop coping skills that may reduce the effects of her disorder on her daily functioning and her relationships.

Medication Interactions

More and more doctors are faced with the decision of whether to maintain treatment or stop during pregnancy as more women are diagnosed with ADHD. Most of the time, these decisions are taken in the absence of any evidence that is clear and definitive in either case, which means that doctors must weigh their knowledge from their own experiences, those of other doctors, and what research says on the topic and their best judgment for each patient.

The issue of risk to the infant can be particularly tricky. The research on this issue is based on observation instead of controlled studies and a lot of the results are conflicting. In addition, most studies limit their analysis to live births, which may underestimate the severity of teratogenic effects that could result in abortion or termination of the pregnancy. The study discussed in this journal club addresses these issues by looking at data from both live and deceased births.

Conclusion A few studies have revealed an association between ADHD medications and certain birth defects, other studies have not established a link. Most studies show that there is a neutral, or slightly negative, effect. As a result, a careful risk/benefit analysis is required in every case.

For a lot of women with ADHD who suffer from strongest adhd medication, the decision to stop medication is difficult, if not impossible. In a recent article published in the Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping adhd Medication Pregnancy medications during pregnancy can increase depression and feelings of loneliness. The loss of medication can also impact the ability to safely drive and to perform work-related tasks which are vital aspects of normal life for people with ADHD.

She suggests that women who are unsure about whether to continue or stop medication in light of their pregnancy, consider the possibility of educating friends, family members and colleagues about the condition, its effects on daily functioning, and on the advantages of staying on the current treatment plan. It can also help a woman feel confident about her decision. It is also worth noting that certain drugs can pass through the placenta so if the patient decides to discontinue her ADHD medication during pregnancy and breastfeeding, she must be aware that traces of the drug could be transferred to the child.

Risk of Birth Defects

As the use of ADHD medications to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases there are concerns about the effects that the drugs might have on the fetuses. A study that was published in the journal Molecular Psychiatry adds to the body of knowledge about this subject. With two massive data sets researchers were able analyze more than 4.3 million pregnancies and see whether stimulant medications increased the risk of birth defects. While the overall risk is low, the researchers did find that first-trimester exposure to ADHD medicines was associated with an increase in the risk of certain heart defects like ventriculo-septal defects (VSD).

The authors of the study found no link between the use of early medications and congenital abnormalities such as facial clefting or club foot. The results are in the same vein as previous studies that have shown an insignificant, but small increase in cardiac malformations for women who started taking ADHD medication prior to the time of pregnancy. The risk increased in the latter half of pregnancy, when a lot of women decided to stop taking their medication.

Women who took ADHD medications during the first trimester of pregnancy were also more likely to experience caesarean sections, a low Apgar score following delivery, and a baby who required breathing assistance at birth. The authors of the study were not able to eliminate bias due to selection because they restricted the study to women who did not have any other medical conditions that might have contributed to the findings.

The researchers hope their study will aid in the clinical decisions of doctors who see pregnant women. The researchers recommend that, while discussing benefits and risks are crucial, the decision on whether to continue or stop medication should be according to the severity of each woman's ADHD symptoms and her needs.

The authors also caution that, while stopping the medication is an option, it is not an option to consider due to the high incidence of depression and other mental health issues for women who are expecting or recently post-partum. Furthermore, research suggests that women who choose to stop taking their medications are more likely to experience a difficult time adjusting to life without them following the birth of their baby.

Nursing

The responsibilities that come with being a new mom can be overwhelming. Women who suffer from ADHD are often faced with a number of difficulties when they must manage their symptoms, go to doctor appointments and prepare for the birth of a baby and adjust to a new routine. Many women decide to continue taking their ADHD medication during pregnancy.

The risk to breastfeeding infant is not too high since the majority of stimulant medication is absorbed through breast milk in low amounts. However, the amount of exposure to medications by the newborn may differ based on dosage, frequency it is taken and the time of day it is administered. In addition, different medications are introduced into the baby's system via the gastrointestinal tract or breast milk. The impact of these medications on the health of a newborn is not completely understood.

Because of the lack of research, some doctors might be tempted to stop taking stimulant medication during the course of pregnancy. It is a difficult decision for the mother, who must weigh the advantages of continuing her medication against the risks to the foetus. In the meantime, until more information is available, GPs should ask all pregnant patients about their history of ADHD and whether they plan or are taking to take medication during the perinatal time.

Numerous studies have demonstrated that women can continue taking their ADHD medication without risk during pregnancy and while breast-feeding. In response, an increasing number of patients are opting to continue their medication. They have discovered through consultation with their doctors that the benefits of keeping their current medication far outweigh any risk.

Women who suffer from ADHD who plan to breastfeed should seek the advice of a specialist psychiatrist before becoming pregnant. They should discuss their medication with their prescriber and discuss the pros and cons for continuing treatment. This includes non-pharmacological strategies. Psychoeducation is also required to help pregnant people with ADHD be aware of their symptoms and the root cause, learn about available treatments and to reinforce existing strategies for managing. This should involve a multidisciplinary approach, which includes the GP, obstetricians and psychiatry. Pregnancy counseling should include discussion of a treatment plan for the mother as well as the child, and monitoring for indicators of deterioration, and, if necessary modifications to the medication regimen.