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ADHD Medication During Pregnancy and Breastfeeding

Women suffering from ADHD have to make a difficult choice regarding whether or not to stop taking ADHD medication during pregnancy and breastfeeding. There aren't enough data regarding how exposure over time may affect a fetus.

A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication during the uterus don't develop neurological conditions like hearing or vision impairment seizures, febrile seizures, or IQ impairment. The authors acknowledge the need for more high-quality research.

Risk/Benefit Analysis

Pregnant women who use ADHD medications must weigh the benefits of taking them against potential risks to the fetus. The doctors don't have the information to provide clear recommendations however they can provide information about risks and benefits to assist pregnant women to make informed decisions.

A study published in Molecular Psychiatry found that women who took ADHD medications during early pregnancy did not have an increased risk of fetal heart malformations or major structural birth defects. 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 early pregnancy, as well as those who had not. Pediatric cardiologists and clinical geneticists looked over the cases to ensure correct classification of the cases and to reduce the possibility of bias.

However, the researchers' study had its limitations. The researchers were unable to, in the first place to differentiate the effects of the medication from the disorder. This makes it difficult to determine whether the small differences observed in the groups that were exposed are due to the use of medication or confounding by comorbidities. Researchers also did not look at long-term outcomes for the offspring.

The study found that infants whose mothers took ADHD medication during pregnancy had a slightly higher chance of being admitted to the neonatal care unit (NICU) in comparison to mothers who did not use any medication during pregnancy or had stopped taking their medication before or during pregnancy. This was due to central nervous system disorders, and the increased risk of admission did not appear to be influenced by the stimulant medications were taken during pregnancy.

Women who took stimulant ADHD medication during pregnancy also had an elevated risk of having a caesarean birth or having a baby with low Apgar score (less than 7). These increases did appear to be unrelated to the type of medication taken during pregnancy.

The researchers suggest that the small risk associated with the use of ADHD medications during the early stages of pregnancy may be offset by the greater benefit to both mother and child of continuing treatment for the woman's condition. Physicians should discuss this with their patients and, when possible, assist them in developing strategies to improve coping skills that may minimize the effects of her disorder on her daily functioning and relationships.

Medication Interactions

Many doctors are confronted with the dilemma of whether to keep treatment or stop as more women are diagnosed with ADHD. These decisions are usually made without clear and reliable evidence. Instead, doctors must consider their own expertise, the experience of other doctors and the research on the topic.

The issue of potential risks to the infant can be particularly tricky. Many of the studies on this topic are based on observational data instead of controlled research and their conclusions are often contradictory. The majority of studies focus on live births, which may underestimate the teratogenic impact leading to terminations or abortions of pregnancy. The study discussed in the journal club addresses these issues, by examining both the data from deceased and live births.

The conclusion is that while certain studies have demonstrated that there is a positive correlation between ADHD medications and the risk of certain birth defects, other studies have found no such relationship, and most studies show a neutral or even slightly negative effect. Therefore an accurate risk-benefit analysis is required in every situation.

For women suffering from ADHD and ADD, the decision to stop medication is difficult, if not impossible. In fact, in an article recently published in the 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 can interfere with the ability to perform work-related tasks and safely drive, which are important aspects of daily life for many people suffering from prescribe adhd medication.

She recommends women who are uncertain about whether to keep or stop taking medication because of their pregnancy, consider informing family members, friends and colleagues about the condition, its impact on daily functioning, and the benefits of keeping the current treatment plan. Educating them can also make the woman feel more comfortable in her struggle with her decision. It is important to note that certain medications can pass through the placenta so if the patient decides to stop taking her ADHD medication during pregnancy and breastfeeding, she must be aware that the effects of the medication 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) grows there are concerns about what medication is given for adhd impact the medications could have on foetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge regarding this subject. Utilizing two huge 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, while the risk overall is low, first-trimester ADHD medication exposure was associated with slightly higher risk of certain heart defects, like ventriculoseptal defects.

The authors of the study found no connection between early use of medication and other congenital anomalies, such as facial clefting or club foot. The findings are in line with previous studies that have shown the presence of a small, but significant increase in the risk of heart malformations in women who started taking ADHD medications before the time of pregnancy. The risk was higher in the latter half of pregnancy, as many women are forced to stop taking their ADHD medication.

Women who were taking ADHD medication during the first trimester were more likely to need a caesarean or have a low Apgar after delivery, and have a baby that needed breathing assistance when they were born. The researchers of the study were not able to eliminate bias due to selection because they limited the study to women who did not have any other medical conditions that could have contributed to the findings.

Researchers hope that their study will help doctors when they encounter pregnant women. They advise that while discussing the risks and benefits is crucial, the decision to stop or keep medication must be based on each woman's requirements and the severity of her ADHD symptoms.

The authors also warn that while discontinuing the medications is an option, it isn't an option to consider due to the high prevalence of depression and other mental health problems among women who are pregnant or recently post-partum. Furthermore, research suggests that women who decide 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

It can be a challenge becoming a mother. Women with ADHD who have to manage their symptoms while attending doctor appointments and preparing for the arrival of a baby and adjusting to new household routines may face a lot of challenges. Many women decide to continue taking their ADHD medication during pregnancy.

The majority of stimulant medications are absorbed through breast milk in very small amounts, therefore the risk to breastfeeding infant is minimal. The amount of exposure to medications can vary depending upon the dosage, frequency of administration and time of day. In addition, individual medications enter the body of the baby differently through the gastrointestinal tract and breast milk, and the effect of this on a newborn infant is not fully understood.

Due to the absence of research, some physicians might be tempted to stop taking stimulant medication during the pregnancy of a woman. This is a difficult decision for the patient, who must weigh the benefits of continuing her medication against the possible dangers to the fetus. Until more information becomes available, GPs may inquire about pregnant patients whether they have an history of ADHD or if they intend to take medication for inattentive adhd during the perinatal stage.

A increasing number of studies have proven that women can continue taking their ADHD medication during pregnancy and breastfeeding. This has led to an increasing number of patients choose to do so, and after consulting with their doctor, they have found that the benefits of continuing their current medication exceed any risk.

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 advantages and disadvantages of continued treatment, including non-pharmacological strategies. Psychoeducation is also required to help pregnant women with ADHD recognize the signs and the underlying disorder. They should also be educated about treatment options and reinforce coping mechanisms. This should include an approach that is multidisciplinary, including the GP doctors, obstetricians and psychiatrists. Pregnancy counselling should include discussion of a management plan for both the mother as well as the child, and monitoring for signs of deterioration, and the need for adjustments to the medication regimen.