The 10 Scariest Things About ADHD Medication Pregnancy
The 10 Scariest Things About ADHD Medication Pregnancy
Blog Article
ADHD Medication During Pregnancy and Breastfeeding
The decision to stop or continue ADHD medication during pregnancy and nursing is challenging for women with the condition. There are few data regarding how exposure over time may affect a pregnant fetus.
A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus don't develop neurological developmental disorders such as impaired vision or hearing seizures, febrile seizures, or IQ impairment. The authors acknowledge that more high-quality research is needed.
Risk/Benefit Analysis
Women who are expecting and taking ADHD medication should weigh the benefits of taking it versus the dangers for the baby. Physicians don't have the data to provide clear recommendations but they can provide information on the risks and benefits to aid pregnant women in making an informed decision.
A study published in Molecular Psychiatry concluded that women who were taking ADHD medication during early pregnancy were not at a higher risk of fetal malformations, or structural birth defects. The researchers used a large population-based case-control study to assess the risk of major structural birth defects in babies born to mothers who had taken stimulants during early pregnancy, as well as those who had not. Clinical geneticists, pediatric cardiologists and other experts looked over the cases to ensure that the classification was accurate and to eliminate any bias.
However, the study had its limitations. The researchers were unable to, in the first place to differentiate the effects of the medication from the disorder. That limitation makes it difficult to know whether the limited associations observed in the exposed groups are due to medication use or comorbidities that cause confusion. Additionally the study did not look at the long-term outcomes of offspring.
The study revealed that infants whose mother had taken ADHD medication during pregnancy were at a slightly higher chance of being admitted to the neonatal care unit (NICU) in comparison to mothers who did not take any medication during pregnancy, or had discontinued taking their medication prior to or during pregnancy. This increase was caused by central nervous system disorders. The higher 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 chance of having a caesarean delivery or having a baby born with low Apgar score (less than 7). These increases appear to be unrelated to the type of medication taken during pregnancy.
Researchers suggest that the small risk of using ADHD medication during pregnancies in the early stages may be offset by the greater benefits for baby and mother of continued treatment for the woman's condition. Physicians should discuss the issue with their patients and, if possible, assist them in developing strategies for improving their coping skills which can reduce the effects of her disorder on her daily life and relationships.
Medication Interactions
As more women than ever are diagnosed with ADHD and treated with medication, the dilemma of whether to continue or discontinue treatment during pregnancy is one that doctors are having to have to face. The majority of these decisions are taken in the absence of any evidence that is clear and definitive regardless, so doctors must weigh their knowledge about their experiences, the experiences of other doctors, and what research suggests about the subject, along with their own best judgment for each patient.
The issue of potential risks to the infant can be particularly tricky. Many studies on this issue are based on observations instead of controlled research and their conclusions are often contradictory. Most studies restrict their analysis to live-births, which could underestimate the teratogenic impact that can lead to terminations or abortions of pregnancy. The study discussed in the journal club addresses these shortcomings, by examining both information on deceased and live births.
The conclusion: While some studies have shown a positive association between ADHD medications and the possibility of certain birth defects, other studies have found no connection and the majority of studies have a neutral or slight negative effect. As a result, a careful risk/benefit assessment must be done in each case.
It can be challenging, if not impossible for women with ADHD to stop taking their medication. In a recent article published in Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can increase depression and feelings of loneliness. The loss of medication can also affect the ability to drive safely and to perform work-related tasks which are vital aspects of everyday life for people with ADHD.
She suggests that women who are not sure whether to continue taking the medication or stop due to pregnancy should educate family members, coworkers, and their friends about the condition, its effects on daily functioning, and the benefits of keeping the current treatment plan. It can also help women feel supported in her decision. It is important to note that some medications can pass through the placenta, so if the patient decides to discontinue her ADHD medication during pregnancy and breastfeeding, she must be aware that the effects of the drug could be transferred to the child.
Risk of Birth Defects
As the use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases as do concerns about the effects that the medications could have on fetuses. Recent research published in the journal Molecular Psychiatry has added to the body knowledge on this topic. Using two massive data sets researchers were able analyze more than 4.3 million pregnancies and determine whether stimulant medications increased the risk of birth defects. Although the risk overall is low, the researchers found that exposure in the first trimester to ADHD medications was associated with an increase in the risk of certain heart defects such as ventriculoseptal defect (VSD).
The researchers of the study found no connection between early medication use and congenital abnormalities like facial clefting, or club foot. The findings are in line with previous studies that have shown an increase, but not significant, in the risk of developing cardiac malformations in women who started taking ADHD medications prior to the time of pregnancy. The risk increased in the latter part of pregnancy when a large number of women decided to stop taking their medication.
Women who took ADHD medication in the first trimester of pregnancy were also more likely to have a caesarean section, a low Apgar score after delivery and a baby who required breathing assistance at birth. However the authors of the study were unable to eliminate selection adhd medication adults uk bias by restricting the study to women who did not have other medical issues that could have contributed to the findings.
Researchers hope that their research will inform physicians when they meet pregnant women. They suggest that although the discussion of the risks and benefits is crucial but the decision to stop or keep treatment should be based on the woman's needs and the severity of her ADHD symptoms.
The authors also caution that, while stopping the medication is an option, it is not a recommended practice because of the high rate of depression and other mental health problems for women who are expecting or who are recently post-partum. Research has also shown that women who stop taking their medication will have a tough time adjusting to a life without them after the baby is born.
Nursing
The responsibilities of being a new mother can be overwhelming. Women suffering from ADHD are often faced with a number of difficulties when they must manage their symptoms, attend doctor appointments, prepare for the birth of their child and adjust to a new routine. Many women opt to continue taking their ADHD medication during pregnancy.
The risk to a breastfeeding infant is minimal because the majority of stimulant medications passes through breast milk at low levels. The rate of medication exposure will differ based on dosage and frequency of administration as well as the time of the day. In addition, individual medications enter the body of the baby differently through the gastrointestinal tract and breast milk. The impact of this on a newborn infant is not fully known.
Some physicians may discontinue stimulant medications during a woman's pregnancy due to the absence of research. This is a complicated decision for the patient, who must balance the benefits of keeping her medication against the possible risks to the fetus. In the meantime, until more information is available, doctors can inquire about pregnant patients whether they have any history of ADHD or if they intend to take medication during the perinatal stage.
A increasing number of studies have shown that women can continue taking their ADHD medication during pregnancy and breastfeeding. As a result, more and more patients are choosing to do so and after consulting with their doctor, they have found that the benefits of maintaining their current medication outweigh any potential risks.
Women who suffer from ADHD who are planning to nurse should seek advice from a specialist psychiatrist before becoming pregnant. They should discuss their medication with their doctor as well as the pros and cons for continuing treatment. This includes non-pharmacological strategies. Psychoeducation is also required to help pregnant women suffering from ADHD recognize their symptoms and the root cause Learn about the available treatments and to reinforce existing strategies for managing. This should be a multidisciplinary process with the GPs, obstetricians, and psychiatrists. Pregnancy counseling should include discussion of a treatment plan for the mother and child, and monitoring for indicators of deterioration, and, if needed, adjustments to the medication regimen.