How To Beat Your Boss On ADHD Medication Pregnancy
ADHD Medication During Pregnancy and BreastfeedingThe decision to stop or keep ADHD medications during breastfeeding and pregnancy is a difficult decision for women suffering from the condition. Little data exists about how long-term exposure to these medications may affect the foetus.
A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus do not develop neurological developmental conditions like hearing loss or impaired vision seizures, febrile seizures, or IQ impairment. The authors acknowledge that more high-quality studies are required.
Risk/Benefit Analysis
Women who are expecting and taking ADHD medication need to weigh the benefits of taking it against the possible dangers for the fetus. Physicians don't have the data to make unambiguous recommendations, but can provide information on risks and benefits to assist pregnant women to make an informed decision.
A study published in Molecular Psychiatry found that women who were taking ADHD medications during early pregnancy did not face an higher risk of fetal cardiac malformations or major birth defects that are structural. Researchers used a large sample-based case control study to compare the incidence of major structural defects in infants born to mothers who took stimulants during pregnancy. Clinical geneticists and pediatric cardiologists looked over the cases to ensure an accurate classification of the cases and to reduce 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 the effects of the disorder that is underlying. This makes it difficult to determine whether the small differences observed in the exposed groups are due to the use of medication or confounding by comorbidities. In addition the researchers did not look at long-term offspring outcomes.
The study did show that infants whose mothers had taken ADHD medications during pregnancy were at a slightly more risk of being admitted to the neonatal intensive care unit (NICU) than infants who were born without any medication or had cut back on their medications prior to or during pregnancy. This increase was due to central nervous system-related disorders, and the higher risk of admission did not appear to be influenced by the stimulant medications were used during pregnancy.
Women who were taking stimulant ADHD medication during pregnancy also had an elevated risk of having a caesarean section or having a baby with an low Apgar score (less than 7). These increases 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 early pregnancy could be offset by the higher benefit to both mother and child from continued treatment for the woman's disorder. Physicians should discuss this with their patients and, where possible, assist them in developing strategies to improve their coping abilities which can reduce the negative impact of her condition on her daily life and relationships.
Medication Interactions
Many doctors are confronted with the dilemma of whether to keep treatment or stop during pregnancy as more women are diagnosed with ADHD. Often, these decisions are made without any evidence that is clear and definitive regardless, so doctors have to weigh their experience from their own experiences, those of other doctors, and what the research says on the topic and their own judgments for each individual patient.
The issue of potential risks for infants can be difficult to determine. Many studies on this issue are based on observations instead of controlled research and their findings are often contradictory. Furthermore, most studies restrict their analysis to live births, which could 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 limitations by examining data on both live and deceased births.
Conclusion Some studies have revealed a positive correlation between ADHD medications and certain birth defects However, other studies haven't established a link. The majority of studies show an unintended, or somewhat negative, effect. In all cases, a careful analysis of the risks and benefits must be performed.
It can be challenging, if not impossible for women suffering from ADHD to stop taking their medication. In fact, in an article published in Archives of Women's Mental Health psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can increase depression, feelings of isolation and family conflict for patients with ADHD. A decrease in medication could also affect the ability to drive safely and perform work-related tasks, which are vital aspects of normal life for those with ADHD.
She suggests women who are uncertain about whether to continue or stop taking medication because of their pregnancy should consider the possibility of educating friends, family members, and coworkers on the condition, its impact on daily life, and the advantages of staying on the current treatment plan. It can also help women feel supported in her decision. Some medications can pass through the placenta. If the patient decides to stop taking her ADHD medication while pregnant and breastfeeding, it is important to be aware that the medication may be transferred to her baby.
Birth Defects and Risk of
As the read more use of ADHD medications to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases, so do concerns about what impact the drugs might have on fetuses. A recent study published in the journal Molecular Psychiatry adds to the existing information on this topic. Using two massive data sets researchers were able look at more than 4.3 million pregnancies and see whether the use of stimulant medications increased the risk of birth defects. Although the risk overall remains low, the scientists discovered that the first-trimester exposure to ADHD medications was associated with an increased risk of certain heart defects like ventriculo-septal defects (VSD).
The researchers behind the study found no link between the use of early medications and congenital abnormalities like facial clefting, or club foot. The results are consistent with previous studies showing the presence of a small, but significant increase in the risk of heart 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 lot of women decided to stop taking their medication.
Women who were taking ADHD medication during the first trimester were more likely need a caesarean, have an insufficient Apgar after delivery and have a baby who needed breathing assistance after birth. The authors of the study were not able to eliminate selection bias because they limited their study to women without other medical conditions that might have contributed to the findings.
Researchers hope that their research will provide doctors with information when they see pregnant women. The researchers recommend that, while discussing risks and benefits are important, the decision on whether to continue or stop taking medication should be in light of the severity of each woman's ADHD symptoms and her requirements.
The authors warn that, although stopping the medication is an option to look into, it is not recommended because of the high incidence of depression and other mental problems in women who are expecting or who have recently given birth. Further, the research suggests that women who choose to stop taking their medication are more likely to have difficulties adjusting to life without them after the birth of their baby.
Nursing
It can be a challenge to become a mother. Women with ADHD may face a lot of 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 drugs are absorbed by breast milk in low amounts, so the risk to infant who is breastfeeding is low. However, the amount of exposure to medication by the newborn can vary depending on dosage, how often it is taken and the time of day it is administered. Additionally, different medications are introduced into the baby's system through the gastrointestinal tract or breast milk. The effect on the health of a newborn is not completely known.
Because of the lack of research, some physicians may be inclined to discontinue stimulant drugs during the pregnancy of a woman. This is a difficult decision for the woman who must weigh the advantages of taking her medication as well as the risk to the foetus. In the meantime, until more information is available, GPs should ask all pregnant patients about their experience with ADHD and whether they are planning or taking to take medication during the perinatal time.
A growing number of studies have shown that women can continue their ADHD medication during pregnancy and breastfeeding. In response, an increasing number of patients are opting to do this. They have concluded through consultation with their doctors that the benefits of retaining their current medication outweigh possible risks.
It is essential for women with ADHD who are considering breastfeeding to seek a specialist psychiatrist's advice prior becoming pregnant. They should discuss the medication they are taking with their physician and discuss the pros and cons for continuing treatment. This includes non-pharmacological strategies. Psychoeducation should also be offered to help pregnant women suffering from ADHD understand their symptoms and the underlying disorder and learn about treatment options and reinforce existing strategies for managing. This should be a multidisciplinary process including obstetricians, GPs, and psychiatrists. Pregnancy counselling should include discussion of a management plan for both the mother as well as the child, monitoring for signs of deterioration, and when necessary, making adjustments to the medication regimen.