What's The Most Creative Thing Happening With ADHD Medication Pregnancy

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 isn't much information on how long-term exposure to these medications can affect the fetus.

A recent study published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological problems like hearing loss or vision, febrile seizures or IQ impairment. The authors acknowledge the need for higher-quality studies.

Risk/Benefit Analysis

Women who are pregnant and taking ADHD medication must consider the benefits of taking it against the possible dangers for the baby. The doctors don't have the information to make unambiguous recommendations, but can provide information on risks and benefits to aid pregnant women in making informed decisions.

I Am Psychiatry  published in Molecular Psychiatry found that women who took ADHD medications during early pregnancy did not have an higher risk of fetal cardiac malformations or major structural birth defects. Researchers conducted a massive sample-based case control study to assess the frequency of structural defects that were major in infants who were born to mothers who used stimulants during pregnancy. Pediatric cardiologists, clinical geneticists and other experts looked over the cases to ensure that the classification was correct and to eliminate any bias.

The research conducted by the researchers had some limitations. Researchers were unable in the beginning to differentiate the effects of the medication from the disorder. This makes it difficult for researchers to determine if the small differences observed between the groups exposed were due to the use of medication or if they were caused by comorbidities. Additionally, the researchers did not look at the long-term outcomes of offspring.

The study showed that infants whose mother had taken ADHD medication during pregnancy had a slightly higher chance of being admitted to the neonatal care unit (NICU), compared to mothers who did not use any medication during pregnancy or had discontinued taking their medication prior to or during pregnancy. The reason for this was central nervous system-related disorders, and the higher risk of admission did not appear to be influenced by which stimulant medication was used during pregnancy.

Women who took stimulant ADHD medication during pregnancy were also at an increased risk of having a caesarean delivery or having a baby born with an low Apgar score (less than 7). These increases did appear to be independent of the type of medication taken during pregnancy.

The researchers suggest that the risk of a small amount with the use of ADHD medications during the early stages of pregnancy could be offset by the greater benefits for both mother and child from continued treatment for the woman's condition. Physicians should discuss the issue with their patients and, when they are able, assist them in developing strategies for improving their coping skills which can reduce the negative impact of her condition on her daily life and relationships.

Interactions with Medication

As more women than ever are diagnosed with ADHD and being treated with medication, the question of whether to continue or end treatment during pregnancy is a question that more and more physicians confront. Most of the time, these decisions are made in the absence of any evidence that is clear and definitive regardless, so doctors must weigh their knowledge from their own experiences, those of other doctors, and what research suggests on the subject, along with their own judgments for each patient.

Particularly, the issue of potential risks to the infant can be difficult. Many studies on this subject are based on observational evidence instead of controlled research and their findings are often contradictory. Additionally, the majority of studies limit their analysis to live births, which can underestimate the severity of teratogenic effects that could lead to abortion or termination of the pregnancy. The study that is discussed in this journal club addresses these shortcomings by examining data on both live and deceased births.

The conclusion: While some studies have found an association between ADHD medications and the risk of certain birth defects, others have found no connection and the majority of studies demonstrate a neutral or slightly negative impact. In the end, a careful risk/benefit assessment must be done in each case.

It can be difficult, if not impossible, for women suffering from 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. In addition, a decrease in medication can interfere with the ability to do jobs and drive safely that are crucial aspects of a normal life for a lot of people with ADHD.

She suggests women who are uncertain about whether or not to stop taking medication because of their pregnancy, consider the possibility of educating friends, family members, and coworkers on the condition, its effects on daily functioning, and on the advantages of staying on the current treatment plan. In addition, educating them can aid in ensuring that the woman feels supported in her struggle with her decision. It is also worth noting that certain medications are able to pass through the placenta so if a woman decides to stop taking 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 medication to treat the symptoms of attention deficit hyperactivity disorder (ADHD) grows as do concerns about the effects that the medications could have on fetuses. A recent study published in the journal Molecular Psychiatry adds to the body of knowledge about this subject. Using two massive data sets, researchers were able to examine more than 4.3 million pregnancies and determine whether the use of stimulant medications increased the risk of birth defects. While the overall risk remains low, the scientists found that exposure in the first trimester to ADHD medicines was associated with a slightly higher rate of specific heart defects, such as ventriculo-septal defect (VSD).

The researchers of the study did not discover any connection between early medication usage and other congenital anomalies, like facial deformities, or club feet. The findings are in line with previous studies showing a small but significant increase in the risk of heart malformations in women who started taking ADHD medications prior to the time of the time of pregnancy. 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 medications in the first trimester of their pregnancy were also more likely to undergo caesarean sections, a low Apgar score following delivery, and a baby that required breathing assistance at birth. The authors of the study were unable to eliminate selection bias because they limited their study to women who did not have any other medical conditions that could have contributed to the findings.

Researchers hope that their research will provide doctors with information when they meet pregnant women. The researchers advise that while discussing risks and benefits are crucial, the decision regarding whether or not to stop medication should be made based on the severity of each woman's ADHD symptoms and her requirements.

The authors also advise that while discontinuing the medications is an option, it isn't an option to consider due to the high rate of depression and other mental health issues for women who are expecting or who are recently postpartum. Further, research shows that women who stop taking their medication will have a difficult transitioning to life without them after the baby is born.

Nursing

The responsibilities that come with being a new mother can be overwhelming. Women suffering from ADHD are often faced with a number of difficulties when they have to manage their symptoms, go to doctor appointments, prepare for the birth of a child and adjust to a new routine. As such, many women elect to continue taking their ADHD medications throughout the course of pregnancy.

The risk for breastfeeding infant is not too high since the majority of stimulant medication is absorbed through breast milk at low levels. The rate of medication exposure will vary based on the dosage, frequency of administration and time of day. In addition, individual medications enter the infant's system differently through the gastrointestinal tract as well as breast milk and the impact of this on a newborn isn't yet fully understood.

Because of the lack of evidence, some doctors may be inclined to discontinue stimulant drugs during the course of pregnancy. It is a difficult decision for the woman who must weigh the advantages of continuing her medication against the potential risks to the fetus. In the meantime, until more information is available, GPs may inquire about pregnant patients if they have a background of ADHD or if they plan to take medication during the perinatal stage.

Numerous studies have proven that women can continue to take their ADHD medication in a safe manner during pregnancy and breast-feeding. This has led to more and more patients choose to do so, and in consultation with their physician, they have found that the benefits of continuing their current medication outweigh any potential risks.

Women with ADHD who are planning to nurse should seek the advice of an expert psychiatrist prior to becoming pregnant. They should discuss their medication with their prescriber, and the pros and cons of continuing treatment. This includes non-pharmacological strategies. Psychoeducation is also required to help pregnant women with ADHD recognize the signs and underlying disorder. They should also learn about treatment options and strengthen the coping mechanisms. This should be a multidisciplinary process together with obstetricians, GPs, and psychiatry. Pregnancy counseling should include discussion of a treatment plan for the mother as well as the child, and monitoring for signs of deterioration and, if necessary modifications to the medication regime.