ADHD Medication Pregnancy: 10 Things I'd Love To Have Known Sooner

ADHD Medication During Pregnancy and Breastfeeding

The decision to stop or continue ADHD medication during pregnancy and nursing is a difficult decision for women suffering from the condition. There are few data regarding how exposure over time may affect the fetus.

A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication in utero do not develop neurological developmental disorders such as 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 need to balance the advantages of taking them against potential risks to the foetus. The doctors don't have the information to give clear advice however they can provide information about risks and benefits to help pregnant women make informed choices.

A study published in Molecular Psychiatry concluded that women who took ADHD medication during early pregnancy did not have a greater risk of fetal malformations or structural birth defects. 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. Clinical geneticists and pediatric cardiologists examined the cases to ensure accurate case classification and to minimize the possibility of bias.

However, the study had its limitations. Most important, they were unable to distinguish the effects of the medication from the disorder at hand. This makes it difficult for researchers to establish whether the few associations observed between the groups that were exposed to the use of medications or confounded by co-morbidities. Additionally the study did not study the long-term effects of offspring on their parents.

The study did find that babies whose mothers had taken ADHD medications during pregnancy were at a slightly greater risk of being admitted to the neonatal intensive care unit (NICU) than those who whose mothers did not take any medication or had stopped their medications before or during pregnancy. This was due to central nervous system disorders. The increased risk of admission was not influenced by the stimulant medication that was used during pregnancy.

Women who were taking stimulant ADHD medications during pregnancy also had a higher likelihood of having a caesarean section or the baby was not scoring well on the Apgar scale (less than 7). These risks did not appear to be affected by the type of medication that was used during pregnancy.

The research suggests that the risk of a small amount with the use of ADHD medications during early pregnancy could be offset by the higher benefit to both the 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 for improving their coping skills which can reduce the effects of her disorder on her daily functioning and relationships.

Interactions with Medication

More and more doctors are confronted with the dilemma of whether to maintain treatment or stop during pregnancy as more women are diagnosed with ADHD. These decisions are frequently taken without clear and authoritative evidence. Instead, physicians must weigh their own knowledge, the experience of other doctors and the research that has been conducted on the subject.

In particular, the issue of potential risks for the baby can be a challenge. Many studies on this issue 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 may undervalue the serious teratogenic effects that can lead to abortion or termination of the pregnancy. The study that is discussed in the journal club addresses these limitations by analyzing the data from deceased and live births.

The conclusion: While some studies have found that there is a positive correlation between ADHD medications and the risk of certain birth defects, other studies have found no connection and the majority of studies have a neutral or slightly negative effect. Therefore an accurate risk-benefit analysis is required in every case.

For a lot of women with ADHD, the decision to discontinue medication can be difficult, if not impossible. In fact, in an article published in the 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. Additionally, the loss of medication can affect the ability to do jobs and drive safely, which are important aspects of daily life for a lot of people with ADHD.

She suggests that women who are not sure whether to take the medication or stop it due to their pregnancy should educate family members, coworkers, and acquaintances about the condition, the impact on daily functioning and the advantages of staying on the current treatment plan. It can also help a woman feel more confident in her decision. It is important to remember that some medications are able to be absorbed through the placenta therefore, if a patient decides to stop her ADHD medication during pregnancy and breastfeeding, she should be aware that traces of the drug could be transferred to the infant.

Risk of Birth Defects

As the use and use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases the concern over the potential adverse effects of the drugs on fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge on this topic. With two massive data sets researchers were able to analyze more than 4.3 million pregnancies to determine whether stimulant medications increased the risk of birth defects. Although  add medication adults  remains low, the scientists discovered that the first-trimester exposure 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 found no association between the use of early medications and congenital abnormalities like facial clefting, or club foot. The results are consistent with previous studies showing a small but significant increase in the risk of heart malformations among women who started taking ADHD medications prior to pregnancy. This risk increased in the later part of pregnancy, as many women decide to stop taking their medication.

Women who took ADHD medications in the first trimester of their pregnancies were also more likely to undergo caesarean section, low Apgar score after delivery and a baby who required breathing assistance at birth. The researchers of the study could not eliminate selection bias because they restricted the study to women with no other medical conditions that could have contributed to the findings.

Researchers hope that their study will help doctors when they encounter pregnant women. The researchers recommend that, while discussing the risks and benefits are important, the choice regarding whether or not to stop medication should be made according to the severity of each woman's ADHD symptoms and her requirements.

The authors warn that, while stopping the medication is an option to think about, it isn't recommended due to the high prevalence of depression and other mental problems in women who are expecting or who have recently given birth. Further, research shows that women who stop taking their medication will have a tough transitioning to life without them once the baby is born.

Nursing

It can be a stressful experience becoming a mother. Women with ADHD who have to manage their symptoms while attending physician appointments and getting ready for the arrival of a child and getting used to new routines at home are often faced with a number of difficulties. This is why many women decide to continue taking their ADHD medications throughout pregnancy.

The risk for nursing infant is low because the majority of stimulant medications passes through breast milk in low amounts. However, the amount of exposure to medication by the infant can differ based on the dosage, frequency it is taken and the time of day the medication is administered. Additionally, different medications enter the baby's system differently through the gastrointestinal tract and breast milk and the impact of this on a newborn infant is not fully known.

Due to the absence of research, some doctors might be tempted to stop taking stimulant drugs during the pregnancy of a woman. This is a complicated decision for the patient, who must weigh the benefits of keeping her medication against the possible risks to the fetus. In the meantime, until more information is available, doctors should ask all pregnant patients about their experience with ADHD and whether they are taking or planning to take medication during the perinatal period.

A growing number of studies have revealed that the majority of women are able to safely continue their ADHD medication while they are pregnant and nursing. 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 far exceed any risk.

Women who suffer from ADHD who plan to breastfeed should seek the advice of a specialist psychiatrist prior to becoming pregnant. They should discuss the medication they are taking with their physician as well as the pros and cons for continuing treatment. This includes non-pharmacological strategies. Psychoeducation should also be offered to help pregnant women suffering from ADHD recognize their symptoms and the underlying disorder and learn about treatment options and strengthen existing strategies for managing. This should include a multidisciplinary approach, which includes the GP, obstetricians and psychiatry. Counselling for pregnancy should include discussion of a management plan for both mother and child, monitoring for signs of deterioration and when necessary, making adjustments to the medication regimen.