10 Things You Learned From Kindergarden They'll Help You Understand ADHD Medication Pregnancy
10 Things You Learned From Kindergarden They'll Help You Understand ADHD Medication Pregnancy
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ADHD Medication During Pregnancy and Breastfeeding
Women suffering from ADHD face a difficult decision on whether to keep or stop taking ADHD medication during pregnancy and breastfeeding. Little data exists about how long-term exposure to these medications may affect the fetus.
A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological issues such as hearing loss or vision, febrile seizures or IQ impairment. The authors acknowledge that more high-quality studies are needed.
Risk/Benefit Analysis
Pregnant women who use ADHD medications need to balance the benefits of taking them against the potential risks to the fetus. Physicians don't have the information needed to make unequivocal recommendations however they can provide information about risks and benefits that help pregnant women make informed choices.
A study published in Molecular Psychiatry found that women who were taking ADHD medications during their early pregnancy did not have a significantly increased risk of fetal heart malformations or major structural birth defects. Researchers conducted a massive population-based study of case control to examine the prevalence of structural defects that were major in infants born to mothers who took stimulants during pregnancy. Clinical geneticists and pediatric cardiologists looked over the cases to ensure accurate case classification and to minimize the possibility of bias.
The study of the researchers was not without limitations. Researchers were unable in the beginning to distinguish the effects triggered by the medication from the disorder. This makes it difficult to know whether the small associations observed in the exposed groups are due to medication use or confounding by comorbidities. Additionally the researchers did not look at the long-term effects of offspring on their parents.
The study found that infants whose mother took ADHD medication during pregnancy had a higher risk of admission to the neonatal care unit (NICU) as compared to those whose mothers didn't take any medication during pregnancy or stopped taking their medication before or during pregnancy. This was due to central nervous system disorders. The higher risk of admission was not influenced by the stimulant medications used during pregnancy.
Women who used stimulant ADHD medication during pregnancy also had an increased risk of having a caesarean delivery or having a baby born with low Apgar score (less than 7). These increases didn't seem to be influenced by the type of medication that was used during pregnancy.
The researchers suggest that the small risk associated with the use of ADHD medications during early pregnancy may be offset by the greater benefit to both the mother and child of continued treatment for the woman's disorder. Physicians should speak with their patients about this and, if possible, help them develop coping skills that could reduce the impact of her disorder in her daily life and relationships.
Medication Interactions
More and more doctors are confronted with the dilemma of whether to continue treatment or stop during pregnancy as more women are diagnosed with ADHD. The majority of these decisions are taken in the absence of solid and reliable evidence regardless, so doctors must weigh their knowledge from their own experiences, those of other doctors, and what research suggests on the subject and their best judgment for each individual patient.
In particular, the issue of potential risks for the baby can be tricky. The research on this subject is based on observation rather than controlled studies, and many of the findings are conflicting. In addition, most studies limit their analysis to live births, which can underestimate severe teratogenic effects that result in abortion or termination of the pregnancy. The study presented in the journal club addresses these shortcomings by analyzing data on live and deceased births.
Conclusion Some studies have shown a positive correlation between ADHD medications and certain birth defects however, other studies haven't shown such a relationship. Most studies show that there is a neutral, or slight negative effect. In all cases an in-depth analysis of the potential risks and benefits must be performed.
For many women with ADHD and ADD, the decision to discontinue medication is difficult, if not impossible. In an article published in the Archives of Women's Mental Health, psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can lead to increased depression, feelings of isolation, and family conflict for patients with ADHD. A loss of medication may also affect the ability to drive safely and perform work-related tasks, which are crucial aspects of everyday life for those suffering from ADHD.
She suggests that women who are unsure whether to continue taking medication or stop it due to their pregnancy should educate family members, coworkers and their friends about the condition, the effects on daily functioning, and the benefits of keeping the current treatment plan. Educating them can also help the woman feel supported when she is struggling with her decision. Certain medications can be passed through the placenta. If a woman decides not to take her ADHD medication while breastfeeding, it is crucial to be aware that the medication could be transferred to the infant.
Birth Defects and Risk of
As the use and abuse of ADHD medications to treat the symptoms of attention deficit disorder hyperactivity disorder (ADHD) increases as does the concern about the potential adverse effects of the drugs on the fetuses. A study that was published in the journal Molecular Psychiatry adds to the body of information on this topic. Researchers utilized two massive data sets to examine over 4.3 million pregnancies and determine whether stimulant medications increased the risk of birth defects. Researchers discovered that although the overall risk is low, the first trimester ADHD medication use was associated with slightly higher rates of specific heart defects like ventriculoseptal defects.
The researchers of the study could not find any association between early medication usage and other congenital anomalies such as facial deformities or club feet. The results are in the same vein as previous studies that showed a small, but significant increase in the number of cardiac malformations among women who began taking ADHD medication prior to the time of pregnancy. The risk increased in the latter part of pregnancy when many women began to stop taking their medication.
Women who used ADHD medication in the first trimester of their pregnancy were also more likely to have caesarean section, low Apgar score after delivery and a baby that required breathing assistance during birth. The authors of the study could not remove bias in selection since they limited their study to women with no other medical conditions that could have contributed to the findings.
Researchers hope their research will provide doctors with information when they meet pregnant women. They recommend that, while a discussion of risks and benefits is important however, the decision to stop or continue medication should be based on each woman's requirements and the severity of her ADHD symptoms.
The authors also advise that, while stopping the medication is an option, it is not an option that is recommended due to the high incidence of depression and other mental health problems among women who are pregnant or post-partum. Further, the research suggests that women who choose to stop taking their medications are more likely to experience a difficult time getting used to life without them after the birth of their baby.
Nursing
The responsibilities of a new mother can be overwhelming. Women who suffer from ADHD who have to deal with their symptoms while attending physician appointments, preparing for the arrival of a child and adjusting to new household routines may face a lot of challenges. Many women opt to continue taking their ADHD medication during pregnancy.
The majority of stimulant drugs are absorbed by breast milk in very small amounts, therefore the risk for breastfeeding infant is minimal. However, the rate of exposure to medication by the newborn may differ based on the dosage, frequency it is administered, and at what time it is administered. In addition, various medications enter the baby’s system through the gastrointestinal tract, non prescription adhd medication or through breast milk. The effect on a newborn's health is not fully comprehended.
Some doctors may decide to stop stimulant medications during a woman's pregnancy due to the absence of research. This is a difficult decision for the woman, who must weigh the advantages of continuing her medication against the potential risks to the embryo. Until more information is available, doctors should inquire with all pregnant patients about their history of ADHD and if they are taking or planning to take medication during the perinatal period.
Numerous studies have proven that women can continue taking their ADHD medication safely during pregnancy and while breast-feeding. This has led to many patients are choosing to do so and, in consultation with their doctor they have discovered that the benefits of continuing their current medication outweigh any risks.
It is essential for women with ADHD who are contemplating breastfeeding to seek a specialist psychiatrist's advice prior becoming pregnant. They should discuss their medication with their prescriber as well as the pros and cons of continuing treatment. This includes non-pharmacological methods. Psychoeducation is also required to help pregnant women with ADHD understand the symptoms and underlying disorder. They should also learn about treatment options and reinforce strategies for coping. This should be an approach that is multidisciplinary, including the GP doctors, obstetricians and psychiatrists. Pregnancy counseling should consist of a discussion of a treatment plan for the mother and the child, as well as monitoring for signs of deterioration, and, if needed modifications to the medication regimen.