Why ADHD Medication Pregnancy Isn't A Topic That People Are Interested In ADHD Medication Pregnancy
Why ADHD Medication Pregnancy Isn't A Topic That People Are Interested In ADHD Medication Pregnancy
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ADHD Medication During Pregnancy and Breastfeeding
The choice of whether to stop or continue ADHD medication during pregnancy and nursing is challenging for women with the condition. Little data exists about how long-term exposure to these drugs may affect the foetus.
A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus do not develop neurological conditions like hearing or vision impairment seizures, febrile seizures or IQ impairment. The authors acknowledge that more high quality research is needed.
Risk/Benefit Analysis
Women who are pregnant and taking ADHD medications must weigh the advantages of using them against the risks to the foetus. Physicians do not have the necessary data to give clear guidelines but they can provide information on the risks and benefits to assist pregnant women in making informed decisions.
A study published in Molecular Psychiatry concluded that women who were taking ADHD medication during early pregnancy did not have a higher risk of fetal malformations, or structural birth defects. The researchers used a large population-based case-control study to determine the prevalence of major structural birth defects in babies born to mothers who had taken stimulants in early pregnancy, and those who did not. Clinical geneticists and pediatric cardiologists looked over the cases to ensure correct classification of the cases and to reduce the possibility of bias.
The study conducted by the researchers was not without its limitations. The researchers were unable, in the first place, to separate the effects caused by the medication from the disorder. This makes it difficult for researchers to establish whether the few associations observed between the groups that were exposed to medication use, or if they were confounded by the presence of comorbidities. The researchers did not examine long-term outcomes for offspring.
The study found that infants whose mothers took ADHD medication during pregnancy had a higher risk of admission to the neonatal care unit (NICU) as compared to mothers who didn't take any medication during pregnancy or stopped taking their medication before or during pregnancy. The reason for this was central nervous system disorders. The higher risk of admission was not affected by the stimulant medications used during pregnancy.
Women who took stimulant ADHD medications during pregnancy also had a higher risk of having a caesarean section or the baby was not scoring well on the Apgar scale (less than 7). These increases didn't appear to be affected by the type of medication that was used during pregnancy.
The researchers suggest that the risk of a small amount with the use of ADHD medications during early pregnancy may be offset by the greater benefits to both mother and child from continued treatment for the woman's disorder. Physicians should discuss the issue with their patients and, if possible, assist them in developing strategies to improve coping skills that can lessen the negative impact of her condition on her daily functioning and relationships.
Medication Interactions
As more women than ever before are being diagnosed with ADHD and treated with medication, the dilemma of whether to continue or stop treatment during pregnancy is a question that more and more doctors confront. These decisions are usually taken without clear and authoritative evidence. Instead, doctors have to weigh their own knowledge and experience, as well as the experiences of other doctors and the research on the topic.
Particularly, the issue of potential risks to the baby can be tricky. The research on this subject is based on observations rather than controlled studies, and the results are in conflict. In addition, most 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 discussed in this journal club addresses these limitations by looking at data from both live and deceased births.
The conclusion: While some studies have shown an association between ADHD medications and the risk of certain birth defects, others have not found any evidence of a link and the majority of studies show a neutral or even slightly negative effect. In all cases an in-depth analysis of the potential risks and benefits is required.
It can be challenging, if not impossible, for women with ADHD to stop taking their medication. In a recent piece published in Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can lead to depression and feelings of isolation. In addition, a decrease in medication can affect the ability to complete jobs and drive safely that are crucial aspects of daily life for many people with ADHD.
She suggests that women who are not sure whether to continue taking the medication or stop it due to their pregnancy educate family members, coworkers, and acquaintances about the condition, its effects on daily functioning, and the benefits of keeping the current treatment. It can also make the woman feel more comfortable in her struggle with her decision. Certain medications can be passed through the placenta. If a patient decides not to take her ADHD medication while breastfeeding, it is crucial to be aware that the drug may be transferred to her infant.
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 drugs could have on fetuses. A study that was published in the journal Molecular Psychiatry adds to the body of information on this topic. Researchers used two huge datasets to analyze more than 4.3 million pregnancy and determine if the use of stimulant medications caused birth defects. Researchers discovered that although the risk overall is low, first-trimester ADHD medication use was associated with slightly higher rates of specific heart defects such as ventriculoseptal defect.
The researchers behind the study found no link between early use of medication and other congenital anomalies, like facial clefting, or club foot. The results are in the same vein as previous studies that showed the existence of a slight, but significant increase in cardiac malformations for women who began taking ADHD medication prior to the time of pregnancy. The risk increased in the latter stages of pregnancy when many women decided to stop taking their medication.
Women who used ADHD medications during the first trimester of their pregnancies 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 researchers of the study were unable to eliminate bias due to selection by limiting the study to women who did not have any other medical issues that could have contributed to the findings.
Researchers hope that their study will provide doctors with information when they see pregnant women. They suggest that although discussing the risks and benefits is crucial however, the decision to stop or maintain medication should be based on the woman's needs and the severity of her ADHD symptoms.
The authors also caution that while discontinuing the medications is an option, it is not an option that is recommended due to the high prevalence of depression and other mental health issues among women who are pregnant or postpartum. Research has also shown that women who stop taking their medication will have a harder adjustment to life without them after the baby is born.
Nursing
It can be a challenge becoming a mother. Women with ADHD may face a lot of challenges when they must manage their symptoms, go to doctor appointments and prepare for the birth of a baby and adjust to new routines. Many women choose to continue taking their ADHD medication during pregnancy.
The majority of stimulant medicines pass through breast milk in low quantities, so the risk to the nursing infant is very low. However, the amount of exposure to medications by the infant can differ based on dosage, how often it is taken and the time of the day it is administered. In addition, individual 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 understood.
Due to the absence of evidence, some doctors might be tempted to stop taking stimulant medication during the pregnancy of a woman. This is a complicated decision for the patient, who must weigh the benefit of continuing her medication against the possible dangers to the embryo. Until more information becomes available, doctors can ask pregnant patients if they have a history of ADHD or if they plan to take medication during the perinatal period.
Numerous studies have proven that women can continue taking their ADHD medication without risk during pregnancy and while breast-feeding. In response, a growing number of patients are opting to do so. They have found after consulting with their doctor, that the benefits of continuing their current medication outweigh risk.
Women who suffer from ADHD who are planning to nurse should seek the advice of a specialist psychiatrist prior to becoming pregnant. They should discuss their medication with more info their physician and discuss the advantages and disadvantages of continued treatment, including non-pharmacological management strategies. Psychoeducation is also required to help pregnant women suffering from ADHD be aware of their symptoms and underlying disorder, learn about available treatment options and strengthen existing coping strategies. This should include a multidisciplinary approach with the GP as well as obstetricians, psychiatry and obstetricians. Pregnancy counseling should consist of a discussion of a treatment plan for the mother and child, and monitoring for indicators of deterioration, and, if needed modifications to the medication regime.