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ADHD Medication During Pregnancy and Breastfeeding
The decision to stop or keep ADHD medication during breastfeeding and pregnancy is challenging for women with the condition. Little data exists about how long-term exposure to these drugs could 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 impaired hearing or vision, 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 need to balance the advantages of taking them against potential risks to the fetus. Doctors don't have the information needed to make unequivocal recommendations however they can provide information on benefits and risks that can aid pregnant women in making informed choices.
A study published in Molecular Psychiatry concluded that women who were taking ADHD medication in early pregnancy were not at greater risk of fetal malformations, or structural birth defects. Researchers conducted a large population-based study of case-control to evaluate the incidence of major structural birth defects in babies born to mothers who took stimulants during early pregnancy and those who had not. Clinical geneticists and pediatric cardiologists reviewed the cases to ensure accurate case classification and to minimize the chance of bias.
However, the study was not without its flaws. In particular, they were not able to differentiate the effects of the medication from the disorder that is underlying. This limitation makes it difficult for researchers to determine whether the few associations observed between the exposed groups were due to medication use or if they were confounded by the presence of comorbidities. The researchers also did not study the long-term effects for the offspring.
The study did find that infants whose mothers took ADHD medication during pregnancy were at slightly higher risk of being admitted to the neonatal intensive care unit (NICU) than those who were born without any medication or had cut back on their medications prior to 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 took stimulant ADHD medication during pregnancy were also at an elevated chance of having a caesarean birth or having a baby born with a low Apgar score (less than 7). These increases did not appear to be influenced by the kind of medication used during pregnancy.
The researchers suggest that the low risk associated with the use of ADHD medications during the early stages of pregnancy may be offset by the greater benefits for both mother and child from continued treatment for the woman's condition. Physicians should speak with their patients about this issue and as much as possible, assist them develop coping strategies that may reduce the effects of her disorder on her daily functioning and her relationships.
Interactions with Medication
As more women than ever are being diagnosed with ADHD and treated with medication, the issue of whether to continue or end treatment during pregnancy is one that more and more physicians confront. adult add medication are often taken without clear and authoritative evidence. Instead, physicians must weigh their own knowledge, the experience of other physicians and the research on the subject.
The issue of risk for infants can be difficult to determine. Many of the studies on this topic are based on observational evidence instead of controlled research and their findings are often contradictory. The majority of studies focus on live-births, which could underestimate the teratogenic impact that can lead to terminations or abortions of pregnancy. The study discussed in the journal club addresses these limitations, by examining both the data from deceased and live births.
The conclusion: While certain studies have demonstrated an association between ADHD medications and the risk of certain birth defects, other studies have not found any evidence of a link and the majority of studies demonstrate a neutral or slightly negative effect. In every case an in-depth study of the benefits and risks is required.
It can be difficult, if not impossible for women with ADHD to stop taking their medication. 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 cause depression, feelings of loneliness, and family conflict for those suffering from the disorder. A loss of medication may also impact the ability to drive safely and to perform work-related tasks which are vital aspects of daily life for those suffering from ADHD.
She suggests that women who are unsure whether to continue taking the medication or stop due to pregnancy, educate their family members, colleagues, and their friends about the condition, its effects on daily functioning, and the advantages of staying on the current treatment regimen. It can also help a woman feel more confident in her decision. It is important to remember that certain medications are able to be absorbed through the placenta therefore, if a patient decides to discontinue her ADHD medication during pregnancy and breastfeeding, she must be aware that traces of the drug could be passed on to the baby.
Risk of Birth Defects
As the use of ADHD medication to treat the symptoms of attention deficit hyperactivity disorder (ADHD) grows, so do concerns about the effects that the drugs could have on foetuses. A study that was published in the journal Molecular Psychiatry adds to the body of information on this topic. With two massive data sets, researchers were able to examine more than 4.3 million pregnancies to determine whether stimulant medications increased the risk of birth defects. Although the risk overall remains low, the researchers discovered that the first-trimester exposure to ADHD medications was associated with a slightly higher rate of specific heart defects, such as ventriculoseptal defect (VSD).
The researchers of the study found no association between early medication use and other congenital abnormalities, such as facial clefting or club foot. The results are in the same vein as previous studies that have shown the existence of a slight, but significant increase in cardiac malformations for women who started taking ADHD medication prior to the time of the birth of their child. This risk increased during the latter part of pregnancy when a large number of women stopped taking their medication.
Women who took ADHD medication in the first trimester of their pregnancy were also more likely to experience caesarean section, low Apgar score after delivery and a baby who required breathing assistance during birth. The researchers of the study could not eliminate selection bias because they limited the study to women without other medical conditions that might have contributed to the findings.
The researchers hope their research will aid in the clinical decisions of physicians who see pregnant women. They suggest that although a discussion of risks and benefits is important however, the decision to stop or keep treatment should be based on the woman's needs and the severity of her ADHD symptoms.
The authors caution that, even though stopping the medication is a possibility to consider, it is not advised due to the high rate depression and mental health issues in women who are expecting or have recently given birth. Additionally, research suggests that women who stop taking their medication will have a difficult adjustment to life without them once the baby is born.
Nursing
The responsibilities of a new mother can be overwhelming. Women who suffer from ADHD who have to manage their symptoms while attending physician appointments as well as preparing for the arrival of a child and adapting to new routines in the home are often faced with a number of difficulties. As such, many women elect to continue taking their ADHD medications throughout the course of pregnancy.
The majority of stimulant medications pass through breast milk in low amounts, so the risk to the nursing infant is very low. However, the frequency of medication exposure to the newborn can vary depending on dosage, frequency it is administered and at what time it is administered. Additionally, different medications enter the infant's system differently through the gastrointestinal tract and breast milk and the impact of this on a newborn infant is not yet fully known.
Some doctors may decide to stop stimulant medications during a woman's pregnancy due to the absence of research. This is a complicated decision for the patient, who must weigh the benefits of continuing her medication against the potential dangers to the foetus. Until more information is available, doctors should inquire with all pregnant patients about their experience with ADHD and if they are taking or planning to take medication during the perinatal period.
A increasing number of studies have shown that women can continue taking their ADHD medication during pregnancy and while breastfeeding. In response, an increasing number of patients are choosing to continue their medication. They have discovered through consultation with their doctor, that the benefits of retaining their current medication far 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 review their medications with their prescriber and discuss the pros and cons of continued treatment, including non-pharmacological strategies. Psychoeducation should also be provided to help pregnant people with ADHD be aware of their symptoms and the root cause, learn about available treatment options and strengthen existing coping strategies. This should be a multidisciplinary approach with the GP doctors, obstetricians and psychiatrists. Pregnancy counseling should include a discussion of a treatment plan for the mother and child, as well as monitoring for indicators of deterioration, and, if needed adjustments to the medication regimen.
Here's my website: https://www.iampsychiatry.uk/adult-adhd-medication/
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