ADHD Medication During Pregnancy and Breastfeeding

Women with ADHD face a difficult decision on whether to keep or stop taking ADHD medication during pregnancy and breast-feeding. There aren't enough data on how exposure to ADHD for a long time could affect a foetus.

A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication in utero do not develop neurological disorders such as 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 take ADHD medication need to evaluate the benefits of using it against the possible dangers for the baby. Physicians don't have the necessary data to provide clear recommendations but they can provide information about risks and benefits that aid pregnant women in making informed decisions.

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 massive population-based study of case control to assess the frequency of major structural defects in infants born to mothers who were taking stimulants during pregnancy. Clinical geneticists, pediatric cardiologists and other experts reviewed the cases in order to ensure that the classification was accurate and to eliminate any bias.

The study conducted by the researchers had some limitations. The researchers were unable in the beginning, to separate the effects triggered by the medication from the disorder. This makes it difficult for researchers to determine whether the small associations observed among the groups exposed were due to the use of medication or confounded by co-morbidities. In addition, the researchers did not examine long-term offspring outcomes.

The study did reveal that infants whose mothers took ADHD medications during pregnancy were at a more risk of being admitted to the neonatal intensive care unit (NICU) than infants whose mothers had not taken any medication or had stopped their medications before or during pregnancy. This increase was caused by central nervous system disorders. The higher risk of admission was not influenced by the stimulant medication used during pregnancy.

Women who took stimulant ADHD medications during pregnancy also had a higher risk of having a caesarean section or one whose baby scored low on the Apgar scale (less than 7). These increases did appear to be independent of the type of medication taken during pregnancy.

Researchers suggest that the small risk of using ADHD medications during early pregnancies could be offset by the more beneficial outcomes for both baby and mother of continued treatment for the woman's condition. Physicians should discuss the issue with their patients and, where possible, assist them in developing strategies to improve coping skills that may minimize the impact of her disorder on her daily functioning and relationships.

Medication Interactions

Many doctors are confronted with the dilemma of whether to keep treatment or stop it during pregnancy as more women are diagnosed with ADHD. These decisions are usually made without clear and authoritative evidence. Instead, doctors must consider their own expertise, the experience of other doctors, and the research on the subject.

Particularly, the issue of possible risks to the baby can be a challenge. Many of the studies on this subject are based on observations instead of controlled research and their conclusions are often contradictory. The majority of studies restrict their analysis to live-births, which could underestimate the severity of teratogenic effects which can cause abortions or terminations of pregnancy. The study discussed in this journal club addresses these issues by examining data on both live and deceased births.

Conclusion: While some studies have shown an association between ADHD medications and certain birth defects, other studies have not established a link. The majority of studies show that there is a neutral, or slightly negative, impact. Therefore, a careful risk/benefit analysis is required in every situation.

For a lot of women with ADHD and ADD, the decision to discontinue medication is difficult, if not impossible. 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. Additionally, the loss of medication can affect the ability to do job-related tasks and drive safely, which are important aspects of a normal life for a lot of people with ADHD.

She recommends that women who are unsure about whether to keep or stop medication in light of their pregnancy, consider the possibility of educating friends, family members and colleagues about the condition, its impact on daily life, and the advantages of continuing the current treatment plan. add medication uk can also help the woman feel supported as she struggles with her decision. It is important to remember that certain medications can be absorbed through the placenta therefore, if a patient decides to stop her ADHD medication during pregnancy and breastfeeding, she should be aware that the effects of the drug can be transferred to the child.

Risk of Birth Defects

As the use and misuse of ADHD medication to treat symptoms of attention deficit disorder hyperactivity disorder (ADHD), increases, so does concern about the potential effects of these drugs on the fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge regarding this topic. Researchers utilized two massive data sets to study more than 4.3 million pregnancies and determine if stimulant medication use increased birth defects. Researchers found that while the risk overall is low, the first trimester ADHD medication use was associated with slightly higher risk of specific heart defects like ventriculoseptal defect.

The researchers behind the study found no association between early use of medication and congenital abnormalities such as facial clefting or club foot. The results are in agreement with previous studies that have shown the existence of a slight, but significant increase in cardiac malformations for women who began taking ADHD medication prior to the time of the time of pregnancy. This risk increased during the latter half of pregnancy when many women decided to stop taking their medication.

Women who took ADHD medication during the first trimester were more likely to require a caesarean birth and also have an insufficient Apgar after delivery and had a baby that required breathing assistance at birth. However the researchers of the study were unable to eliminate selection bias by restricting the study to women who didn't have any other medical issues that could be a contributing factor to these findings.


Researchers hope that their study will help doctors when they encounter pregnant women. They recommend that, while the discussion of the risks and benefits is crucial but the decision to stop or keep treatment should be based on each woman's needs and the severity of her ADHD symptoms.

The authors caution that, even though stopping the medication is an option to consider, it is not recommended because of the high incidence of depression and mental health issues among women who are pregnant or have recently given birth. 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

It can be overwhelming to become a mom. Women with ADHD who must work through their symptoms while attending doctor appointments, preparing for the arrival of a baby and getting used to new routines at home can experience severe challenges. Many women choose to continue taking their ADHD medication during pregnancy.

The majority of stimulant medications are absorbed by breast milk in small amounts, therefore the risk to the infant who is breastfeeding is low. However, add medication uk of exposure to medications by the infant can differ based on dosage, frequency it is taken and the time of day the medication is administered. In addition, various medications enter the baby’s system through the gastrointestinal tract or through breast milk. The impact on a newborn's health is not completely comprehended.

Some physicians may discontinue stimulant medication during a woman's pregnancy due to the absence of research. It's a difficult choice for the mother, who must weigh the benefits of taking her medication as well as the potential risks to the embryo. In the meantime, until more information is available, doctors may inquire about pregnant patients whether they have a background of ADHD or if they intend to take medication during the perinatal stage.

Many studies have shown that women can continue taking their ADHD medication without risk during pregnancy and while breast-feeding. This has led to more and more patients are choosing 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 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 doctor and discuss the pros and cons for continuing treatment. This includes non-pharmacological methods. Psychoeducation should also be provided to help women with ADHD recognize their symptoms and underlying disorder and learn about treatment options and strengthen existing coping strategies. This should be a multidisciplinary approach with the GP, obstetricians and psychiatry. Pregnancy counseling should include a discussion of a treatment plan for the mother and child, as well as monitoring for signs of deterioration, and, if needed, adjustments to the medication regimen.