ADHD Medication During Pregnancy and Breastfeeding

Women with ADHD have to make a difficult choice on whether to keep or stop taking ADHD medication during pregnancy and breastfeeding. There aren't enough data on how exposure to ADHD for a long time could affect a pregnant fetus.

A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus don't develop neurological conditions like hearing loss or impaired vision, febrile seizures, or IQ impairment. The authors acknowledge that more high-quality research is needed.

Risk/Benefit Analysis

Pregnant women who use ADHD medications need to balance the advantages of taking them against the potential risks to the fetus. Doctors don't have enough data to make unambiguous recommendations, but can provide information on risks and benefits to help pregnant women make informed choices.

A study published in Molecular Psychiatry found that women who used ADHD medications during early pregnancy did not have an increased risk of fetal cardiac malformations or major birth defects that are structural. Researchers conducted a massive sample-based case control study to examine the prevalence of major structural defects in infants who were born to mothers who used stimulants during pregnancy. Pediatric cardiologists, clinical geneticists and other experts examined the cases to confirm that the classification was correct and to reduce any bias.

The research conducted by the researchers had some limitations. Researchers were unable to, in the first place to differentiate the effects triggered by the medication from the disorder. This makes it difficult for researchers to establish whether the few associations observed between the groups exposed were due to the use of medications or caused by comorbidities. Additionally the study did not examine long-term offspring outcomes.


The study did show that infants whose mothers had taken ADHD medication during pregnancy were at a slightly more risk of being admitted to the neonatal intensive care unit (NICU) than infants who were born without any medication or taken off their medication prior to or during pregnancy. This was due to central nervous system disorders, and the higher risk of admission did not appear to be influenced by the stimulant medications were taken during pregnancy.

Women who were taking stimulant ADHD medications during pregnancy also had a higher chance of having to have a caesarean section or one whose baby scored low on the Apgar scale (less than 7). These increases did not seem to be influenced by the type of medication that was used during pregnancy.

Researchers suggest that the small risks associated with the use ADHD medications during early pregnancies may be offset by the greater benefits to both mother and baby of continuing treatment for the woman’s disorder. Physicians should talk to their patients about this issue and, if possible, help them improve coping skills which could reduce the effects of her disorder on her daily life and relationships.

Medication Interactions

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. Most of the time, these decisions are taken in the absence of any evidence that is clear and definitive regardless, so doctors have to weigh their experience about their experiences, the experiences of other doctors, and what the research suggests on the subject as well as their own best judgment for each patient.

The issue of risk to infants is difficult to determine. Many studies on this issue are based on observational data rather than controlled research, and their conclusions are often contradictory. Additionally, the majority of studies limit their analysis to live births, which can undervalue the serious teratogenic effects that can result in abortion or termination of the pregnancy. The study discussed in the journal club addresses these shortcomings by analyzing both data on live and deceased births.

Conclusion: While some studies have found an association between ADHD medications and certain birth defects, other studies have not shown such a relationship. The majority of studies show that there is a neutral, or somewhat negative, effect. In the end, a careful risk/benefit analysis must be conducted in every situation.

It can be difficult, if not impossible for women suffering from ADHD to stop taking their medication. In fact, in an article published in Archives of Women's Mental Health, psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can cause depression, feelings of isolation, and family conflict for patients with ADHD. A decrease in medication could also affect the ability to safely drive and to perform work-related tasks which are vital aspects of daily life for those suffering from ADHD.

She suggests women who are uncertain about whether or not to stop medication in light of their pregnancy, consider educating family members, friends, and coworkers on the condition, its effects on daily functioning, and on the advantages of continuing the current treatment plan. In addition, educating them can aid in ensuring that the woman feels supported when she is struggling with her decision. Certain medications can be passed through the placenta. If the patient decides to stop taking her ADHD medication while pregnant and breastfeeding, it is important to be aware that the drug may be transferred to her baby.

Risk of Birth Defects

As the use and misuse of ADHD medication to treat symptoms of attention deficit disorder hyperactivity disorder (ADHD) is increasing as does the concern about the potential effects of these drugs on foetuses. A study that was published in the journal Molecular Psychiatry adds to the existing knowledge about this subject. Researchers used two massive data sets to study more than 4.3 million pregnancy and determine whether stimulant medications caused birth defects. While the overall risk remains low, the scientists did find that first-trimester exposure to ADHD medications was associated with an increase in the risk of specific heart defects, such as ventriculo-septal defect (VSD).

The authors of the study didn't find any association between early use of medication and other congenital anomalies, like facial deformities or club feet. The results are consistent with previous studies showing an increase, but not significant, in the risk of developing cardiac malformations in women who started taking ADHD medications prior to the time of pregnancy. The risk increased in the latter half of pregnancy when many women began to stop taking their medication.

Women who were taking ADHD medication during the first trimester were more likely to need a caesarean and also have an insufficient Apgar after birth and have a baby who needed breathing assistance when they were born. 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 conditions that could have contributed to these findings.

Researchers hope their research will inform physicians when they see pregnant women. They recommend that, while discussing the risks and benefits is crucial however, the decision to stop or continue medication must be based on each woman's needs and the severity of her ADHD symptoms.

The authors also advise that even though stopping the medication is an option, it is not a recommended practice because of the high prevalence of depression and other mental health issues among women who are pregnant or who are recently post-partum. Further, the research suggests that women who decide to stop their medications are more likely to have difficulties getting used to life without them after the birth of their baby.

Nursing

It can be overwhelming becoming a mother. Women who suffer from ADHD may face a lot of challenges when they have to manage their symptoms, attend doctor appointments, 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 are absorbed through breast milk in very small amounts, therefore the risk to the nursing infant is very low. However, the amount of exposure to medications by the newborn may differ based on dosage, frequency it is administered, and at what time the medication is administered. In addition, various drugs enter the infant's system through the gastrointestinal tract or through breast milk. adhd depression medication of these medications on a newborn's health is not completely understood.

Because of the lack of evidence, some doctors might be tempted to stop taking stimulant medications during a woman's pregnancy. This is a difficult decision for the mother, who must weigh the advantages of continuing her medication against the potential risks to the fetus. In the meantime, until more information is available, GPs can ask pregnant patients whether they have a history of ADHD or if they plan to take medication in the perinatal period.

A growing number of studies have proven that women can continue their ADHD medication while they are pregnant and nursing. This has led to an increasing number of patients opt to do this and in consultation with their physician, they have found that the benefits of keeping their current medication far outweigh any potential risks.

Women with ADHD who are planning to nurse should seek advice from an expert psychiatrist prior to becoming pregnant. They should discuss their medication with their prescriber and discuss the pros and cons for continuing treatment. This includes non-pharmacological strategies. Psychoeducation is also required to help pregnant women suffering from ADHD be aware of their symptoms and the underlying disorder, learn about available treatment options and reinforce existing coping strategies. This should be a multidisciplinary approach with the GPs, obstetricians, and psychiatry. Pregnancy counselling should include discussion of a management plan for both the mother and child, as well as monitoring for signs of deterioration and the need for adjustments to the medication regimen.