ADHD Medication During Pregnancy and Breastfeeding

The decision to stop or continue ADHD medication during pregnancy and nursing is a difficult decision for women suffering from the condition. There are few data regarding how exposure over time may affect the fetus.

A recent study published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological problems such as impaired hearing 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 must weigh the advantages of using them against the risks to the fetus. The doctors don't have the information to make unambiguous recommendations however they can provide information on risks and benefits to assist pregnant women to make informed choices.

A study published in Molecular Psychiatry found that women who used ADHD medications during early pregnancy did not face an increased risk of fetal cardiac malformations or major structural birth defects. The researchers used a large population-based study of case-control to assess the risk of major structural birth defects in infants born to mothers who had taken stimulants during early pregnancy, as well as those who had not. Pediatric cardiologists, clinical geneticists and other experts reviewed the cases in order to ensure that the classification was correct and to reduce any bias.

However, the researchers' study had its limitations. In particular, they were unable to distinguish the effects of the medication from the effects of the disorder that is underlying. This limitation makes it difficult for researchers to determine if the small associations observed among the groups that were exposed to the use of medications or affected by co-morbidities. In addition, the researchers did not look at the long-term effects of offspring on their parents.

The study revealed that infants whose mother took ADHD medication during pregnancy had a slightly higher chance of being admitted to the neonatal care unit (NICU) in comparison to mothers who did not use any medication during pregnancy, or had quit taking the medication prior to or during pregnancy. This was due to central nervous system disorders. The higher risk of admission was not influenced by the stimulant medication used during pregnancy.

adhd treatment without medication who were taking stimulant ADHD medication during pregnancy were also at an increased chance of having a caesarean delivery or having a baby with an low Apgar score (less than 7). These increases did appear to be unrelated to the type of medication taken during pregnancy.

The research suggests that the low risk associated with the use of ADHD medications during early pregnancy may be offset by the greater benefit to both mother and child of continuing treatment for the woman's disorder. Physicians should discuss this with their patients and, where possible, help them develop strategies for improving their coping skills that can lessen the impact of her disorder on her daily functioning and relationships.

Medication Interactions

As more women than ever before are being diagnosed with ADHD and being treated with medication, the dilemma of whether or not to stop treatment during pregnancy is one that more and more physicians face. These decisions are usually made without clear and authoritative evidence. Instead, doctors have to consider their own expertise in conjunction with the experiences of other doctors and the research that has been conducted on the subject.

In particular, the issue of possible risks to the baby can be a challenge. Many studies on this topic are based on observations rather than controlled research, and their findings are often contradictory. Furthermore, most studies restrict their analysis to live births, which could underestimate severe teratogenic effects that cause abortion or termination of the pregnancy. The study presented in this journal club addresses these shortcomings by looking at data from both live and deceased births.

The conclusion: While some studies have found that there is a positive correlation between ADHD medications and the risk of certain birth defects, others have not found any evidence of a link, and most studies show a neutral or even slightly negative impact. In every case an in-depth study of the risks and benefits should be conducted.

It can be challenging, if not impossible for women with ADHD to stop taking their medication. In a recent article in Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can cause depression and feelings of being isolated. A decrease in medication could affect the ability to drive safely and perform work-related tasks, which are vital aspects of normal life for those suffering from ADHD.

She suggests that women who aren't sure whether to continue taking medication or stop it due to their pregnancy, educate their family members, coworkers, and friends about the condition, the effects on daily functioning, and the advantages of staying on the current treatment. In addition, educating them can help the woman feel supported in her struggle with her decision. Certain medications can pass through the placenta. If the patient decides to not take her ADHD medication while pregnant and breastfeeding, it's important to be aware that the medication could be transferred to the infant.


Risk of Birth Defects

As the use of ADHD medication to treat the symptoms of attention deficit hyperactivity disorder (ADHD) increases, so do concerns about what impact the drugs might have on fetuses. A study that was published in the journal Molecular Psychiatry adds to the existing knowledge on this subject. Researchers utilized two massive data sets to study more than 4.3 million pregnancies and determine if stimulant medication use caused birth defects. Although the risk overall remains low, the scientists did find that first-trimester exposure to ADHD medications was linked to an increased risk of specific heart defects, such as ventriculo-septal defect (VSD).

The authors of the study could not discover any connection between early use of medication and other congenital anomalies, such as facial deformities or club feet. The results are consistent with previous studies showing an increase, but not significant, in the risk of heart malformations among women who began taking ADHD medications prior to the time of the time of pregnancy. The risk increased in the latter part of pregnancy, when a lot of women decided to stop taking their medication.

Women who used ADHD medication in the first trimester of their pregnancies were also more likely to have caesarean sections, a low Apgar score following delivery, and a baby who required breathing assistance during birth. However, the authors of the study were not able to eliminate bias due to selection by limiting the study to women who did not have any other medical issues that could be a contributing factor to these findings.

The researchers hope that their research will serve to inform the clinical decisions of doctors who see pregnant women. The researchers advise that, while discussing the risks and benefits are crucial, the decision regarding whether or not to stop taking medication should be according to the severity of each woman's ADHD symptoms and her needs.

The authors also warn that even though stopping the medication is an alternative, it is not an option to consider due to the high incidence of depression and other mental health problems among women who are pregnant or who are recently postpartum. Additionally, the research suggests that women who decide to stop their medications are more likely to have difficulties adjusting to life without them after the baby's arrival.

Nursing

It can be overwhelming to become a mom. Women who suffer from ADHD who have to deal with their symptoms while attending physician appointments, preparing for the arrival of a child and adapting to new routines in the home may face a lot of challenges. Many women decide to continue taking their ADHD medication during pregnancy.

The majority of stimulant medications pass through breast milk in small amounts, so the risk to the breastfeeding infant is minimal. The rate of exposure to medication can vary depending upon the dosage, frequency of administration and the time of the day. Additionally, individual medications enter the baby's system differently through the gastrointestinal tract as well as breast milk. The impact of this on a newborn infant is not fully understood.

Because of the lack of research, some doctors might be tempted to stop taking stimulant medications during a woman's pregnancy. This is a difficult decision for the patient, who must balance the benefit of continuing her medication with the potential risks to the fetus. As long as more information is available, doctors can ask pregnant patients whether they have an history of ADHD or if they are planning to take medication in the perinatal phase.

Many studies have shown that women can continue to take their ADHD medication in a safe manner during pregnancy and while breast-feeding. In response, a rising number of patients are choosing to continue their medication. They have concluded, in consultation with their doctor that the benefits of retaining their current medication outweigh potential risks.

Women with ADHD who are planning to breastfeed 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 of continued treatment, including non-pharmacological management strategies. Psychoeducation is also needed to help pregnant women with ADHD recognize the signs and the underlying disorder. They should also be educated about treatment options and build strategies for coping. This should be a multidisciplinary approach, which includes the GP as well as obstetricians, psychiatry and obstetricians. Pregnancy counselling should include the discussion of a plan for management for both the mother and child, as well as monitoring for signs of deterioration, and when necessary, making adjustments to the medication regimen.