The Reasons To Focus On Enhancing ADHD Medication Pregnancy
ADHD Medication During Pregnancy and Breastfeeding
The choice of whether to stop or continue ADHD medication during breastfeeding and pregnancy is challenging for women with the condition. There is a lack of information about how long-term exposure to these drugs can affect the foetus.
A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication during utero do not develop neurological disorders like hearing loss or impaired vision seizures, febrile seizures or IQ impairment. The authors acknowledge the need for more high-quality research.
Risk/Benefit Analysis
Pregnant women who use ADHD medications need to balance the advantages of taking them against the potential risks to the fetus. Physicians do not have the necessary data to provide clear recommendations, but they can provide information on benefits and risks that can aid pregnant women in making informed decisions.
A study published in Molecular Psychiatry concluded that women who took ADHD medication during early pregnancy were not at greater risk of fetal malformations, or structural birth defects. Researchers conducted a large population-based case control study to examine the prevalence of structural defects that were major in infants who were born to mothers who took stimulants during pregnancy. Clinical geneticists, pediatric cardiologists and other experts looked over the cases to confirm that the classification was accurate and to eliminate any bias.
However, the researchers' study was not without its flaws. The researchers were unable, in the first place, to separate the effects caused by the medication from the disorder. This makes it difficult to know whether the small differences observed in the exposed groups are due to the use of medication or confounding by comorbidities. The researchers also did not look at long-term outcomes for offspring.
The study showed that infants whose mother took ADHD medication during pregnancy were at a slightly greater risk of being admitted to the neonatal care unit (NICU) in comparison to those whose mothers did not use any medication during pregnancy or had stopped taking their medication before or during pregnancy. The reason for this was central nervous system-related disorders, and the increased risk of admission did not appear to be influenced by which stimulant medications were used during pregnancy.
Women who took stimulant ADHD medication during pregnancy were also at an increased chance of having a caesarean delivery or having a child with a low Apgar score (less than 7). These increases appear to be independent of the type of medication taken 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 higher benefit to both mother and child of continuing treatment for the woman's disorder. Physicians should talk to their patients about this issue and as much as possible, assist them develop coping strategies that can lessen the effects of her disorder on her daily life and relationships.
Interactions with Medication
Many doctors are faced with the decision of whether to maintain treatment or stop as more women are diagnosed with ADHD. These decisions are often made without clear and reliable evidence. Instead, doctors have to take into account their own experience in conjunction with the experiences of other physicians and the research on the subject.
Particularly, the subject of potential risks for the baby can be tricky. The research on this issue is based on observations rather than controlled studies, and the results are contradictory. In addition, most studies limit their analysis to live births, which could underestimate the severity of teratogenic effects that could cause abortion or termination of the pregnancy. The study that is discussed in the journal club addresses these limitations, by examining both data on live and deceased births.
The conclusion is that while certain studies have demonstrated that there is a positive correlation between ADHD medications and the possibility of certain birth defects, other studies have found no such relationship and the majority of studies show a neutral or even slightly negative effect. As a result, a careful risk/benefit assessment must be conducted in every instance.
For a lot of women with ADHD who suffer from ADHD, the decision to discontinue medication can be difficult, if not impossible. In a recent piece published in the 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. Furthermore, a loss of medication can interfere with the ability to complete work-related tasks and safely drive which are essential aspects of a normal life for many people with 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 acquaintances about the condition, its impact on daily functioning and the advantages of staying on the current treatment. It will also help a woman feel more confident in her decision. Certain medications can pass through the placenta. If a woman decides not to take 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 hyperactivity disorder (ADHD) increases the concern over the possible effects of the drugs on fetuses. A recent study published in the journal Molecular Psychiatry adds to the existing knowledge on this subject. Utilizing medication for adult adhd sets researchers were able examine more than 4.3 million pregnancies and see whether stimulant medications increased the risk of birth defects. Researchers discovered that although the overall risk is low, the first trimester ADHD medication exposure was associated with slightly higher rates of specific heart defects like ventriculoseptal defect.
The authors of the study did not find any association between the use of early medications and other congenital anomalies, like facial deformities or club feet. The results are consistent with previous studies showing a small but significant increase in the risk of cardiac malformations among women who began taking ADHD medications before pregnancy. This risk increased in the latter half of pregnancy, when many women begin to discontinue their ADHD medication.
Women who were taking ADHD medication in the first trimester were more likely to require a caesarean delivery or have an insufficient Apgar after birth and had a baby that required help breathing after birth. However the authors of the study were unable to eliminate bias due to selection by limiting the study to women who didn't have other medical issues that could be a contributing factor to these findings.
Researchers hope that their study will inform physicians when they meet pregnant women. They recommend that, while the discussion of the risks and benefits is crucial but the decision to stop or continue treatment should be based on each woman's requirements and the severity of her ADHD symptoms.
The authors also warn that, while stopping the medication is an alternative, it is not a recommended practice because of 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 medications will have a difficult time adjusting to a life without them after the baby is born.
Nursing
The responsibilities of a new mother can be overwhelming. Women who suffer from ADHD who have to deal with their symptoms while attending physician appointments as well as getting ready for the arrival of their child and getting used to new routines at home are often faced with a number of difficulties. Many women choose to continue taking their ADHD medication during pregnancy.
The majority of stimulant medications are absorbed through breast milk in very small amounts, so the risk to infant who is breastfeeding is low. However, the frequency of exposure to medication by the newborn can vary depending on dosage, how often it is taken and at what time the medication is administered. In addition, individual medications enter the body of the baby differently through the gastrointestinal tract and breast milk and the impact of this on a newborn is not fully understood.
Because of the lack of research, some physicians may recommend stopping stimulant medication during a woman's pregnancy. This is a difficult decision for the mother, who must weigh the advantages of her medication against the risk to the fetus. As long as more information is available, GPs can ask pregnant patients if they have any history of ADHD or if they are planning to take medication in the perinatal stage.
Numerous studies have proven that women can continue to take their ADHD medication safely during pregnancy and breast-feeding. As a result, an increasing number of patients opt to do this and in consultation with their doctor they have discovered that the benefits of maintaining their current medication far outweigh any potential risks.
It's important for women with ADHD who are thinking of breastfeeding to seek out a specialist psychiatrist's advice prior to becoming pregnant. They should discuss their medication with their prescriber and discuss the advantages and disadvantages of continued treatment, including non-pharmacological management strategies. Psychoeducation should also be offered to help women with ADHD understand their symptoms and the underlying disorder and learn about treatment options and reinforce existing strategies for managing. This should be a multidisciplinary effort with the GPs, obstetricians, and psychiatry. Pregnancy counseling should include discussion of a treatment plan for the mother and child, as well as monitoring for signs of deterioration, and, if necessary, adjustments to the medication regimen.