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ADHD Medication During Pregnancy and Breastfeeding

The decision to stop or keep ADHD medications during pregnancy and nursing is challenging for women with the condition. Little data exists about how long-term exposure to these medications could affect the foetus.

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

Risk/Benefit Analysis

Women who are pregnant and taking ADHD medications need to balance the benefits of taking them against potential risks to the foetus. Doctors don't have the necessary data to provide clear recommendations but they can provide information regarding benefits and risks that can help pregnant women make informed choices.

A study published in Molecular Psychiatry found that women who took ADHD medications during early pregnancy did not have an higher risk of fetal cardiac malformations or major structural birth defects. Researchers conducted a large sample-based case control study to assess the frequency of structural defects that were major in infants born to mothers who were taking stimulants during pregnancy. Clinical geneticists, pediatric cardiologists and other experts examined the cases to confirm that the classification was correct and to reduce any bias.

The study of the researchers was not without its limitations. In particular, they were unable to separate the effects of the medication from the disorder that is underlying. That limitation makes it difficult to determine whether the small associations observed in the exposed groups are due to medication use or confounding by comorbidities. The researchers also did not examine long-term outcomes for offspring.

The study found that infants whose mother had taken ADHD medication during pregnancy had a slightly higher chance of being admitted to the neonatal care unit (NICU) as compared to mothers who did not use any medication during pregnancy or quit taking the medication prior to or during pregnancy. The reason for this was central nervous system disorders. The increased risk of admission was not influenced by the stimulant medications used during pregnancy.

Women who took stimulant ADHD medications during pregnancy also had a higher likelihood of having an emergency caesarean section or having the baby was not scoring well on the Apgar scale (less than 7). These increases appear to be independent of the type of medication taken during pregnancy.

The research suggests that the risk of a small amount with the use of ADHD medications during the early stages of pregnancy may be offset by the higher benefit to both mother and child of continuing treatment for the woman's disorder. Physicians should discuss the issue with their patients and, when they are able, assist them in developing strategies for improving their coping skills which can reduce the impact of her disorder on her daily functioning and relationships.

Medication Interactions

Many doctors are confronted with the dilemma of whether to maintain treatment or stop as more women are diagnosed with ADHD. The majority of these decisions are taken in the absence of any evidence that is clear and definitive regardless, so doctors must weigh what they know, the experiences of other doctors, and what research suggests on the subject and their own best judgment for each patient.

Particularly, the subject of possible risks to the infant can be difficult. The research on this subject is based on observations rather than controlled studies and the results are in conflict. Most studies limit their analysis to live births, which may underestimate the teratogenic impact which can cause terminations or abortions of pregnancy. The study that is discussed in the journal club addresses these shortcomings, by examining both data on live and deceased births.

The conclusion is that while certain studies have demonstrated an association between ADHD medications and the risk of certain birth defects, others have found no such relationship and the majority of studies demonstrate a neutral or slightly negative impact. In the end, a careful risk/benefit analysis must be done in each situation.

For women suffering from ADHD who suffer from ADHD, the decision to discontinue medication can be difficult, if not impossible. In fact, in an article recently published in Archives website of Women's Mental Health psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can increase depression, feelings of isolation, and family conflict for those suffering from the disorder. A loss of medication may also affect the ability to drive safely and perform work-related tasks, which are vital aspects of daily life for those with ADHD.

She suggests that women who are unsure whether to continue taking medication or discontinue it due to pregnancy, educate their family members, coworkers, and their friends about the condition, its effects on daily functioning, and the advantages of staying on the current treatment plan. It can also help the woman feel supported when she is struggling with her decision. Certain medications can be passed through the placenta. If a patient decides to not take her ADHD medication while breastfeeding, it is important to be aware that the drug could be passed on to her baby.

Risk of Birth Defects

As the use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases there are concerns over the impact that these medications could have on foetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge on this topic. Using two massive data sets, researchers were able to examine more than 4.3 million pregnancies to determine whether stimulant medication use increased the risk of birth defects. Although the risk overall is low, the researchers discovered that the first-trimester exposure to ADHD medications was linked to an increase in the risk of specific heart defects, such as ventriculoseptal defect (VSD).

The authors of the study could not discover any link 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 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 a lot of women decided to stop taking their medication.

Women who were taking ADHD medication during the first trimester were more likely to require a caesarean birth, have a low Apgar after birth and have a baby who needed help breathing at birth. However the authors of the study were not able to eliminate selection bias by limiting 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 research will inform physicians when they encounter pregnant women. They recommend that, while discussing the risks and benefits is crucial but the decision to stop or continue medication should be based on each woman's requirements and the severity of her ADHD symptoms.

The authors warn that, although stopping the medication is an option to look into, it is not recommended due to the high rate depression and mental health issues for women who are pregnant or who have recently given birth. Further, research shows that women who stop taking their medications will have a tough adjustment to life without them once the baby is born.

Nursing

It can be overwhelming to become a mother. Women with ADHD may face a lot of challenges when they must deal with their symptoms, attend doctor appointments and prepare for the birth of a baby and adjust to a new routine. Therefore, many women decide to continue taking their ADHD medication throughout the pregnancy.

The majority of stimulant drugs are absorbed by breast milk in small amounts, therefore the risk for breastfeeding infant is minimal. The rate of medication exposure can vary depending upon the dosage and frequency of administration as well as the time of the day. In addition, individual medications enter the body of the baby differently through the gastrointestinal tract as well as breast milk and the impact of this on a newborn isn't yet fully understood.

Some doctors may decide to stop stimulant medication during a woman's pregnancy due to the lack of research. This is a difficult decision for the woman, who must weigh the advantages of her medication against the risks to the foetus. As long as more information is available, doctors can ask pregnant patients whether they have an background of ADHD or if they plan to take medication in the perinatal stage.

Many studies have shown that women can continue to take their ADHD medication in a safe manner during pregnancy and while breast-feeding. This has led to more and more patients choose to do so, and in consultation with their physician, they have found that the benefits of keeping their current medication outweigh any risks.

Women with ADHD who are planning to nurse should seek the advice of a specialist psychiatrist before becoming pregnant. They should discuss their medication with their doctor as well as the pros and cons of continuing treatment. This includes non-pharmacological methods. Psychoeducation is also required to help pregnant women with ADHD understand the symptoms and underlying disorder. They should also be educated about treatment options and reinforce coping mechanisms. This should be a multidisciplinary approach with the GPs, obstetricians and psychiatry. The pregnancy counselling should consist of discussion of a management plan for both the mother as well as the child, and monitoring for signs of deterioration, and, if necessary, adjustments to the medication regimen.