Why No One Cares About ADHD Medication Pregnancy
Why No One Cares About ADHD Medication Pregnancy
Blog Article
ADHD Medication During Pregnancy and Breastfeeding
The decision to stop or keep ADHD medication during pregnancy and breastfeeding is challenging for women with the condition. There are few data on how exposure to ADHD for a long time could affect the pregnant fetus.
A study recently published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological issues 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 take ADHD medications need to balance the benefits of taking them against potential risks to the foetus. Doctors don't have enough data to make unambiguous recommendations, but can provide information about risks and benefits to help pregnant women make informed decisions.
A study published in Molecular Psychiatry concluded that women who took ADHD medication in early pregnancy did not have a greater risk of fetal malformations, or structural birth defects. Researchers used a large population-based study of case control to examine the prevalence of major structural defects in infants born to mothers who took stimulants during pregnancy. Pediatric cardiologists and clinical geneticists looked over the cases to ensure an accurate case classification and to minimize the possibility of bias.
The study conducted by the researchers was not without limitations. The researchers were unable in the beginning to differentiate the effects caused by the medication from the disorder. This limitation makes it difficult for researchers to determine if the small differences observed between the groups exposed were due to the use of medications or if they were caused by comorbidities. In addition the study did not examine the long-term effects of offspring on their parents.
The study found that infants whose mother had taken ADHD medication during pregnancy had a higher chance of being admitted to the neonatal care unit (NICU), compared to those whose mothers did not use any medication during pregnancy or discontinued taking their medication prior to or during pregnancy. This increase was due to central nervous system-related disorders and the increased risk for admission did not appear to be affected by the type of stimulant medication was used during pregnancy.
Women who were taking stimulant ADHD medication during pregnancy were also at an increased chance of having a caesarean birth or having a child with low Apgar score (less than 7). These increases didn't appear to be influenced by the type of medication that was used during pregnancy.
The research suggests that the low risk associated with the use of ADHD medications during the early stages of pregnancy could be offset by the greater benefit to both mother and child of continuing treatment for the woman's condition. Physicians should discuss this with their patients and, where possible, assist them in developing strategies for improving their coping skills that may minimize the effects of her disorder on her daily life and relationships.
Medication Interactions
As more women than ever are diagnosed with ADHD and being treated with medication, the dilemma of whether to continue or stop treatment during pregnancy is one that more and more physicians face. These decisions are frequently taken without clear and authoritative evidence. Instead, physicians must weigh their own knowledge in conjunction with the experiences of other doctors and the research that has been conducted on the subject.
Particularly, the subject of potential risks for the baby can be a challenge. Many of the studies on this subject are based on observational evidence instead of controlled research and their conclusions are often contradictory. Additionally, the majority of studies limit their analysis to live births, which may underestimate severe teratogenic effects that cause abortion or termination of the pregnancy. The study that is discussed in the journal club addresses these issues by analyzing data on live and deceased births.
The conclusion: While some studies have shown an association between ADHD medications and the possibility of certain birth defects, others have found no connection and the majority of studies show a neutral or even slight negative effect. Therefore, a careful risk/benefit analysis must be conducted in every situation.
It can be difficult, if not impossible, for women with ADHD to stop taking their medication. In fact, in an article recently published in the Archives of Women's Mental Health, psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can lead to increased depression, feelings of isolation, and family conflict for those suffering from the disorder. Additionally, the loss of medication can interfere with the ability to do job-related tasks and drive safely which are essential aspects of daily life for a lot of people with ADHD.
She suggests that women who are not sure whether to continue taking the medication or discontinue it due to pregnancy educate family members, coworkers, and acquaintances about the condition, its impact on daily functioning and the benefits of continuing the current treatment plan. Educating them can also make the woman feel more comfortable when she is struggling with her decision. It is important to remember that some drugs can be absorbed through the placenta therefore, if a patient decides to discontinue her ADHD medication during pregnancy and breastfeeding, she should be aware that the effects of the drug can be transferred to the infant.
Risk of Birth Defects
As the use and misuse of ADHD medications to treat the symptoms of attention deficit disorder 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 body of knowledge on this subject. Researchers used two huge data sets to study over 4.3 million pregnancies and determine whether stimulant medications increased the risk of birth defects. Although the risk overall is low, the researchers found that exposure in the first trimester to ADHD medications was linked to a slightly higher rate of certain heart defects such as ventriculo-septal defect (VSD).
The authors of the study did not discover any connection between early medication usage and other congenital anomalies like facial deformities, or club feet. The findings are in line with previous studies that have shown an increase, but not significant, in the risk of cardiac malformations among women who started taking ADHD medications before the time of pregnancy. The risk was higher in the later part of pregnancy, as many women are forced to stop taking their ADHD medication.
Women who were taking ADHD medication in the first trimester were more likely require a caesarean birth, have an insufficient Apgar after delivery and have a baby that needed breathing assistance at birth. However, the authors of the study were not able to eliminate bias due to selection by limiting the study to women who didn't have any other medical issues that could have contributed to the findings.
Researchers hope that their research will inform physicians when they meet pregnant women. The researchers recommend that, while discussing risks and benefits are important, the choice about whether to continue or stop medication should be according to the severity of each woman's ADHD symptoms and her needs.
The authors caution that, although stopping the medication is an option to consider, it is not recommended due to the high prevalence of depression and mental health issues among women who are pregnant or who have recently given birth. Research has also shown that women who stop taking their medication will have a tough transitioning to life without them after the baby is born.
Nursing
It can be a challenge becoming a mother. Women who suffer from ADHD who must work through their symptoms while attending physician appointments, making preparations 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 drugs pass through breast milk in very small amounts, so the risk for nursing infant is very low. However, the amount of exposure to medication by the newborn may differ based on dosage, how often it is administered and the time of day the medication is administered. Additionally, individual medications enter the baby's system differently through the gastrointestinal tract and breast milk and the impact of this on a newborn infant is not yet fully understood.
Some physicians may discontinue stimulant medication during a woman's pregnancy due to the lack of research. click here This is a complicated decision for the patient, who must weigh the benefit of continuing her medication against the possible dangers to the embryo. Until more information is available, doctors should inquire with all pregnant patients about their experience with ADHD and whether they are planning or taking to take medication during the perinatal time.
A growing number of studies have revealed that the majority of women are able to safely continue taking their ADHD medication during pregnancy and breastfeeding. In response, a rising number of patients are opting to do so. They have discovered after consulting with their physicians, that the benefits of retaining their current medication far outweigh any potential risks.
It is crucial for women suffering from ADHD who are considering breastfeeding to seek a specialist psychiatrist's guidance prior to becoming pregnant. They should discuss their medication with their prescriber and discuss the advantages and disadvantages of continuing treatment, including non-pharmacological strategies. Psychoeducation is also necessary to help pregnant women with ADHD recognize the signs and the underlying disorder. They should also learn about treatment options and reinforce coping mechanisms. This should be an approach that is multidisciplinary, including the GP doctors, obstetricians and psychiatrists. Pregnancy counselling should include discussion of a management plan for both the mother and child, and monitoring for signs of deterioration, and the need for adjustments to the medication regimen.