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 choice of whether to stop or continue ADHD medication during pregnancy and nursing is a challenge for women suffering from the condition. Little data exists about how long-term exposure to these drugs can affect the 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 required.
Risk/Benefit Analysis
Pregnant women who take ADHD medications must weigh the benefits of taking them against potential risks to the foetus. The doctors don't have the information to give clear advice but they can provide information about risks and benefits to help pregnant women make an informed decision.
A study published in Molecular Psychiatry concluded that women who were taking ADHD medication during early pregnancy were not at greater risk of fetal malformations or structural birth defects. The researchers used a large population-based study of case-control to determine the prevalence of major structural birth defects in babies born to mothers who took stimulants during early pregnancy, and those who did not. Clinical geneticists, pediatric cardiologists and other experts examined the cases to ensure that the classification was correct and to minimize any bias.
However, the study was not without its flaws. The researchers were unable, in the first place, to separate the effects of the medication from the disorder. This makes it difficult to determine whether the small differences observed in the groups that were exposed are due to the use of medication or the confounding effect of comorbidities. The researchers also did not look at long-term outcomes for offspring.
The study showed that infants whose mother had taken ADHD medication during pregnancy were at a slightly greater risk of being admitted to the neonatal care unit (NICU) in comparison to mothers who didn't take any medication during pregnancy, or had quit taking the medication prior to or during pregnancy. This was due to central nervous system disorders. The increased risk of admission was not affected by the stimulant medication used during pregnancy.
Women who were taking stimulant ADHD medications during pregnancy also had a higher likelihood of having an emergency caesarean section or having one whose baby scored low on the Apgar scale (less than 7). These risks did not appear to be influenced by the type of medication that was used during pregnancy.
Researchers suggest that the small risk of using ADHD medication during pregnancies in the early stages may be offset by the more beneficial outcomes for both mother and baby of continuing treatment for the woman's disorder. Physicians should discuss the issue with their patients and, when possible, assist them in developing strategies to improve coping skills that may minimize the effects of her disorder on her daily functioning and relationships.
Medication Interactions
As more women than ever are being diagnosed with ADHD and treated with medication, the issue of whether to continue or discontinue treatment during pregnancy is a question that doctors are having to have to face. These decisions are usually taken without clear and authoritative evidence. Instead, physicians must weigh their own knowledge and experience, as well as the experiences of other physicians and the research that has been conducted on the subject.
The issue of risk to the infant can be particularly tricky. A lot of studies on this topic are based on observational data instead of controlled research and their conclusions are often contradictory. In addition, most studies limit their analysis to live births, which could underestimate the severity of teratogenic effects that could lead to abortion or termination of the pregnancy. The study discussed in this journal club addresses these issues by looking at data from both live and deceased births.
Conclusion: While some studies have revealed a positive correlation between ADHD medications and certain birth defects However, other studies haven't shown such a relationship. Most studies have shown that there is a neutral, or somewhat negative, effect. As a result, a careful risk/benefit assessment must be conducted in every situation.
For women suffering from ADHD and ADD, the decision to stop taking medication is difficult, if not impossible. In fact, in a recent article in the Archives 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. In addition, a decrease in medication may affect the ability to complete work-related tasks and safely drive that are crucial aspects of a normal life for a lot of people with ADHD.
She suggests that women who aren't sure whether to continue taking medication or discontinue it due to pregnancy educate family members, coworkers, and acquaintances about the condition, its impact on daily functioning and the advantages of staying on the current treatment regimen. It can also help a woman feel confident about her decision. It is also worth noting that certain medications are able to pass through the placenta so if the patient decides to stop taking her ADHD medication during pregnancy and breastfeeding, she must be aware of the possibility that traces of the drug could be passed on to the baby.
Risk of Birth Defects
As the use of ADHD medication to treat the symptoms of attention deficit hyperactivity disorder (ADHD) grows as do concerns over the impact that these medications could have on the fetuses. A study that was published in the journal Molecular Psychiatry adds to the existing knowledge on this subject. Utilizing two huge data sets researchers were able to examine more than 4.3 million pregnancies and see whether stimulant medications increased the risk of birth defects. Researchers found that while the risk overall is low, first-trimester ADHD medication exposure was associated with slightly higher rates of certain heart defects, such as ventriculoseptal defect.
The researchers of the study didn't 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 a small but significant increase in the risk of heart malformations among women who started taking ADHD medications before the time of pregnancy. This risk increased during the latter part of pregnancy, when many women are forced to stop taking their ADHD medications.
Women who used ADHD medications in the first trimester of their pregnancies were also more likely to undergo caesarean sections, a low Apgar score following delivery, and a baby that required breathing assistance during birth. However, the authors of the study were not able to eliminate bias due to selection by restricting the study to women who did not have other medical issues that could have contributed to the findings.
The researchers hope that their research will serve to inform the clinical decisions of doctors who treat pregnant women. They suggest that although the discussion of the risks and benefits is crucial however, the decision to stop or maintain treatment must be based on each woman's needs and the severity of her ADHD symptoms.
The authors also warn that even though stopping the medication is an option, it isn't an option that is recommended due to the high prevalence of depression and other mental health issues for women who are expecting or recently post-partum. Further, here research shows that women who stop taking their medications will have a difficult time adjusting to a life without them once the baby is born.
Nursing
The responsibilities of being a new mother can be overwhelming. Women suffering from ADHD can face severe challenges when they have to manage their symptoms, attend doctor appointments and prepare for the birth of a baby and adjust to new routines. As such, many women choose to continue taking their ADHD medication throughout the pregnancy.
The risk for breastfeeding infant is not too high since the majority of stimulant medication passes through breast milk at a low level. The amount of exposure to medications will vary based on the dosage and frequency of administration as well as the time of 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 physicians may be inclined to discontinue stimulant medications during the pregnancy of a woman. It is a difficult decision for the mother, who must weigh the benefits of her medication against the potential risks to the foetus. Until more information is available, doctors should ask all pregnant patients about their experience with ADHD and if they plan or are taking to take medication during the perinatal period.
Numerous studies have proven that women can continue to take their ADHD medication without risk while breastfeeding and during pregnancy. As a result, many patients are choosing to do so and, in consultation with their physician, they have found that the benefits of keeping their current medication exceed any risk.
Women who suffer from ADHD who are planning to nurse should seek the advice of a specialist psychiatrist before becoming pregnant. They should discuss their medication with their physician and discuss the advantages and disadvantages of continued treatment, including non-pharmacological strategies. Psychoeducation is also required to help pregnant women suffering from ADHD recognize the signs and underlying disorder. They should also learn about treatment options and reinforce strategies for coping. This should be a multidisciplinary approach including obstetricians, GPs and psychiatry. Pregnancy counseling should consist of a discussion of a treatment plan for the mother and child, monitoring of signs of deterioration, and, if necessary, adjustments to the medication regimen.