add adult medications During Pregnancy and Breastfeeding
Women suffering from ADHD must make a difficult decision about whether to continue or stop taking ADHD medication during pregnancy and breast-feeding. There aren't many studies on how exposure to ADHD for a long time could affect a pregnant fetus.
A recent study published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological disorders like hearing loss or vision, febrile seizures or IQ impairment. The authors acknowledge the need for higher-quality studies.
Risk/Benefit Analysis
Women who are pregnant and take ADHD medication should evaluate the benefits of using it versus the risks for the baby. Doctors don't have enough data to provide clear recommendations however they can provide information about risks and benefits to aid pregnant women in making informed decisions.
A study published in Molecular Psychiatry found that women who used ADHD medications in early pregnancy did not have an increased risk of fetal cardiac malformations or major birth defects that are structural. The researchers used a large population-based case-control study to determine the prevalence of major structural birth defects in infants born to mothers who had taken stimulants during the early stages of pregnancy, and those who did not. Clinical geneticists, pediatric cardiologists and other experts looked over the cases to ensure that the classification was correct and to eliminate any bias.
However, the study was not without its flaws. In particular, they were unable to separate the effects of the medication from the disorder at hand. This limitation makes it difficult for researchers to determine if the small differences observed between the exposed groups were due to the use of medication, or if they were caused by co-morbidities. Additionally, the researchers did not look at long-term offspring outcomes.
The study did find that infants whose mothers had taken ADHD medications during pregnancy were at a slightly greater risk of being admitted to the neonatal intensive care unit (NICU) than those who were born without any medication or cut back on their medications prior to or during pregnancy. The reason for this was central nervous system-related disorders, and the higher risk of admission was not found to be influenced by the stimulant medications were used during pregnancy.
Women who were taking stimulant ADHD medications during pregnancy also had a higher chance of having an emergency caesarean section or having the baby was not scoring well on the Apgar scale (less than 7). These increases appeared to be independent of the type of medication taken during pregnancy.
Researchers suggest that the minor risks posed by the use of ADHD medications in early pregnancies could be offset by the more beneficial outcomes for both mother and baby from continuing treatment for the woman's condition. Physicians should discuss the issue with their patients and, when possible, assist them in developing strategies to improve their coping abilities which can reduce the negative impact of her condition on her daily functioning and relationships.
Medication Interactions
As more women than ever are being diagnosed with ADHD and being treated with medication, the issue of whether or not to stop treatment during pregnancy is one that more and more doctors confront. Most of the time, these decisions are made without any evidence that is clear and definitive regardless, so doctors must weigh what they know from their own experiences, those of other doctors, and what the research suggests about the subject and their own best judgment for each individual patient.
The issue of possible risks to the infant can be particularly tricky. A lot of studies on this issue are based on observational data rather than controlled research and their conclusions are often contradictory. The majority of studies focus on live births, which can underestimate the teratogenic impact which can cause terminations or abortions of pregnancy. The study that is discussed in this journal club addresses these issues by examining data on both live and deceased births.
The conclusion: While certain studies have demonstrated that there is a positive correlation between ADHD medications and the possibility of certain birth defects, others have found no such relationship, and most studies demonstrate a neutral or slightly negative effect. In all cases it is imperative to conduct a thorough evaluation of the potential risks and benefits should be conducted.
click through the following website can be challenging, if not impossible for women with ADHD to stop taking their medication. In a recent article published in Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can lead to depression and feelings of being isolated. A loss of medication may also affect the ability to safely drive and complete work-related tasks, which are vital aspects of everyday life for those with ADHD.
She recommends that women who are unsure about whether to keep or stop medication in light of their pregnancy, consider the possibility of educating friends, family members and colleagues about the condition, its impact on daily functioning, and on the benefits of keeping the current treatment regimen. It can also help a woman feel supported in her decision. It is also worth noting that certain medications can pass through the placenta so if the patient decides to stop taking her ADHD medication during pregnancy and breastfeeding, she must be aware that the effects of the drug could be transferred to the child.
Risk of Birth Defects
As the use and abuse of ADHD medications to treat the symptoms of attention deficit hyperactivity disorder (ADHD) increases as does the concern about the potential effects of these drugs on fetuses. A recent study published in the journal Molecular Psychiatry adds to the existing information on this topic. Utilizing two huge data sets researchers were able to look at more than 4.3 million pregnancies and determine whether the use of stimulant medications increased the risk of birth defects. Researchers discovered that, while the risk overall is low, the first trimester ADHD medication exposure was associated with slightly higher risk of specific heart defects like ventriculoseptal defect.
The authors of the study found no link between early use of medication and congenital abnormalities such as facial clefting or club foot. The results are in line with previous studies revealing the presence of a small, but significant increase in the risk of heart malformations in women who started taking ADHD medications prior to the time of pregnancy. This risk increased during the latter part of pregnancy, as many women begin to discontinue their ADHD medication.
Women who used ADHD medications in the first trimester of their pregnancies were also more likely to have caesarean sections, a low Apgar score after delivery and a baby who needed help breathing at birth. However the researchers of the study were not able to eliminate selection bias by restricting the study to women who did not have any other medical issues that could have contributed to the findings.
The researchers hope their study will help inform the clinical decisions of physicians who see pregnant women. The researchers advise that, while discussing risks and benefits are important, the decision about whether to continue or stop taking medication should be in light of the severity of each woman's ADHD symptoms and her requirements.
The authors warn that, although stopping the medication is a possibility to consider, it is not advised due to the high rate depression and other mental disorders among women who are pregnant or who have recently given birth. Furthermore, research suggests that women who choose to stop taking their medications are more likely to experience difficulties getting used to life without them after the birth of their baby.
Nursing
The responsibilities of being a new mom can be overwhelming. Women with ADHD who must work through their symptoms while attending doctor appointments as well as preparing for the arrival of a child and getting used to new routines at home are often faced with a number of difficulties. Therefore, many women elect to continue taking their ADHD medications throughout pregnancy.
The majority of stimulant medications are absorbed through breast milk in small amounts, so the risk for nursing infant is very low. The rate of exposure to medication can vary depending upon the dosage and frequency of administration as well as the time of the day. Additionally, individual medications enter the infant's system differently through the gastrointestinal tract and breast milk and the impact of this on a newborn isn't fully understood.
Due to the absence of evidence, some doctors may recommend stopping stimulant medication during a woman's pregnancy. It is a difficult decision for the woman who must weigh the advantages of continuing her medication against the risk to the foetus. Until more information is available, doctors should ask all pregnant patients about their experience with ADHD and whether they plan or are taking to take medication during the perinatal time.
A increasing number of studies have shown that women can continue their ADHD medication while they are pregnant and nursing. This has led to more and more patients choose to do so, and after consulting with their doctor, they have discovered that the benefits of keeping their current medication far outweigh any risks.
Women who suffer from ADHD who are planning to breastfeed should seek advice from a specialist psychiatrist prior to becoming pregnant. They should review their medications with their prescriber and discuss the advantages and disadvantages of continuing treatment, including non-pharmacological strategies. Psychoeducation is also required to help pregnant women suffering from ADHD be aware of the symptoms and underlying disorder. They should also be educated about treatment options and reinforce the coping mechanisms. This should involve a multidisciplinary approach with the GP doctors, obstetricians and psychiatrists. Pregnancy counseling should include discussion of a treatment plan for the mother and the child, monitoring of signs of deterioration, and, if needed, adjustments to the medication regime.