5 Laws That Anyone Working In ADHD Medication Pregnancy Should Know
5 Laws That Anyone Working In ADHD Medication Pregnancy Should Know
Blog Article
ADHD Medication During Pregnancy and Breastfeeding
Women with ADHD must make a difficult decision on whether to keep or stop taking ADHD medication during pregnancy and breastfeeding. There is a lack of information about how long-term exposure to these medications may affect the fetus.
A study recently 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 that more high quality research is needed.
Risk/Benefit Analysis
Women who are expecting and taking ADHD medication must evaluate the benefits of using it against the possible dangers for the foetus. Physicians don't have the data to provide clear recommendations but they can provide information on the risks and benefits to assist pregnant women to make informed choices.
A study published in Molecular Psychiatry found that women who used ADHD medications in early pregnancy did not face an higher risk of fetal cardiac malformations or major birth defects that are structural. Researchers used a large population-based study of case control to compare the incidence of major structural defects in infants born to mothers who took stimulants during pregnancy. Pediatric cardiologists and clinical geneticists examined the cases to ensure accurate case classification and to minimize the possibility of bias.
However, the researchers' study had its limitations. In particular, they were unable to distinguish the effects of the medication from the effects of the disorder at hand. This makes it difficult to determine whether the limited associations observed in the groups that were exposed result from medication use or confounding by comorbidities. In addition the study did not study long-term offspring outcomes.
The study did find that infants whose mothers took ADHD medications during pregnancy were at slightly higher risk of being admitted to the neonatal intensive care unit (NICU) than infants who were born without any medication or had cut back on their medications 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 medication that was used during pregnancy.
Women who used stimulant ADHD medication during pregnancy were also at an elevated risk of having a caesarean delivery or having a baby born with an low Apgar score (less than 7). These increases appeared to be unrelated to the type of medication taken during pregnancy.
The researchers suggest that the small risk associated with the use of ADHD medications during the early stages of pregnancy could be offset by the greater benefit for both mother and child from continued treatment for the woman's condition. Physicians should speak with their patients about this and, if possible, help them improve coping skills which could reduce the impact of her disorder in her daily life and relationships.
Medication Interactions
More and more doctors are confronted with the dilemma of whether to maintain treatment or stop during pregnancy as more women are diagnosed with ADHD. These decisions are frequently made without clear and authoritative evidence. Instead, physicians must take into account their own experience and experience, as well as the experiences of other physicians and the research on the topic.
In particular, the issue of possible risks to the baby can be tricky. A lot of studies on this topic are based on observational evidence rather than controlled research, and their findings are often contradictory. In addition, most studies limit their analysis to live births, which may underestimate the severity of teratogenic effects that could lead to abortion or termination of the pregnancy. The study presented in this journal club addresses these issues by examining data on both live and deceased births.
The conclusion: While some studies have found an association between ADHD medications and the possibility of certain birth defects, others have not found any evidence of a link, and most studies have a neutral or slightly negative impact. As a result an accurate risk-benefit analysis is required in every case.
For a lot of women with ADHD, the decision to stop taking medication is difficult if not impossible. In a recent article in the 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 loneliness. In addition, a decrease in medication can interfere with the ability to perform jobs and drive safely, which are important aspects of a normal life for many people suffering from ADHD.
She suggests women who are uncertain about whether to continue or discontinue medication due to their pregnancy, consider informing family members, friends and colleagues on the condition, its effects 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 important to note that certain medications are able to pass through the placenta, therefore, if a patient decides to stop her ADHD medication during pregnancy and breastfeeding, she must be aware of the possibility that traces of the drug could be transferred to the child.
Birth Defects and Risk of
As the use and misuse of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD), increases, so does concern about the possible effects of the drugs on the fetuses. A recent study published in the journal Molecular Psychiatry adds to the body of knowledge on this subject. With two massive data sets, researchers were able to analyze more than 4.3 million pregnancies and see whether stimulant medications increased the risk of birth defects. Although the risk overall remains low, the researchers did find that first-trimester exposure to ADHD medications was linked to a slightly higher rate of specific heart defects, such as ventriculo-septal defect (VSD).
The researchers behind the study found no link between the use of early medications and congenital abnormalities like facial clefting, or club foot. The results are in line with previous studies showing the presence of a small, but significant increase in the risk of cardiac malformations among women who started taking ADHD medications prior to pregnancy. This risk increased during the latter part of pregnancy when many women decided to stop taking their medication.
Women who took ADHD medications during the first trimester of their pregnancies were also more likely to undergo caesarean section, low Apgar score after delivery and a baby that required breathing assistance during birth. However the authors of the study were not able to eliminate selection bias by restricting the study to women who did not have other medical issues that could be a contributing factor to these findings.
The researchers hope their study will help inform the clinical decisions of doctors who treat pregnant women. The researchers suggest that while discussing risks and benefits are important, the choice regarding whether or not to stop medication should be made based on the severity of each woman's ADHD symptoms and her requirements.
The authors caution that, while stopping the medication is an option to consider, it is not advised due to the high prevalence of depression and other mental problems in women who are expecting or have recently given birth. Further, research shows that women who stop taking their medication will have a harder transitioning to life without them after the baby is born.
Nursing
The responsibilities of being website a new mom can be overwhelming. Women who suffer from ADHD who must work through their symptoms while attending doctor appointments as well as making preparations for the arrival of a child and adapting to new routines in the home may face a lot of challenges. As such, many women decide to continue taking their ADHD medications throughout the course of pregnancy.
The majority of stimulant medicines are absorbed by breast milk in small amounts, therefore the risk for nursing infant is very low. However, the rate of exposure to medications by the newborn may differ based on the dosage, frequency it is administered and the time of the day it is administered. Additionally, individual medications enter the body of the baby differently through the gastrointestinal tract as well as breast milk. The impact of this on a newborn isn't well known.
Due to the absence of research, some doctors may be inclined to discontinue stimulant medications during the course of pregnancy. This is a difficult choice for the patient, who must weigh the benefit of continuing her medication against the possible risks to the foetus. In the meantime, until more information is available, doctors can ask pregnant patients if they have an history of ADHD or if they intend to take medication in the perinatal stage.
Numerous studies have demonstrated that women can continue to take their ADHD medication without risk during pregnancy and breast-feeding. This has led to many patients opt to do this and in consultation with their doctor they have found that the benefits of continuing their current medication outweigh any risks.
It's important for women with ADHD who are contemplating breastfeeding to seek out a specialist psychiatrist's advice prior becoming pregnant. They should review their medications with their doctor and discuss the advantages and disadvantages of continued treatment, including non-pharmacological management strategies. Psychoeducation should also be offered to help pregnant people with ADHD understand their symptoms and underlying disorder and learn about treatments and to reinforce existing coping strategies. This should be a multidisciplinary effort with the GPs, obstetricians, and psychiatrists. The pregnancy counselling should consist of the discussion of a plan for management for both the mother and child, and monitoring for signs of deterioration and the need for adjustments to the medication regimen.