Why People Don't Care About ADHD Medication Pregnancy
Why People Don't Care About ADHD Medication Pregnancy
Blog Article
ADHD Medication During Pregnancy and Breastfeeding
The decision to stop or continue ADHD medications during pregnancy and nursing is a challenge for women suffering from the condition. There aren't enough data on how long-term exposure may affect the foetus.
A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication during the uterus don't develop neurological disorders such as impaired vision or hearing seizures, febrile seizures or IQ impairment. The authors acknowledge the need for higher-quality research.
Risk/Benefit Analysis
Women who are pregnant and taking ADHD medications need to balance the advantages of taking them against potential risks to the fetus. Physicians don't have the data to give clear advice but they can provide information on risks and benefits to aid pregnant women in making an informed decision.
A study published in Molecular Psychiatry found that women who were taking ADHD medications in early pregnancy did not face an increased risk of fetal cardiac malformations or major structural birth defects. Researchers used a large population-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 looked over the cases to confirm that the classification was accurate and to minimize any bias.
The study conducted by the researchers was not without its limitations. Most important, they were unable to separate the effects of the medication from those of the underlying disorder. That limitation makes it difficult to know whether the limited associations observed in the groups that were exposed are due to medication use or confounding by comorbidities. In addition the researchers did not look at the long-term effects of offspring on their parents.
The study showed that infants whose mother took ADHD medication during pregnancy had a greater risk of being admitted to the neonatal care unit (NICU), compared to mothers who did not take any medication during pregnancy, or had stopped taking their medication before or during pregnancy. This increase was caused by central nervous system disorders. The increased risk of admission was not affected by the stimulant medication used during pregnancy.
Women who took stimulant ADHD medication during pregnancy also had an elevated risk of having a caesarean birth or having a child with low Apgar score (less than 7). These increases did appear to be unrelated to the type of medication taken 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 this with their patients and, if they are able, assist them in developing strategies for improving their coping skills which can reduce the impact of her disorder on her daily life and relationships.
Interactions with Medication
More and more doctors are faced with the decision of whether to keep treatment or stop it during pregnancy as more women are diagnosed with ADHD. These decisions are often made without clear and authoritative evidence. Instead, physicians must weigh their own knowledge, the experience of other physicians and the research on the topic.
Particularly, the subject of potential risks for the baby can be a challenge. The research on this issue is based on observation rather than controlled studies, and a lot of the results are in conflict. Additionally, the majority of studies limit their analysis to live births, which may underestimate severe teratogenic effects that lead to abortion or termination of the pregnancy. The study that is discussed in the journal club addresses these shortcomings 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 most studies have a neutral or slightly negative impact. In all cases, a careful evaluation of the risks and benefits should be conducted.
It can be difficult, if not impossible, for women with ADHD to stop taking their medication. In an article recently published in 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. Additionally, the loss of medication can interfere with 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 are unsure about whether to continue or stop medication in light of their pregnancy consider educating family members, friends and colleagues on the condition, its impact on daily functioning, and the benefits of keeping the current treatment plan. It can also make the woman feel more comfortable when she is struggling with her decision. It is also worth noting that some medications are able to pass through the placenta so if a woman decides to discontinue her ADHD medication during pregnancy and breastfeeding, she should be aware of the possibility that traces of the medication could be transferred to the child.
Birth Defects Risk
As the use of ADHD drugs to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases there are concerns over the impact that these drugs could have on foetuses. A recent study published in the journal Molecular Psychiatry adds to the body of information on this topic. Researchers used two massive data sets to examine over 4.3 million pregnancies and determine if the use of stimulant medications caused birth defects. Although the risk overall remains low, the scientists found that exposure in the first trimester to ADHD medications was linked to an increased risk of specific heart defects, such as ventriculo-septal defect (VSD).
The authors check here of the study found no link between the use of early medications and other congenital anomalies, like facial clefting, or club foot. The results are in the same vein as previous studies that showed the existence of a slight, but significant increase in cardiac malformations for women who began taking ADHD medication before pregnancy. This risk increased during the latter stages of pregnancy when many women stopped taking their medication.
Women who took ADHD medication in the first trimester of their pregnancy were also more likely to experience caesarean section, low Apgar score after delivery and a baby who required breathing assistance at birth. The authors of the study were unable to eliminate selection bias because they restricted the study to women with no other medical conditions that might have contributed to the findings.
Researchers hope that their research will inform physicians when they see pregnant women. The researchers suggest that, while discussing the risks and benefits are important, the choice about whether to continue or stop medication should be made according to the severity of each woman's ADHD symptoms and the needs of the woman.
The authors also caution that while discontinuing the medications is an option, it isn't an option that is recommended due to the high incidence of depression and other mental health problems in women who are pregnant or who are recently postpartum. Further, research shows that women who stop taking their medications will have a tough transitioning to life without them once the baby is born.
Nursing
It can be overwhelming to become a mom. Women with ADHD may face a lot of challenges when they have to manage their symptoms, go to doctor appointments, prepare for the birth of a baby and adjust to a new routine. Many women decide to continue taking their ADHD medication during pregnancy.
The risk to a breastfeeding infant is minimal because the majority of stimulant medications passes through breast milk at low levels. However, the frequency of exposure to medications by the newborn may differ based on dosage, how often it is administered, and at what time the medication is administered. In addition, individual medications enter the baby's system differently through the gastrointestinal tract as well as breast milk, and the effect of this on a newborn isn't yet fully known.
Some physicians may discontinue stimulant medications during a woman's pregnancy due to the lack of research. This is a difficult decision for the patient, who must weigh the benefits of keeping her medication with the potential risks to the embryo. As long as more information is available, GPs may ask pregnant patients whether they have a history of ADHD or if they plan to take medication in the perinatal phase.
Numerous studies have demonstrated that women can continue to take their ADHD medication safely during pregnancy and while breast-feeding. In response, a growing number of patients are choosing to continue their medication. They have concluded, in consultation with their doctors that the benefits of retaining their current medication outweigh potential risks.
It's important for women with ADHD who are considering breastfeeding to seek out a specialist psychiatrist's guidance prior to becoming pregnant. They should review their medications with their physician and discuss the advantages and disadvantages of continued 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 be educated about treatment options and strengthen strategies for coping. This should be a multidisciplinary approach including obstetricians, GPs, and psychiatrists. Counselling for pregnancy should include discussion of a management plan for both mother and child, as well as monitoring for signs of deterioration, and, if necessary, adjustments to the medication regimen.