What's The Most Important "Myths" About ADHD Medication Pregnancy Could Be True

ADHD Medication During Pregnancy and Breastfeeding

The choice of whether to stop or continue ADHD medication during breastfeeding and pregnancy is challenging for women with the condition. Little data exists about how long-term exposure to these medications may affect the foetus.

A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus do not develop neurological disorders like hearing loss or impaired vision seizures, febrile seizures or IQ impairment. The authors acknowledge the need for higher-quality studies.

Risk/Benefit Analysis

Women who are pregnant and taking ADHD medications need to balance the advantages of using them against the risks to the fetus. Doctors don't have the information needed to provide clear recommendations but they can provide information about the risks and benefits to aid pregnant women in making informed choices.

A study published in Molecular Psychiatry concluded that women who were taking ADHD medication in early pregnancy were not at higher risk of fetal malformations or structural birth defects. Researchers conducted a massive 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 reduce any bias.

The research conducted by the researchers was not without its limitations. Most important, they were not able to differentiate the effects of the medication from the underlying disorder. That limitation makes it difficult to determine whether the small differences observed in the groups that were exposed are due to the use of medication or comorbidities that cause confusion. The researchers did not study long-term outcomes for the offspring.

The study revealed that infants whose mother had taken ADHD medication during pregnancy had a higher risk of admission to the neonatal care unit (NICU), compared to mothers who didn't take 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 of admission did not appear to be affected by the type of stimulant medication was used during pregnancy.

Women who took stimulant ADHD medications during pregnancy also had a higher likelihood of having to have an emergency caesarean section or having one whose baby scored low on the Apgar scale (less than 7). These increases appeared to be independent of the type of medication taken during pregnancy.

The researchers suggest that the low risk associated with the use of ADHD medications during early pregnancy may be offset by the greater benefits to both the mother and child from continued treatment for the woman's condition. Physicians should talk to their patients about this and, if possible, help them develop coping skills that could reduce the impact of her disorder in her daily functioning and her relationships.

Medication Interactions

As more women than ever are diagnosed with ADHD and treated with medication, the issue of whether to keep or end treatment during pregnancy is a question that more and more doctors face. Often, these decisions are taken in the absence of any evidence that is clear and definitive either way, so physicians have to weigh their experience from their own experiences, those of other doctors, and what the research says on the topic, along with their best judgment for each patient.

The issue of possible risks for infants can be particularly tricky. Many of the studies on this issue are based on observational data rather than controlled research and their findings are often contradictory. In addition, most studies limit their analysis to live births, which can underestimate severe teratogenic effects that cause 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.

The conclusion is that while some studies have shown an association between ADHD medications and the possibility of certain birth defects, others have found no such relationship and the majority of studies have a neutral or slightly negative effect. In the end an accurate risk-benefit analysis must be done in each case.

For many women with ADHD and ADD, the decision to discontinue medication is difficult if not impossible. In fact, in an article published in Archives of Women's Mental Health, psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can lead to increased depression, feelings of loneliness and family conflict for those suffering from the disorder. A decrease in medication could affect the ability to safely drive and perform work-related tasks, which are vital aspects of everyday life for those with ADHD.

She suggests that women who are unsure whether to continue taking medication or stop it due to their pregnancy should educate family members, coworkers and their friends about the condition, its impact on daily functioning and the benefits of continuing the current treatment plan. It can also make the woman feel more comfortable in her struggle with her decision. It is important to remember that some medications are able to pass through the placenta, therefore, if a patient decides to discontinue her ADHD medication during pregnancy and breastfeeding, she must be aware of the possibility that traces of the drug can be passed on to the baby.

Risk of Birth Defects

As the use of ADHD medications to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases, so do concerns about the effects that the drugs might have on the fetuses. A study that was published in the journal Molecular Psychiatry adds to the existing information on this topic. Researchers used two huge datasets to analyze more than 4.3 million pregnancy and determine whether stimulant medications caused birth defects. While the overall risk remains low, the scientists discovered that the first-trimester exposure to ADHD medications was linked to a slightly higher rate of specific heart defects, such as ventriculoseptal defect (VSD).

The researchers 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 revealing an increase, but not significant, in the risk of heart malformations among women who began taking ADHD medications prior to the time of the birth of their child. The risk increased in the latter half of pregnancy, when a lot of women stopped taking their medication.

Women who took ADHD medication in the first trimester of their pregnancies were also more likely to experience a caesarean section, a low Apgar score after delivery and a baby who needed breathing assistance during birth. However, the authors of the study were not able to eliminate selection bias by restricting the study to women who didn't have any other medical conditions that could have contributed to these findings.

The researchers hope their study will serve to inform the clinical decisions of doctors who see pregnant women. The researchers advise 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 her needs.

The authors also caution that, while stopping the medication is an option, it is not a recommended practice because of the high rate of depression and other mental health issues in women who are pregnant or recently post-partum. Additionally, the research suggests that women who choose to stop their medications are more likely to experience a difficult time adapting to life without them following the birth of their baby.

Nursing

The responsibilities of a new mother can be overwhelming. Women who suffer from ADHD can face severe challenges when they must manage their symptoms, go to doctor appointments and prepare for the birth of their child and adjust to a new routine. As such, many women decide to continue taking their ADHD medication throughout the pregnancy.

The risk to a nursing infant is low because the majority of stimulant medications is absorbed through breast milk at low levels. The amount of exposure to medications can vary depending upon the dosage and frequency of administration as well as time of day. Additionally, different medications enter the baby’s system through the gastrointestinal tract, or through breast milk. The effect on the health of a newborn isn't fully known.

Some physicians may discontinue stimulant medication during a woman’s pregnancy due to the lack of research. This is a complicated decision for the patient, who must balance the benefit of continuing her medication with the potential dangers to the embryo. Until more information is available, GPs should ask all pregnant patients about their experience with ADHD and if they plan or are taking to take medication during the perinatal period.

A growing number of studies have proven that most women can safely continue to take their ADHD medication while they are pregnant and nursing. In the end, more and more patients are choosing to do so and, after consulting with their doctor, they have found that the benefits of continuing their current medication outweigh any risks.

Women with ADHD who are planning to breastfeed should seek the advice of an expert psychiatrist prior to becoming pregnant.  iampsychiatry.uk  should discuss their medication with their prescriber, and the pros and cons for continuing treatment. This includes non-pharmacological methods. Psychoeducation is also needed to help pregnant women suffering from ADHD recognize the signs and the underlying disorder. They should also learn about treatment options and strengthen strategies for coping. This should be an approach that is multidisciplinary, including the GP doctors, obstetricians and psychiatrists. Pregnancy counseling should include a discussion of a treatment plan for the mother as well as the child, monitoring of signs of deterioration, and, if necessary adjustments to the medication regime.