20 Trailblazers Setting The Standard In ADHD Medication Pregnancy
20 Trailblazers Setting The Standard In ADHD Medication Pregnancy
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ADHD Medication During Pregnancy and Breastfeeding
The choice of whether to stop or continue ADHD medications during pregnancy and nursing is challenging for women with the condition. There aren't many studies regarding how exposure over time may affect a pregnant fetus.
A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus don't develop neurological developmental conditions like impaired vision or hearing seizures, febrile seizures or IQ impairment. The authors acknowledge that more high quality studies are needed.
Risk/Benefit Analysis
Women who are pregnant and taking ADHD medication should evaluate the benefits of using it against the potential risks for the fetus. Physicians don't have the necessary data to give clear guidelines however they can provide information on the risks and benefits to aid pregnant women in making informed decisions.
A study published in Molecular Psychiatry found that women who were taking ADHD medications during their early pregnancy did not have an higher risk of fetal cardiac malformations or major birth defects that are structural. Researchers used a vast, population-based case-control study to determine the prevalence of major structural birth defects in babies born to mothers who had taken stimulants during the early stages of pregnancy, as well as those who had not. Pediatric cardiologists, clinical geneticists and other experts examined the cases to make sure that the classification was accurate and to reduce any bias.
The study conducted by the researchers was not without limitations. Most important, they were unable to separate the effects of the medication from the disorder that is underlying. This limitation makes it difficult to determine whether the small differences observed in the groups that were exposed result from medication use or the confounding effect of comorbidities. In addition the researchers did not study the long-term effects of offspring on their parents.
The study found that infants whose mothers took ADHD medication during pregnancy were at a slightly higher chance of being admitted to the neonatal care unit (NICU) as compared to mothers who did not use any medication during pregnancy or discontinued taking their medication prior to or during pregnancy. This was due to central nervous system-related disorders, and the increased risk of admission was not found to be influenced by the stimulant medication was used during pregnancy.
Women who used stimulant ADHD medication during pregnancy were also at an increased chance 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 used during pregnancy.
Researchers suggest that the minor risks posed by the use of ADHD medications in early pregnancies may be offset by the greater benefits for mother and baby of continuing treatment for the woman's disorder. Physicians should talk to their patients about this and as much as possible, assist them develop coping skills that could reduce the effects of her disorder on her daily functioning and her relationships.
Interactions with Medication
As more women than ever are being diagnosed with ADHD and being treated with medication, the dilemma of whether to keep or end treatment during pregnancy is one that more and more doctors confront. These decisions are frequently made without clear and reliable evidence. Instead, physicians must take into account their own experience, the experience of other doctors, and the research on the topic.
Particularly, the issue of potential risks for the infant can be difficult. A lot of studies on this issue are based on observations instead of controlled research and their conclusions are often contradictory. Additionally, the majority of studies limit their analysis to live births, which can underestimate the severity of teratogenic effects that could cause abortion or termination of the pregnancy. The study that is discussed in this journal club addresses these limitations by looking at data from both live and deceased births.
The conclusion is that while certain studies have demonstrated an association between ADHD medications and the possibility of certain birth defects, other studies have found no connection and the majority of studies have a neutral or slightly negative impact. As a result an accurate risk-benefit analysis must be done in each instance.
It can be difficult, if not impossible, for women suffering from ADHD to stop taking their medication. In a recent piece published in Archives of Women's Mental Health by psychologist Jennifer Russell, she notes that stopping ADHD medications during pregnancy can cause depression and feelings of loneliness. In addition, a decrease in medication can affect the ability to perform job-related tasks and drive safely that are crucial aspects of a normal life for a lot of people with ADHD.
She suggests that women who are not sure whether to take the medication or discontinue it due to pregnancy, educate their family members, coworkers and their friends about the condition, the effects on daily functioning, and the benefits of continuing the current treatment regimen. In addition, educating them can make the woman feel more comfortable when she is struggling with her decision. It is also worth noting that some drugs can be absorbed through the placenta so if the 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 transferred to the infant.
Birth Defects and Risk of
As the use and abuse of ADHD medication to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases, so does concern about the potential adverse effects of the drugs on fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge regarding this subject. Researchers used two huge datasets to analyze more than 4.3 million pregnancy and determine if the use of stimulant medications caused birth defects. Although the risk overall remains low, the scientists discovered that the first-trimester exposure to ADHD medicines was associated with an increase in the risk of specific heart defects, like ventriculo-septal defects (VSD).
The researchers of the study found no link between early use of medication and other congenital abnormalities, such as facial clefting or club foot. The results are in line with previous studies revealing an increase, but not significant, in the risk of developing cardiac malformations among women who started taking ADHD medications before the birth of their child. The risk was higher in the latter half of pregnancy, when a lot of women are forced to stop taking their ADHD medications.
Women who used ADHD medications during the first trimester of their pregnancies were also more likely to experience caesarean sections, a low Apgar score after delivery and a baby who required breathing assistance at birth. The researchers of the study were unable to remove bias in selection since they limited their study to women without other medical conditions that could have contributed to the findings.
Researchers hope that their study will help doctors when they see pregnant women. They suggest that although the discussion of the benefits and risks is important, the decision to stop or continue treatment should be based on each woman's requirements and the severity of her ADHD symptoms.
The authors also caution that even though stopping the medication is an alternative, it is not an option to consider due to the high prevalence of depression and other mental health problems in women who are pregnant or who are recently post-partum. Further, research shows that women who stop taking their medications will have a tough time adjusting to a life without them after the baby is born.
Nursing
It can be a challenge becoming a mother. Women suffering from ADHD are often faced with a number of difficulties when they have to manage their symptoms, attend doctor appointments and prepare for the birth of their child and adjust to a new routine. Many women choose to continue taking their ADHD medication during pregnancy.
The majority of stimulant drugs pass through breast milk in low amounts, so the risk for nursing infant is very low. However, the frequency of medication exposure to the newborn may differ based on dosage, how often it is administered, and the time of day the medication is administered. In addition, various drugs enter the infant's system via the gastrointestinal tract, or through breast milk. The impact of these medications on a newborn's health is not completely understood.
Some physicians may discontinue stimulant medication during a woman’s pregnancy due to the absence of research. It is a difficult decision for the mother, who must weigh the benefits of taking her medication as well as the risks to the embryo. Until more information becomes available, GPs can ask pregnant patients if they have any background of ADHD or if they plan to take medication during the perinatal stage.
Numerous studies have proven that women can continue taking their ADHD medication in a safe manner while breastfeeding and during pregnancy. In response, a growing number of patients are choosing to do so. They have found after consulting with their physicians that the benefits of keeping their current medication outweigh any possible risks.
Women with ADHD who plan to breastfeed should seek the advice of a specialist psychiatrist before becoming pregnant. They should review their medications with their prescriber and discuss the advantages and disadvantages of continued treatment, including non-pharmacological strategies. Psychoeducation should also be provided to help pregnant women suffering from ADHD understand their symptoms and underlying disorder Learn about the available treatment options and strengthen existing coping strategies. This should be a multidisciplinary effort with the GPs, obstetricians and psychiatry. Counselling for pregnancy should include discussion of a get more info management plan for both the mother as well as the child, as well as monitoring for signs of deterioration and when necessary, making adjustments to the medication regimen.