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Why No One Cares About ADHD Medication Pregnancy
ADHD Medication During Pregnancy and Breastfeeding
Women suffering from ADHD face a difficult decision about whether to continue or stop taking ADHD medication during pregnancy and breastfeeding. There isn't much information on how long-term exposure to these medications can affect the fetus.
A study recently published in Molecular Psychiatry shows that children exposed to ADHD medication during utero do not develop neurological developmental disorders like 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 benefits of taking them against the potential risks to the fetus. Doctors don't have enough data to make unambiguous recommendations however they can provide information about risks and benefits to assist pregnant women to make informed choices.
A study published in Molecular Psychiatry concluded that women who took ADHD medication in early pregnancy did not have a greater risk of fetal malformations, or structural birth defects. Researchers used a vast population-based case-control study to assess the risk of major structural birth defects in infants born to mothers who had taken stimulants during early pregnancy, and those who did not. Clinical geneticists, pediatric cardiologists and other experts looked over the cases to make sure that the classification was correct and to reduce any bias.
The study conducted by the researchers had some limitations. Most important, they were unable to separate the effects of the medication from the effects of the disorder that is underlying. This limitation makes it difficult to know whether the small associations observed in the groups that were exposed are due to the use of medication or confounding by comorbidities. The researchers also did not look at the long-term effects for the offspring.
The study found that infants whose mother took ADHD medication during pregnancy were at a slightly higher chance of being admitted to the neonatal care unit (NICU) in comparison to mothers who didn't take any medication during pregnancy or discontinued taking their medication prior to or during pregnancy. This was due to central nervous system disorders, and the higher risk of admission was not found to be influenced by which stimulant medications were taken during pregnancy.
Women who took stimulant ADHD medications during pregnancy also had a higher risk of having an emergency caesarean section or having the baby was not scoring well on the Apgar scale (less than 7). These increases appear to be unrelated to the type of medication taken during pregnancy.
The researchers suggest that the risk of a small amount with the use of ADHD medications during the early stages of pregnancy may be offset by the higher benefit to both the mother and child from continued treatment for the woman's disorder. Physicians should talk to their patients about this issue and try to help them develop coping strategies that could reduce the impact of her disorder in her daily life and relationships.
Interactions with Medication
As more women than ever are being diagnosed with ADHD and being treated with medication, the issue of whether to continue or stop treatment during pregnancy is one that more and more physicians have to face.
medication for adhd are usually made without clear and authoritative evidence. Instead, physicians must consider their own expertise and experience, as well as the experiences of other doctors and the research on the subject.
The issue of risk for infants can be difficult to determine. The research that has been conducted on this topic is based on observation rather than controlled studies and a lot of the results are in conflict. The majority of studies focus on live births, which can underestimate the severity of teratogenic effects that can lead to abortions or terminations of 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 The conclusion: While certain studies have demonstrated a positive association between ADHD medications and the risk of certain birth defects, others have not found any evidence of a link, and most studies have a neutral or slightly negative impact. In the end, a careful risk/benefit assessment is required in every instance.
For women suffering from ADHD, the decision to stop 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 cause depression and feelings of being isolated. Additionally, the loss of medication can affect the ability to do job-related tasks and drive safely which are essential aspects of a normal life for many people suffering from ADHD.
She suggests that women who are not sure whether to take the medication or stop due to pregnancy, educate their family members, coworkers, and acquaintances about the condition, the effects on daily functioning, and the benefits of keeping the current treatment. It can also aid in ensuring that the woman feels supported as she struggles with her decision. It is important to remember that certain drugs can pass through the placenta, therefore, if a patient decides to stop her ADHD medication during pregnancy and breastfeeding, she should be aware that the effects of the medication could be transferred to the child.
Birth Defects and Risk of
As the use of ADHD medications to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases, so do concerns over the impact that these drugs might have on foetuses. Recent research published in the journal Molecular Psychiatry has added to the body knowledge on this topic. Utilizing two huge data sets researchers were able to look at more than 4.3 million pregnancies and determine whether stimulant medications increased the risk of birth defects. Researchers discovered that, while the overall risk is low, first-trimester ADHD medication use was associated with slightly higher risk of specific heart defects such as ventriculoseptal defect.
The researchers of the study found no association between the use of early medications and other congenital abnormalities, like facial clefting, or club foot. The results are in agreement with previous studies that have shown a small, but significant increase in cardiac malformations for women who started taking ADHD medication before the birth of their child. This risk increased in the later part of pregnancy, when many women decide to stop taking their ADHD medications.
Women who were taking ADHD medication during the first trimester were more likely to need a caesarean and also have a low Apgar after delivery, and had a baby that required help breathing when they were born. However the researchers of the study were not able to eliminate bias due to selection by limiting the study to women who did not have other medical issues that could have contributed to the findings.
Researchers hope that their research will inform physicians when they encounter pregnant women. They suggest that although the discussion of the benefits and risks is important but the decision to stop or maintain medication must be based on each woman's requirements and the severity of her ADHD symptoms.
The authors also caution that while discontinuing the medications is an alternative, it is not an option to consider due to the high incidence of depression and other mental health problems among women who are pregnant or recently post-partum. Further, research shows that women who stop taking their medications will have a difficult adjustment to life without them once the baby is born.
Nursing
The responsibilities that come with being 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 new routines. Many women choose to continue taking their ADHD medication during pregnancy.
The majority of stimulant drugs are absorbed by breast milk in very small amounts, so the risk to the breastfeeding infant is minimal. The rate of medication exposure will vary based on the dosage, frequency of administration and the time of the day. In addition, different medications enter the baby’s system via the gastrointestinal tract, or through breast milk. The impact of these medications on the health of a newborn isn't completely comprehended.
Due to the absence of research, some doctors may be inclined to discontinue stimulant medications during the pregnancy of a woman. This is a difficult choice for the patient, who must balance the benefits of keeping her medication against the possible dangers to the fetus. In the meantime, until more information is available, GPs can inquire about pregnant patients if they have a background of ADHD or if they plan to take medication in the perinatal period.
Numerous studies have proven that women can continue to take their ADHD medication in a safe manner during pregnancy and while breast-feeding. In response, a growing number of patients are choosing to do this. They have discovered, in consultation with their physicians, that the benefits of retaining their current medication outweigh risk.
Women who suffer from ADHD who plan to breastfeed should seek advice from a specialist psychiatrist before becoming pregnant. They should discuss their medication with their prescriber, and the pros and cons of continuing treatment. This includes non-pharmacological strategies. Psychoeducation is also needed to help pregnant women with ADHD recognize the signs and underlying disorder. They should also be informed about treatment options and build strategies for coping. This should be a multidisciplinary process 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, monitoring for signs of deterioration and the need for adjustments to the medication regimen.
