7 Small Changes That Will Make A Big Difference In Your ADHD Medication Pregnancy
7 Small Changes That Will Make A Big Difference In Your ADHD Medication Pregnancy
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ADHD Medication During Pregnancy and Breastfeeding
Women suffering from ADHD have to make a difficult choice on whether to keep or stop taking ADHD medication during pregnancy and breast-feeding. There aren't many studies on how long-term exposure may affect a foetus.
A recent study published in Molecular Psychiatry shows that children exposed to ADHD medication in the uterus do not develop neurological disorders such as impaired vision or hearing seizures, febrile seizures or IQ impairment. The authors acknowledge that further high-quality studies are needed.
Risk/Benefit Analysis
Pregnant women who take ADHD medications need to balance the benefits of taking them against potential risks to the foetus. Physicians do not have the information needed to make unequivocal recommendations however they can provide information regarding risks and benefits that help pregnant women make informed decisions.
A study published in Molecular Psychiatry found that women who were taking ADHD medications in early pregnancy did not have a significantly increased risk of fetal cardiac malformations or major birth defects that are structural. The researchers used a large population-based study of case-control to determine the prevalence of major structural birth defects in infants born to mothers who had taken stimulants in early pregnancy and those who had not. Pediatric cardiologists and clinical geneticists looked over the cases to ensure accurate case classification and to minimize the chance of bias.
However, the study was not without its flaws. Researchers were unable, in the first place to distinguish the effects triggered by the medication from the disorder. This makes it difficult for researchers to determine if the few associations observed between the groups that were exposed to the use of medication or if they were caused by the presence of comorbidities. Additionally the researchers did not study the long-term outcomes of offspring.
The study found that babies whose mothers had taken ADHD medication during pregnancy had a slightly greater risk of being admitted to the neonatal care unit (NICU) as compared to those whose mothers did not use any medication during pregnancy or had stopped taking their medication before or during pregnancy. This was due to central nervous system disorders. The increased risk of admission was not affected by the stimulant medications used during pregnancy.
Women who were taking stimulant ADHD medications during pregnancy also had a higher likelihood of having to have an emergency caesarean section or having a baby that scored low on the Apgar scale (less than 7). These increases did appear to be independent of the type of medication used during pregnancy.
Researchers suggest that the small risks posed by the use of ADHD medication during pregnancies in the early stages may be offset by the greater benefits for baby and mother of continued treatment for the woman's disorder. Physicians should discuss the issue with their patients and, if they are able, assist them in developing strategies to improve their coping abilities that can lessen the effects of her disorder on her daily functioning and relationships.
Medication Interactions
More and more doctors are faced with the decision of whether to keep treatment or stop as more women are diagnosed with ADHD. These decisions are frequently taken without clear and authoritative evidence. Instead, doctors must weigh their own knowledge in conjunction with the experiences of other physicians and the research on the topic.
Particularly, the subject of potential risks for the baby can be tricky. Many of the studies on this topic are based on observations rather than controlled research and their conclusions are often contradictory. In addition, most studies limit their analysis to live births, which could underestimate severe teratogenic effects that lead to abortion or termination of the pregnancy. The study discussed in this journal club addresses these limitations by looking at data from both live and deceased births.
Conclusion Some studies have found a positive correlation between ADHD medications and certain birth defects However, other studies haven't found a correlation. The majority of studies show a neutral, or even slight negative effect. In each case an in-depth analysis of the potential risks and benefits is required.
It can be challenging, if not impossible for women suffering from ADHD to stop taking their medication. In fact, in an article recently published in the Archives of Women's Mental Health psychologist Jennifer Russell notes that stopping ADHD medication during pregnancy can increase depression, feelings of loneliness, and family conflict for patients with ADHD. A loss of medication may also affect the ability to drive safely and to perform work-related tasks which are crucial aspects of everyday life for those with ADHD.
She recommends that women who are unsure about whether or not to stop medication in light of their pregnancy consider informing family members, friends, and coworkers on the condition, its impact on daily functioning, and the advantages of staying on the current treatment plan. In addition, educating them can make the woman feel more comfortable when she is struggling with her decision. Some medications can pass through the placenta. If a woman decides to stop taking her ADHD medication while pregnant and breastfeeding, it is Iam Psychiatry crucial to be aware that the drug could be passed on to her infant.
Risk of Birth Defects
As the use of ADHD medications to treat symptoms of attention deficit hyperactivity disorder (ADHD) increases there are concerns about what impact the drugs could have on fetuses. Recent research published in the journal Molecular Psychiatry has added to the body of knowledge on this subject. Using two massive data sets researchers were able to examine more than 4.3 million pregnancies and see whether stimulant medication use increased the risk of birth defects. Although the risk overall remains low, the scientists did find that first-trimester exposure to ADHD medications was linked to an increase in the risk of certain heart defects like ventriculo-septal defects (VSD).
The authors of the study didn't discover any link between early use of medication and congenital anomalies such as facial deformities or club feet. The results are in line with previous studies which showed a small, but significant increase in the number of cardiac malformations among women who started taking ADHD medication prior to the birth of their child. The risk increased in the latter stages of pregnancy, when a lot of women decided to stop taking their medication.
Women who took ADHD medication during the first trimester were more likely to require a caesarean delivery, have an insufficient Apgar after delivery, and had a baby that required breathing assistance after birth. However the researchers of the study were unable to eliminate selection bias by restricting the study to women who didn't have any other medical conditions that could be a contributing factor to these findings.
The researchers hope that their research will aid in the clinical decisions of physicians who treat pregnant women. They recommend that, while the discussion of the benefits and risks is important however, the decision to stop or maintain medication should be based on each woman's needs and the severity of her ADHD symptoms.
The authors also advise that, while stopping the medication is an alternative, it is not a recommended practice because of the high rate of depression and other mental health issues in women who are pregnant or postpartum. Further, the research suggests that women who decide to stop their medications are more likely to experience a difficult time adjusting to life without them following the baby's arrival.
Nursing
The responsibilities that come with being a new mom can be overwhelming. Women who suffer from ADHD who have to deal with their symptoms while attending physician appointments, preparing for the arrival of their child and adjusting to new household routines can experience severe challenges. Many women choose to continue taking their ADHD medication during pregnancy.
The majority of stimulant drugs pass through breast milk in very small quantities, so the risk to the breastfeeding infant is minimal. However, the rate of exposure to medication by the newborn can vary depending on dosage, how often it is administered, and at what time the medication is administered. Additionally, different medications are introduced into the baby's system via the gastrointestinal tract or through breast milk. The impact on the health of a newborn is not completely understood.
Because of the lack of evidence, some doctors may be inclined to discontinue stimulant medications during the course of pregnancy. This is a complicated decision for the patient, who must balance the benefits of continuing her medication against the potential dangers to the embryo. Until more information is available, doctors should ask all pregnant patients about their history of ADHD and if they are planning or taking to take medication during the perinatal time.
Numerous studies have proven that women can continue to take their ADHD medication without risk during pregnancy and breast-feeding. As a result, an increasing number of patients opt to do this and, in consultation with their doctor they have discovered that the benefits of keeping their current medication far outweigh any potential risks.
It's important for women with ADHD who are considering breastfeeding to seek out a specialist psychiatrist's advice prior to becoming pregnant. They should review their medications with their physician and discuss the pros and cons of continued treatment, including non-pharmacological management strategies. Psychoeducation is also required to help pregnant women with ADHD understand the symptoms and the underlying disorder. They should also be educated about treatment options and reinforce coping mechanisms. This should be a multidisciplinary approach with the GPs, obstetricians and psychiatrists. Pregnancy counselling should include 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.