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https://www.iampsychiatry.uk/adult-adhd-medication/

ADHD Medication During Pregnancy and Breastfeeding Women with ADHD must make a difficult decision on whether to keep or stop taking ADHD medication during pregnancy and breastfeeding There are few data regarding how exposure over time may affect a pregnant fetus A recent study published in Molecular Psychiatry demonstrates that children exposed to ADHD medication during pregnancy do not develop neurological disorders such as impaired hearing or vision febrile seizures or IQ impairment The authors acknowledge that more highquality studies are required RiskBenefit Analysis Women who are expecting and taking ADHD medication should weigh the benefits of taking it against the potential dangers for the foetus Doctors dont have the data needed to make unequivocal recommendations however they can provide information on benefits and risks that can help pregnant women make informed decisions A study published in Molecular Psychiatry concluded that women who were taking ADHD medication during their early pregnancy were not at a higher risk of fetal malformations or structural birth defects I Am Psychiatry used a large populationbased study of case control to examine the prevalence of major structural defects in infants who were born to mothers who used stimulants during pregnancy Pediatric cardiologists clinical geneticists and other experts reviewed the cases in order to confirm that the classification was accurate and to reduce any bias However the study had its limitations In particular they were unable to separate the effects of the medication from the disorder at hand This makes it difficult to know whether the small associations observed in the exposed groups result from medication use or comorbidities that cause confusion In addition the researchers did not examine the longterm effects of offspring on their parents The study revealed that babies whose mothers took ADHD medication during pregnancy had a slightly higher risk of admission to the neonatal care unit NICU in comparison to those whose mothers did not take any medication during pregnancy or had quit taking the medication prior to or during pregnancy The reason for this was central nervous system disorders The increased risk of admission was not influenced by the stimulant medication used during pregnancy Women who were taking stimulant ADHD medications during pregnancy also had a higher chance of having to have an emergency caesarean section or having the baby was not scoring well on the Apgar scale less than 7 These increases appeared to be independent of the type of medication taken during pregnancy The research suggests that the low risk associated with the use of ADHD medications during the early stages of pregnancy may be offset by the greater benefits to both mother and child from continued treatment for the womans disorder Physicians should discuss the issue 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 Medication Interactions As more women than ever are being diagnosed with ADHD and treated with medication the dilemma of whether or not to end treatment during pregnancy is one that more and more doctors face These decisions are usually made without clear and reliable evidence Instead doctors must weigh their own knowledge and experience as well as the experiences of other doctors and the research on the topic The issue of risk to the infant can be difficult to determine The research on this subject is based on observations rather than controlled studies and the results are in conflict Most studies focus on live births which may underestimate the severity of teratogenic effects leading to abortions or terminations of pregnancy The study discussed in the journal club addresses these issues by examining both the data from deceased and live births The conclusion is that 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 show a neutral or even slightly negative impact In every case a careful analysis of the benefits and risks is required It can be difficult if not impossible for women suffering from ADHD to stop taking their medication In fact in a recent article in Archives of Womens 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 Furthermore a loss of medication can interfere with the ability to complete jobs and drive safely which are important aspects of daily life for many people with ADHD She suggests that women who arent sure whether to take the medication or discontinue it due to pregnancy educate family members coworkers and acquaintances about the condition the impact on daily functioning and the benefits of keeping the current treatment regimen It will also help a woman feel confident about her decision Certain medications can be passed through the placenta If a patient decides not to take her ADHD medication while breastfeeding its important to be aware that the drug could be transferred to the infant Birth Defects and Risk of As the use of ADHD medications to treat symptoms of attention deficit hyperactivity disorder ADHD grows as do concerns over the impact that these drugs might have on fetuses A study that was published in the journal Molecular Psychiatry adds to the body of information on this topic Utilizing two huge data sets researchers were able to look at more than 43 million pregnancies and determine whether stimulant medication use increased the risk of birth defects Although the risk overall remains low the scientists discovered that the firsttrimester exposure to ADHD medications was associated with an increased risk of certain heart defects such as ventriculoseptal defect VSD The authors of the study found no link between early medication use and congenital abnormalities like facial clefting or club foot The results are in line with previous studies that have shown the presence of a small but significant increase in the risk of cardiac malformations among women who began taking ADHD medications prior to the birth of their child The risk increased in the latter part of pregnancy when a lot of women stopped taking their medication Women who were taking ADHD medication during the first trimester were more likely to require a caesarean birth or have an insufficient Apgar after delivery and have a baby who needed help breathing at birth However the authors of the study were unable to eliminate selection bias by limiting the study to women who did not have other medical issues that could have contributed to the findings The researchers hope their study will aid in the clinical decisions of physicians who encounter pregnant women The researchers recommend that while discussing the risks and benefits are important the decision regarding whether or not to stop medication should be based on the severity of each womans ADHD symptoms and her needs The authors warn that even though stopping the medication is an option to think about it isnt advised due to the high rate depression and other mental disorders in women who are expecting or have recently given birth Additionally the research suggests that women who decide to stop their medications are more likely to have a difficult time getting used to life without them following the birth of their baby Nursing It can be a stressful experience becoming a mother Women with ADHD are often faced with a number of difficulties when they must deal with 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 for nursing infant is low because the majority of stimulant medications passes through breast milk in low amounts The rate of exposure to medication will vary based on the dosage and frequency of administration as well as the time of the day Additionally different medications are introduced into the babys system via the gastrointestinal tract or breast milk The impact on the health of a newborn isnt fully known Some doctors may stop taking stimulant medication during a womans pregnancy due to the absence of research This is a difficult choice for the patient who must balance the benefits of keeping her medication against the potential risks to the fetus In the meantime until more information is available GPs may ask pregnant patients whether they have a background of ADHD or if they intend to take medication during the perinatal phase A growing number of studies have proven that most women can safely continue their ADHD medication while they are pregnant and nursing In response a rising number of patients are opting to do this They have discovered in consultation with their doctor that the benefits of continuing their current medication far outweigh any possible risks Its important for women with ADHD who are contemplating breastfeeding to seek out a specialist psychiatrists guidance prior to becoming pregnant They should review their medications with their doctor and discuss the advantages and disadvantages of continuing treatment including nonpharmacological management strategies Psychoeducation is also necessary to help pregnant women suffering from ADHD be aware of the symptoms and the underlying disorder They should also be informed about treatment options and reinforce the coping mechanisms This should be an approach that is multidisciplinary including the GP obstetricians and psychiatry Pregnancy counseling should include discussion of a treatment plan for the mother and the child monitoring of signs of deterioration and if necessary adjustments to the medication regime