Pregnancy and Narcolepsy: Potential Hazards and Preparations
Pregnancy can be a challenging time for anyone, but for those living with narcolepsy, it may present additional considerations. A recent study has shown that people with narcolepsy who have cataplexy might have higher rates of gestational diabetes, with 13.6% of people with narcolepsy having gestational diabetes compared to 4.3% without narcolepsy.
Fortunately, people with narcolepsy can give birth in the same way as others. However, there is a possibility of cataplexy happening during or after the birth. Pregnant individuals with narcolepsy may experience more intense symptoms than usual, and some may choose to have a C-section to schedule the birth and relieve fears about cataplexy during labor.
A study of 249 pregnant individuals in Europe found similar rates of pregnancy complications in those with narcolepsy as in the general population. However, it's essential to note that managing blood sugar levels with diet, lifestyle, and, if necessary, insulin can reduce the risk of complications.
When it comes to narcolepsy medications, the use of certain drugs during pregnancy appears to carry varied risks. For instance, modafinil and armodafinil are associated with a significantly increased risk of major congenital malformations. Studies indicate about a 12-13% rate of major malformations in infants with first-trimester exposure, which is notably higher than the 3-4% baseline risk in the general population. Reported defects include congenital torticollis, hypospadias, and congenital heart defects. Because of these risks, these medications are generally not recommended during pregnancy.
On the other hand, methylphenidate, another medication sometimes used in narcolepsy treatment, has not been linked to an increased risk of major birth defects or miscarriage in published studies and postmarketing reports. Animal studies showed no morphological development effects at doses up to 10-15 times the human dose, though very high doses caused some developmental issues not typically relevant to normal human use. There is a pregnancy exposure registry monitoring outcomes, indicating ongoing safety surveillance.
For amphetamines like Adderall, which are sometimes used off-label in narcolepsy, research suggests that while risks of congenital defects seem low, it is generally recommended to avoid use during pregnancy pending further research to guide clinical decisions. Adderall use carries additional risks such as raised blood pressure and potential side effects that may be exacerbated during pregnancy.
Given the limited data on narcolepsy medication safety during pregnancy, many sleep specialists advocate discontinuing or avoiding these drugs during conception, pregnancy, and breastfeeding. Behavioral therapies and coping strategies are often suggested as alternatives in pregnant women or those trying to conceive.
Developing a pregnancy and postpartum plan can help manage the transition to parenthood for people with narcolepsy. This plan may involve equitable division of child care tasks, hiring help, safe breastfeeding practices, taking naps, and discussing medication with a doctor. It is best to speak with a doctor before trying to conceive or as soon as possible if already pregnant to discuss the types of support needed and whether to stop taking narcolepsy medication.
In conclusion, managing narcolepsy during pregnancy requires careful consideration of the potential risks and benefits of various treatments. It is crucial to discuss these matters with a healthcare provider to ensure the best possible outcome for both the parent and the baby.
References: 1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7328287/ 2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6252839/ 3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6446337/ 4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6336603/ 5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7024777/
- In light of the increased risk of gestational diabetes for people with narcolepsy, managing blood sugar levels through diet and lifestyle changes, possibly with insulin, could be crucial during pregnancy to reduce complications.
- Despite concerns about the use of some narcolepsy medications during pregnancy, Pfizer's drug Methylphenidate has not been linked to an increased risk of major birth defects or miscarriage, suggesting it might be a safer option.
- Managing mental health and wellness is equally important for those with narcolepsy during pregnancy. Developing a pregnancy and postpartum plan, addressing mental health concerns, and seeking professional advice should be considered for a healthy pregnancy and parenthood experience.
