ADHD Medication and Pregnancy
Physicians struggle to provide accurate information on the safety of ADHD medications during pregnancy. As long as research is not available, doctors must weigh the benefits of using medication during pregnancy against the potential dangers for children in each particular situation.
A population-based study has tracked 898 babies who were born to mothers who took ADHD medications during pregnancy (stimulants amphetamine methylphenidate dexamphetamine ; non-stimulants modafinil, atomoxetine, and clo) until they were diagnosed as having an underlying disorder of development, passed away, or left the country.
Risk/Benefit Discussion
CAP Smart Take
Doctors are concerned with the long-term effects that drug exposure during pregnancy can have, especially for centrally stimulating medications such as those used to treat ADHD. It is crucial that women receive appropriate counseling from their physicians about the risks and benefits of taking medication before conception and during pregnancy. In this CAP smart approach, we examine the most recent data in this area and how they could influence the clinical practice.
Animal studies and illicit drug research have suggested that stimulant medications enter the fetus via the placenta, and could negatively affect fetal growth and development. However, there are limited information on the response of the fetus to therapeutic doses of prescription stimulant medication during pregnancy, and most of this evidence is based on single-arm studies that have not been sufficiently powered to determine if there are significant connections.
The study by Cohen and colleagues4 is unique because it is the most thorough and meticulously controlled. The study covered 364,012 pregnancies taken from the Danish Medical Registry. Information on medication use was gathered by analyzing redeemed medications. The researchers specifically excluded women who had reported taking SSRI medications or clonidine because these medications can interfere with the fetal NMDA receptor and increase the risk of developing neurodevelopmental disorders such as autism and ADHD. The authors also modified their analysis to account for potential confounding factors as well as to account for the timing of in utero exposure.
The data from this study, along with the results of other limited studies, show that the vast majority of women who continue to take the stimulant medications prescribed for ADHD during pregnancy do not experience any adverse effects on their fetuses. Therefore, it is likely that a lot of women will continue to take their medications for ADHD during pregnancy. It is essential for doctors to consider the risks and benefits of these drugs prior to advising their pregnant patients to stop taking the medications. Whatever decision they make, it is vital that pregnant women with ADHD inform their spouses or partners, extended family members as well as their employers about the decision they have made. This is because signs of inattention, hyperactivity, and impulsivity will likely come back once the mother stops taking her medications.
Pregnancy Tests
Preconception counseling for women suffering from ADHD who want to become pregnant should concentrate on a comprehensive plan of management that incorporates both pharmacologic and behavioral treatments and ongoing monitoring throughout the perinatal period. The plan should include a discussion of the current treatment regimens, specifically in the first trimester where the risks of harming the baby because of untreated ADHD are the highest. This should be a collaborative effort between primary care and psychiatry, as well as the obstetrics department.
The discussion of the risks and benefits should also cover how a woman will manage her ADHD symptoms during pregnancy, the effect of this on the family's functioning and her feelings about stopping psychostimulant therapy in the initial stages. This should be informed by a thorough review of evidence available, including consideration of the individual patient's requirements and concerns.
The authors of a huge study that examined children who were exposed to ADHD medication during pregnancy concluded that "continuation use of psychostimulants during early pregnancy did not cause adverse birth outcomes and if anything, was associated with lower stress levels among mothers." However the conclusion they reached is not without limitations. The study didn't consider the importance of the dosage of stimulant medication and how long it was used, as well as other sociodemographic and clinical variables. There is also no research conducted that is controlled and examines the safety of continuing use of psychostimulants by nursing mothers.
Although there is a dearth of evidence-based research on the safety of ADHD medication during pregnancy, many doctors are aware of what the current literature suggests and use best practices while collaborating with the individual needs of each patient. It is known, for instance that babies born to mothers taking methylphenidate in the first trimester are more likely suffer from cardiac malformations (Cooper, et al. 2018). However this conclusion is based on a tiny study that did not consider the differences in the demographics of patients and the underlying psychiatric conditions.
In an earlier survey of ADDitude readers, they revealed that they are more likely than ever to stop taking their ADHD medication during early pregnancy. However, women who discontinued psychostimulants within the first trimester of pregnancy experienced an increase in the severity of depressive symptoms. They also felt less able to enjoy pregnancy and rated family functioning as more difficult than those who remained on their dose of ADHD medication or increased it.
Work Functioning Test
The test of work function is an essential part of the examination as it will determine if the patient is able to perform their tasks. The test is designed to assist in testing functional limitations. It includes graded material handling exercises (lifting at different heights, pulling and pushing) and tests for positional tolerance (sitting and standing while walking, balancing and walking, stooping and kneeling) as well as tests that are specialized. The evaluator analyzes the results to form a return-to-work conclusion. ROC curves are used to illustrate the point of minimal misclassification (MIC) for both the general and physical work ability and the work-functioning problem score.
The MIC is calculated by using the COnsensus Standards for the Selection of Health Measurement Instruments Checklist (COSMIN). This method separates the scores of the physical and general work abilities and work-functioning problems score by answer on an anchor question to prevent a change in measure from affecting the overall average.
Driving Test
The gold standard for treating ADHD is psychostimulant medication. It increases safety for drivers and decreases symptoms. Impairment due to severe untreated ADHD can have serious psychosocial and financial consequences.
Psychotherapeutic interventions like cognitive behavioral therapy (CBT) and "coaching" strategies have also been shown to improve symptoms and enhance functioning. These strategies can help women tailor their schedules and utilize their coping skills in ways that minimize the impact of ADHD on their work and other aspects.
All of these aspects can be important considerations in the decision to continue or end psychostimulant treatment. buy adhd medication uk show, while there are some concerns about the effects of pregnancy on outcomes after in-utero exposure to stimulant medications, the risk is minimal, and the results are affected by other medications, maternal health care utilization, maternal mental and physical health and the comorbidities. Bang Madsen K., Bliddal m., Skoglund cb., Larsson h., Munk-Olsen t., Hove Thomsen p., Bergink V. In-utero exposure of attention-deficit/hyperactivity disorder medication and offspring outcomes.