ADHD Medication and Pregnancy
Physicians often struggle to counsel patients on the safety of their ADHD medication during pregnancy. In the absence research, physicians must weigh up the benefits and risks of using medication during pregnancy.
A population-based study has followed 898 infants who were born to mothers who had taken ADHD medications during pregnancy (stimulants methylphenidate amphetamine 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
Physicians are concerned about the long-term effects of exposure to drugs during the uterus, especially to centrally stimulating medications such as those prescribed for ADHD. It is crucial that women receive proper counseling from their doctors about the potential risks and benefits of using medication during pregnancy and prior to conception. In this CAP Smart Take, we look at the most current research in this field and how it might inform the clinical practice.
Previous animal studies and illicit drug use research suggest that stimulant medications pass to the fetus through the placenta and may adversely affect the development of the fetus and growth. There are few data on the effects of prescription stimulant medications during pregnancy. The majority of evidence comes from studies conducted in case-control with a single arm, which aren't strong enough to identify any significant connections.
The study by Cohen and colleagues4 is unique because it is the most complete and meticulously controlled. The study covered 364,012 pregnancies that were retrieved from the Danish Medical Registry. Information regarding medication use was collected through the analysis of redeemed medications. my response excluded women who reported taking SSRI medications or clonidine as these drugs may interact with the fetal NMDA receptor and increase the risk of developing neurodevelopmental disorders such as autism and ADHD. The authors adjusted their analyses to take into account the timing of exposure as well as make sure that they control for confounding factors.
The results of this study and other studies show that the majority of women who continue using their stimulant medication prescribed for ADHD during pregnancy are not experiencing adverse effects on their foetuses. Therefore, it is likely that many women will continue to take their medications for ADHD during pregnancy. It is crucial for doctors to carefully weigh the risks and benefits of these medications prior to advising their pregnant patients to stop taking these medications. Regardless of which add adhd medications make, it is crucial that pregnant women suffering from ADHD inform their spouses or relatives, partners as well as their employers about the decision they have made. This is because symptoms of hyperactivity, inattention, and impulsivity are likely to return once the mother stops taking her medications.
Pregnancy Tests
Preconception counseling for women with ADHD who want to become pregnant should concentrate on a comprehensive management plan that includes both pharmacologic and behavioral treatment and continuous monitoring throughout the perinatal period. The plan should include a discussion of the current treatment regimens, specifically in the first trimester when risks of harm to the baby due to untreated ADHD are greatest. This should be a co-operative effort between psychiatry and primary care, as well as obstetrics.
The discussion of risks and benefits should also include the way a woman plans to manage her ADHD symptoms during pregnancy, the effects of this on family functioning and her feelings about a decision to stop psychostimulant treatment in the early stages. This should be based on a thorough evaluation of the evidence available and consider the individual needs of the patient and concerns.
In a recent large study that followed children exposed to ADHD medications during utero and concluded that "continuation of psychostimulant use during the early stages of pregnancy did not increase the risk of adverse birth outcomes, and if anything was associated with less stress for mothers." However this conclusion isn't without its flaws. The study did take into consideration other factors, such as the length of time that stimulant medication was taken, the dose and the sociodemographics. Moreover, there is no controlled research examining the safety of a continuous psychostimulant use in nursing mothers.
Although there is a dearth of scientifically substantiated evidence regarding the safety of ADHD medications during pregnancy, most physicians have a basic understanding of what the research suggests and employ the best practices while collaborating with the specific needs of each patient. It is well-known, for instance that infants born to mothers taking methylphenidate during the first trimester are more likely to have cardiac malformations (Cooper, et al. 2018). However, this finding is based on a comparatively small study that did not take into account differences in the demographics of patients and the underlying psychiatric conditions.
In a recent survey ADDitude readers found that they were more likely to discontinue their ADHD medication during the early stages of pregnancy than in the past. However, women who stopped taking psychostimulants in the first trimester of pregnancy noticed a clinically significant increase in the severity of depressive symptoms. They also reported feeling less than able to enjoy their pregnancy and described their family functioning as being more difficult than women who continued or increased their dosages of ADHD medication.
Work Functioning Test
The test for work function is an essential part of the test as it determines if a patient can perform their job duties. The test is designed to determine functional limitations. It includes graded material handling (lifting to different levels, pulling and pushing) as well as positional tolerance tests (sitting, standing, balancing, walking or stooping, kneeling, crawling) and other relevant specialized tests (hand manipulation). The test evaluator will review the results and formulate an appropriate return to the conclusion of the test. ROC curves are used to determine the point at which there is a minimum misclassification (MIC) for both physical and general work capability as well as the work-functioning problem score.
The MIC is calculated using the COnsensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. This method separates the scores of the physical and general work abilities and work-functioning issues based on an answer on an anchor question to prevent changes in the measurement from affecting the overall average.
Driving Test
Psychostimulant medications are a gold treatment for ADHD. It increases safety for drivers and decreases symptoms. Insufficiency due to severe, untreated ADHD can have significant 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 may aid women in adjusting their schedules and utilize their strategies to cope to minimize the effects of their ADHD on their work and other domains.
adhd medications for adults of these factors can be important considerations in the decision of whether to continue or stop psychostimulant therapy. The most reliable data available show that, despite concerns about pregnancy outcomes when in utero stimulant medications are used, the relative risks of this are small. Also, the results are muddled by other medications, maternal healthcare use and physical and mental health and other comorbidities. Bang Madsen K, Bliddal M, Skoglund CB, Larsson H, Munk-Olsen TL, Hove Thomsen P, Bergink V. In utero exposure to attention-deficit hyperactivity disorder medication and long-term outcomes for offspring.