ADHD Medication and Pregnancy
Physicians often struggle to advise patients on the safety of their ADHD medication during pregnancy. In the absence of further research, doctors must weigh up the benefits and risks of using medication during pregnancy.
A study that was based on a population-based approach has followed 898 infants who were born to mothers who took ADHD medications during pregnancy (stimulants amphetamine methylphenidate dexamphetamine ; non-stimulants modafinil atomoxetine clonidine) 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 consequences of exposure to drugs in the uterus, specifically to centrally stimulating drugs like those used for ADHD. It is essential that women receive adequate counseling from their doctors about the 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 area and how they might guide the clinical practice.
Animal studies and illicit drug research suggests that stimulant drugs enter the fetus via the placenta, and may adversely affect the growth of the fetus and development. There aren't many data on the effects of prescription stimulant medications during pregnancy. The majority of evidence comes from studies conducted in case-control with one arm, which is not powerful enough to reveal any significant associations.
The most recent study by Cohen et al4 stands out from the others because it is the biggest and most carefully controlled. The study involved 364,012 births collected from the Danish Medical Registry. Information regarding medication use was collected through the analysis of redeemed medications. The researchers specifically excluded women who reported taking SSRI drugs or clonidine because these medications can interfere with the fetal NMDA receptor and increase the risk of developing neurodevelopmental disorders like autism and ADHD. The authors also modified their analyses to control for potential confounding factors as well as to take into account the timing of in-utero exposure.
Our Site of this study and other small-scale trials suggest that the majority of women who continue using their stimulant medications prescribed for ADHD during pregnancy don't experience adverse effects on their foetuses. Therefore, it is likely that a large number of women will continue to use their medication for ADHD during pregnancy. It is important for doctors to consider the benefits and risks of these medications before telling their patients during pregnancy to stop taking these medications. No matter what decision they make, it is essential that pregnant women suffering from ADHD inform their spouses, their partners, extended family members, and employers about the choice they have made. It is because the signs of hyperactivity, inattention, and impulsivity are likely to return if the mother ceases taking medication.
Pregnancy Tests
Preconception counseling for women suffering from ADHD who wish to become pregnant should concentrate on a comprehensive management plan that involves both behavioral and pharmacologic treatment and ongoing monitoring throughout the period of perinatal care. The plan should include a discussion of the current treatment regimens, especially during the first trimester when the risks of harming the baby due to untreated ADHD are the highest. This should be a coordinated effort between obstetrics, psychiatry, and primary care.
The discussion of the risks and benefits should also include how a woman intends to manage her ADHD symptoms during pregnancy, the impact of this on the family's functioning and her feelings about discontinuing psychostimulant treatment in the early stages. This should be based on a thorough review of evidence available, including consideration of the individual patient's needs and concerns.
In a study of recent magnitude that followed children exposed to ADHD medications during pregnancy The authors concluded that "continuation of use of psychostimulants in the early stages of pregnancy didn't increase the risk of adverse birth outcomes and, if anything, was associated with reduced maternal stress." However, this conclusion is not without its limitations. The study did take into consideration other factors such as the duration for which stimulant medications were used as well as the dose and sociodemographics. There is no controlled research that examines the safety of a continued use of psychostimulants by nursing mothers.
Although there is Our Site of clear scientific data on the safety of ADHD medications during pregnancy, many doctors have a basic understanding of what the current research suggests and employ the best practices in consultation with the individual needs of each patient. It is known, for instance, that infants born to mothers who are taking methylphenidate in the first trimester are more likely have cardiac malformations (Cooper, et al. 2018). However, this finding is based on a tiny study that did not take into account the different the demographics of patients and the underlying psychiatric conditions.
In an earlier survey of ADDitude readers, they found that they are more likely than ever before to stop taking their ADHD medication during early pregnancy. Women who stopped psychostimulants during the first trimester showed a clinically significant rise in depression symptoms. They also felt less able to enjoy pregnancy and described family functioning as more difficult than those who maintained their dosage of ADHD medication or increased it.
Work Functioning Test
The test for work function is a crucial part of the examination in that it determines whether an individual is able to carry out their duties. The test is designed to assess functional limitations. It includes materials handling that is graded (lifting to different levels, pushing and pulling), positional tolerance activities (sitting in a chair, standing in a balancing position, walking, stooping, kneeling, crawling) and other relevant specialized tests (hand manipulation). The evaluator analyzes the results to formulate the return-to-work conclusions. ROC curves can be used to determine the point of minimal classification (MIC) in the general work capability physical work capability 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 is able to separate the scores of physical and general work abilities and work-functioning issues based on an answering an anchor question to prevent any change in the metric from biasing the overall average.
Driving Test
The gold standard for treating ADHD is psychostimulant medications. It increases safety for drivers and decreases symptoms. If left untreated, severe ADHD can have significant financial and psychosocial consequences.
Psychotherapeutic interventions like cognitive behavioral therapy (CBT) and "coaching" strategies have also been proven to reduce symptoms and enhance functioning. These strategies can assist women in adjusting their schedules and utilize their coping abilities in ways that minimize the effects of ADHD on work and other aspects.
All of these factors are important to consider when deciding whether or not to pursue psychostimulant therapy. As the most recent data available indicate, although there is some concern regarding the outcomes of pregnancy after in utero exposure to stimulant medication, the relative risks are small and the outcomes are affected by other medication, health treatment and physical and mental health, and other 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.