ADHD Medication and Pregnancy
Physicians often struggle to advise patients about the safety of their ADHD medication during pregnancy. In the meantime, until more research is available, physicians must weigh the advantages of using medication during pregnancy against the potential risks for offspring in each particular situation.
A recent study on a population-based cohort followed 898 babies born to women taking ADHD medications throughout pregnancy (stimulants: methylphenidate, amphetamine dexamphetamine, methylphenidate; non-stimulants: modafinil, atomoxetine, clonidine) until they were diagnosed with a developmental disorder, or died or left the country.
Risk/Benefit Discussion
CAP Smart Take
Doctors are concerned about the long-term effects that drug exposure in utero may have, especially for centrally stimulating medications like those used to treat ADHD. It is essential that women receive the appropriate advice from their doctors about the risk/benefit of using medication before conception and during pregnancy. In this CAP Smart Take, we review the most recent research in this area and how it can inform the clinical practice.
Animal studies and illicit drug research suggest that stimulant medications enter the fetus through the placenta, and may negatively affect fetal growth and development. There aren't many studies on the effects of prescription stimulant medications during pregnancy. The majority of evidence comes from studies conducted in case-control with one arm, which aren't strong enough to detect any significant connections.
The study conducted by Cohen and colleagues4 is distinctive because it is the most thorough and well-controlled. The study included 364,012 pregnancies that were retrieved from the Danish Medical Registry. Information on medication use was gathered by analyzing redeemed medications. Researchers excluded women who had taken SSRIs, clonidine or clonidine since these drugs could interact with the fetal NMDA and increase the risk of developing neurodevelopmental disorders like autism and ADHD. The authors modified their analysis in order to account for the timing of exposure as well as control for confounding factors.
The results of this study as well as other small-scale trials suggest that the vast number of women who continue to use their stimulant medication prescribed for ADHD during pregnancy do not experience adverse effects on their foetuses. Therefore, it is likely that many pregnant women will continue to use their ADHD medication. However, it is important that physicians carefully weigh the benefits and risks of these medications for pregnant patients, and be aware of the unique circumstances of each patient, before advising them to discontinue their medications. It is essential that pregnant women suffering from ADHD inform their parents as well as extended families and employers of the choice they've taken. It is because the symptoms of hyperactivity, inattention, and impulsivity are likely return when the mother stops taking her medication.
Pregnancy Tests
Preconception counseling should include an extensive management plan that includes both behavioral and medical treatment 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 harm to the baby from untreated ADHD are greatest. This should be a coordinated effort with obstetrics, psychiatry, and primary care.
The discussion of risks and benefits should also cover the way a woman plans to manage her ADHD symptoms during pregnancy, the effect of this on family functioning and her feelings about discontinuing psychostimulant treatment in the early stages. This should be guided by a thorough analysis of the available evidence, and consideration of the specific patient's needs and concerns.
The authors of a huge study that followed children who were exposed to ADHD medications while in utero concluded that "continuation psychostimulant use during the early stages of pregnancy was not associated with adverse birth outcomes and, if it was, it was associated with less stress among mothers." However their conclusion isn't without limitations. The study did not consider the importance of the dose of stimulant medication or the long it was used for, as well as other sociodemographic and clinical factors. Additionally, there isn't any controlled study that examines the safety of continuing use of psychostimulants in nursing mothers.
There isn't a clear scientific data concerning the safety of ADHD medication during pregnancy. However, the majority of doctors have a general knowledge of what research suggests and apply best practices in consultation with the specific needs of each patient. It is known, for example, that infants born to mothers who take methylphenidate in the first trimester are more likely suffer from cardiac malformations (Cooper, et al. 2018). However this is based on a tiny study that did not take into account differences in patient demographics and underlying psychiatric conditions.
In an earlier survey of ADDitude readers, they reported that they are more likely than ever before to quit taking their ADHD medication in the early stages of pregnancy. However, women who stopped taking psychostimulants during the first trimester of pregnancy noticed a clinically significant increase in symptoms of depression. They also reported that they were less capable of enjoying their pregnancy and rated their families functioning as less than those who maintained or increased their dosages of ADHD medications.
Work Functioning Test
The test of work function is an important part of the examination in that it determines whether a person can perform their job. The test is intended for the evaluation of functional limitations. adhd no medication includes a variety of graded material handling tasks (lifting at various levels, pulling and pushing), positional tolerance exercises (sitting and standing while walking, balancing and walking, stooping and kneeling) as well as specific tests. The test evaluator will review the results and formulate an appropriate return to a conclusion of the work. ROC curves are used to determine the point of minimum misclassification (MIC) for both physical and general work capability as well as the work-functioning score for a particular problem.
The MIC is calculated by using the COnsensus Standards for the Selection of Health Measurement Instruments Checklist (COSMIN). This method differentiates scores for general physical work capabilities and work-functioning problems by answering an anchor question. This prevents a shift in metrics from biasing the average.
Driving Test
Psychostimulant medication is a gold treatment for ADHD. It reduces symptoms and improves functioning in other areas, including driving safety. The effects of severe, untreated ADHD can have significant financial and psychosocial effects.
Psychotherapeutic interventions like cognitive behavioral therapy (CBT) and "coaching" strategies have also been proven to reduce symptoms and enhance functioning. These strategies can help women tailor their schedules and utilize their coping abilities in ways that minimize the effects of ADHD on work and other areas.
All of these aspects are crucial to take into consideration when deciding whether or not to continue psychostimulant therapy. The most reliable data available show that although there are concerns about the outcomes of pregnancy when in utero stimulant medication is used, the relative risks of this are minimal. The results are muddled by other medications, maternal healthcare utilization, maternal mental and physically health and the comorbidities. Bang Madsen K., Bliddal m., Skoglund cb., Larsson h., Munk-Olsen T., Hove Thomsen p., Bergink V. In-utero exposure to attention-deficit/hyperactivity medication and the effects on offspring.