ADHD Medication and Pregnancy
Physicians are unable to provide accurate information on the security of ADHD medications during pregnancy. As long as research is not available, physicians must weigh the advantages of using medication during pregnancy against the possible dangers for children in each individual situation.
A population-based study has followed 898 infants who were born to mothers who were taking ADHD medications during pregnancy (stimulants amphetamine methylphenidate dexamphetamine ; non-stimulants modafinil atomoxetine clonidine), until they were diagnosed as having a developmental disorder, died, or left the country.
Risk/Benefit Discussion
CAP Smart Take:
Doctors are concerned about the long-term effects exposure to drugs in utero can be a source of harm, particularly for centrally stimulating drugs such as those used to treat ADHD. It is crucial that women receive adequate guidance from their physicians about the dangers and benefits of taking medications during pregnancy and prior to conception. In this CAP smart take, we look at the most current data in this area and how they can inform clinical practices.
Previous animal studies and studies on illicit drug use indicate that stimulant medication passes to the fetus through the placenta and can adversely affect the development of the fetus and growth. However, there are limited data regarding the way that the fetus reacts to dosages of prescribed stimulant medication during pregnancy, and the majority of this data comes from single-arm case-control studies that have been underpowered to detect possible significant connections.
The study conducted by Cohen and colleagues4 is distinctive because it is the most thorough and well-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, 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 modified their analysis to take into account the timing of exposure as well as take into account confounding factors.
The results of this study as well as other limited trials indicate that the vast number of women who continue to take their stimulant medications 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. But it is essential that physicians carefully weigh the benefits and risks of these medications for their pregnant patients, and be aware of the unique circumstances of each patient before suggesting they stop their medication. No matter what decision they make, it is crucial that pregnant women suffering from ADHD inform their spouses, their partners, extended family members and employers about the decision they have made. This is because the signs of inattention, hyperactivity, and impulsivity are likely be re-present when the mother stops taking her medication.
Pregnancy Tests
Preconception counseling for women with ADHD who are planning to become pregnant should focus on a comprehensive management plan that involves both pharmacologic and behavioral treatment and continuous monitoring throughout the postnatal period. The plan should include a discussion about the current treatment regimens, especially in the first trimester, when the risk of harming the baby due to untreated ADHD are the highest. Suggested Studying should be a co-operative effort between psychiatry and primary care, as well as obstetrics.
The risk/benefit discussion should also discuss how a woman intends to manage her symptoms of ADHD during pregnancy, as well as the impact on family functioning and how she would feel about a decision to stop psychostimulant therapy in the beginning of pregnancy. This should be based upon an exhaustive review of the available evidence and take into account the individual needs of the patient and concerns.
The authors of a massive study that examined children who were exposed 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 reduced stress among mothers." However the conclusion they reached is not without limitations. The study did not take into account the importance of the dosage of stimulant medication, nor the long it was used for, in addition to other sociodemographic and clinical variables. There is also no research controlled that studies the safety of continuing use of psychostimulants by nursing mothers.
There isn't a clear evidence from a scientific study regarding the safety of ADHD medication during pregnancy. However, most doctors have a general knowledge of the research findings and will apply best practices when assessing each patient's individual needs. For example, it is known that there is a higher rate of cardiac malformations among babies born to mothers who take methylphenidate within the first trimester of pregnancy (Cooper and co., 2018) However, it is important to remember that this result was based on a single study and did not account for variations in the demographics of patients or the underlying psychiatric co-morbidity.
In a recent survey of ADDitude readers, they found that they are more likely than ever before to quit taking their ADHD medication during the first trimester of pregnancy. However, women who stopped psychostimulants during the first trimester of pregnancy experienced an increase in the severity of depressive symptoms. They also found themselves less able enjoy pregnancy and described family functioning as more difficult than those who continued to take their dose of ADHD medication or increased it.
Work Functioning Test
The test for work function is a vital aspect of the test in that it determines whether the candidate is able to perform their duties. The test is designed for evaluating functional limitations. It includes a variety of graded material handling tasks (lifting at different levels, pulling and pushing) as well as postureal tolerance exercises (sitting and standing while walking, balancing and walking or stooping, kneeling and stooping), as well as specific tests. The examiner will analyse the results and come up with a return to a conclusion of the work. ROC curves can be used to determine the point of minimal classification (MIC) in the general work capability, the physical work ability, and the work-functioning problems score.
The MIC is calculated 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 problems score by answering an anchor question, to avoid changes in the metric from biasing the overall average.
Driving Test
Psychostimulant medication is a gold treatment for ADHD. It helps reduce symptoms and improves functioning in other domains, notably driving safety. Impairment due to severe untreated ADHD can have significant financial and psychosocial consequences.
Psychotherapeutic treatments, like cognitive behavior therapy (CBT) or "coaching" techniques have been found to reduce symptoms and improve performance. These strategies can help women tailor their routines, and use their coping abilities to minimize the effects of ADHD on work and other areas.
All of these factors are important to consider when deciding whether or not to continue psychostimulant therapy. As the best available data show, while there is some concern regarding the effects of pregnancy on outcomes after in-utero exposure to stimulant medications the risks are minimal, and the results are affected by other treatments, maternal health care utilization as well as 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.