ADHD Medication and Pregnancy
Physicians often struggle to counsel patients on the safety of their ADHD medications during pregnancy. As long as research is not available, physicians must weigh the benefits of medication use during pregnancy against the possible dangers for children in each unique circumstance.
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, and clo), until they were diagnosed as having a developmental disorder, passed away or left the country.
Risk/Benefit Discussion
CAP Smart Take:
Doctors are concerned with the long-term effects exposure to drugs in utero can have, especially for centrally stimulating drugs such as those used to treat ADHD. It is essential that women receive adequate counseling from their doctors about the potential risks and benefits of using medication during pregnancy and before conception. In this CAP smart take we review the most recent research in this area and how they can inform the practice of a physician.
Previous animal studies and studies on illicit drug use suggest that stimulant drugs are passed to the fetus through the placenta and may adversely affect the development of the fetus and growth. However, there is a lack of information on how the fetus responds to dosages of prescribed stimulant medication during pregnancy and the majority of this evidence comes from single-arm studies that are not sufficiently powered to determine if there are significant correlations.
The most recent study by Cohen and colleagues stands out from the others, as it is the largest and most carefully controlled. The study comprised a sample of 364,012 pregnant women from the Danish Medical Registry, and information on medication use was obtained by analyzing prescriptions that were redeemed. Researchers excluded women who had taken SSRIs or clonidine because these drugs could interact with the fetal NMDA and increase the risk of developing neurodevelopmental disorders like autism and ADHD. The authors also modified their studies to take into account potential confounding factors as well as to take into account the timing of in utero exposure.
The results of this study and other small-scale trials suggest that the majority of women who continue using their stimulant medications prescribed to treat ADHD during pregnancy are not experiencing adverse effects on their fetuses. As best medication for adhd , it is likely that a large number of women will continue to take their medication for ADHD during pregnancy. It is essential for doctors to carefully weigh the risks and benefits of these drugs prior to giving their pregnant patients the advice to stop taking these medications. Regardless of which choice they make, it is crucial that pregnant women suffering from ADHD educate their spouses or their partners, extended family members, and employers about the decision they've made. This is because the symptoms of hyperactivity, inattention and impulsivity will likely be recurred once the mother stops taking her medication.
Pregnancy Tests
Preconception counseling should include a comprehensive program of management that includes both behavioural and pharmaceutical treatment and continuous monitoring during the perinatal stage. The plan should include a review of the current treatment regimens, particularly in the first trimester where risks of harm to the baby resulting from untreated ADHD are greatest. This should be a co-operative effort between psychiatry and primary care, as well as Obstetrics.
The discussion of risk/benefit should also address how a woman plans to manage her symptoms of ADHD during pregnancy, as well as the impact on family functioning as well as how she feels about discontinuing psychostimulant therapy in the early stages of pregnancy. This should be guided by a thorough analysis of evidence available, including consideration of the specific patient's needs and concerns.
The authors of a large study that examined children who were exposed to ADHD medications during utero concluded that "continuation use of psychostimulants during early pregnancy did not cause adverse birth outcomes and if anything, it was associated with less stress among mothers." However, their conclusion is not without a few limitations. The study did consider other aspects, including the length of time that stimulant medications were used as well as the dose and sociodemographics. There is no research controlled that studies the safety of continuing psychostimulant usage in nursing mothers.
There isn't a clear scientific data on the safety of ADHD medication during pregnancy. However, most doctors have a basic understanding of the research findings and will apply best practices in consultation to the specific needs of each patient. It is known, for instance, that infants born to mothers who are taking methylphenidate during the first trimester are more likely to have cardiac malformations (Cooper, et al. 2018). However this is based on a tiny study that didn't take into account the different patient demographics and underlying psychiatric conditions.
In a recent survey, ADDitude readers found that they were more likely to quit their ADHD medication in early pregnancy than in the past. Women who stopped taking psychostimulants during the first trimester showed a clinically significant rise in depression symptoms. They also reported being less capable of enjoying their pregnancy and rated their family functioning as being more difficult than women who maintained or increased their dosages of ADHD medication.
Work Functioning Test
The work function test is a vital aspect of the test in that it determines whether the candidate is able to perform their job. The test is designed for testing functional limitations. It includes graded material handling exercises (lifting at different levels, pulling and pushing) and positional tolerance exercises (sitting and standing as well as walking and balancing or stooping, kneeling and stooping), as well as specific tests. The test evaluator analyses the results to formulate the return-to-work conclusions. ROC curves are used to determine the point at which there is a minimum misclassification (MIC) for both the general and physical work ability and the work-functioning problem score.
The MIC is calculated using the COnsensus Standards for the Selection of Health Measurement Instruments Checklist (COSMIN). This method separates scores for general and physical work abilities and work-functioning issues, by answering an anchor question. This prevents any change in metrics from affecting the average.
Driving Test
The gold standard for treating ADHD is a psychostimulant drug. It helps reduce symptoms and improves functioning in other areas, including driving safety. If left untreated, severe ADHD can have serious financial and psychosocial consequences.
Psychotherapeutic interventions, such as cognitive behavior therapy (CBT) or "coaching" techniques have also been found to improve symptoms and enhance performance. These strategies can help women tailor their routines, and use their coping skills in ways that minimize the effects of ADHD on work and other aspects.
All of these aspects are important to consider when deciding whether or not to continue with psychostimulant therapy. As the most recent data available suggest, even though there is some concern regarding pregnancy outcomes with in utero exposure to stimulant medications, the risk is minimal and the outcomes are confounded by other medication, health treatment as well as physical and mental health and 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 disorder medication and long-term outcomes for offspring.