ADHD Medication and Pregnancy
Physicians often struggle to advise patients about the security of their ADHD medications during pregnancy. Until more research is available, physicians must weigh the advantages of using medication during pregnancy against the possible risks for the offspring in each unique circumstance.
A recent cohort study of the population followed 898 babies born to mothers who were who were taking ADHD medications throughout pregnancy (stimulants amphetamine, methylphenidate dexamphetamine, methylphenidate; and non-stimulants such 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 exposure to drugs in utero may result in, especially for centrally stimulating drugs such as those used to treat ADHD. It is therefore critical that women receive appropriate medical advice from their doctors regarding the risks and benefits of taking medication prior to conception and throughout pregnancy. In this CAP smart take we examine the most recent research in this area and how they can inform the practice of a physician.
Animal studies and illicit drug research suggest that stimulant medication passes to the fetus via the placenta and can negatively affect fetal growth and development. However, there are limited data on how the fetus responds to the therapeutic doses of prescription stimulant medication during pregnancy and most of this evidence comes from single-arm studies that have not been sufficiently powered to determine if there are significant connections.
The study conducted by Cohen and colleagues4 is distinctive because it is the most thorough and well-controlled. The study comprised a sample of 364,012 births from the Danish Medical Registry, and data on the use of medication was gathered through the analysis of prescriptions that were redeemed. Researchers excluded women who had taken SSRIs or clonidine as these drugs could interfere with the fetal NMDA and increase the risk for neurodevelopmental disorders like autism and ADHD. The authors modified their analysis in order to account for the timing of exposure as well as make sure that they control for confounding factors.
The results of this study, along with the results of other trials, indicate that the vast majority of women who continue to take the stimulant medications prescribed for ADHD during pregnancy don't experience adverse effects on their foetuses. It is therefore likely that many women who are pregnant will continue to take their ADHD medication. But it is essential that doctors weigh the benefits and risks of these medications for their pregnant patients, and also consider each patient's unique situation, before suggesting they stop their medications. Whatever decision they make, it is essential that pregnant women suffering from ADHD educate their spouses or relatives, partners and employers about the choice they've made. It is because the signs of hyperactivity, inattention and impulsivity are likely to be re-present when the mother stops taking her medication.
Pregnancy Tests
Preconception counseling for women suffering from ADHD who are planning to become pregnant should focus on a comprehensive management plan that includes both pharmacologic and behavioral treatment and continuous monitoring throughout the period of perinatal care. The plan should include a discussion of the current treatment regimens, especially in the first trimester, when the chances of harming the baby due to untreated ADHD are highest. This should be a coordinated effort between obstetrics, psychiatry, and primary care.
The discussion of the risks and benefits should also include the way a woman plans to manage her ADHD symptoms during pregnancy, the effects of this on the family's functioning, and how she feels about stopping psychostimulant therapy in the initial stages. This should be based on a thorough evaluation of the available evidence and take into account the individual needs of the patient and concerns.
The authors of a massive study that followed children who were exposed to ADHD medications while in utero concluded that "continuation psychostimulant use during the early stages of pregnancy did not cause adverse birth outcomes and if anything, was associated with reduced stress among mothers." However their conclusion isn't without limitations. The study did not take into account the importance of the dosage of stimulant medication or the long it was used for, in addition to other factors related to sociodemographics and clinical. There is no controlled research that examines the safety of continuing psychostimulant usage in nursing mothers.
There isn't a clear research-based evidence regarding the safety of ADHD medication during pregnancy. However, most doctors have a general knowledge of the research findings and can apply the best practices when assessing each patient's specific needs. For example, it is well-known that there is a higher incidence of cardiac malformations in infants born to mothers who have taken methylphenidate during the first trimester of pregnancy (Cooper et al. (2018)), while it is important to note that this result was based on one small study that did not consider variations in the demographics of patients or underlying psychiatric co-morbidity.
In a recent study, ADDitude readers said that they were more likely to discontinue their ADHD medication during early pregnancy than they were in the past. Women who stopped taking psychostimulants during the first trimester noticed a clinically significant rise in depressive symptoms. They also reported being less capable of enjoying their pregnancy and rated their family functioning as less than those who maintained or increased their dosages of ADHD medications.
Work Functioning Test
The test for work function is an essential part of the exam since it will determine if the patient can perform their job tasks. The test is designed to assess functional limitations and include materials handling that is graded (lifting to different heights, pushing and pulling) and positional tolerance exercises (sitting, standing, balancing, walking and stooping, kneeling and crawling) and other relevant specialized tests (hand manipulation). The evaluator evaluates the results to formulate the return-to-work conclusions. ROC curves are used to show the point of minimum misclassification (MIC) for both the general and physical work capability as well as the work-functioning problem score.
The MIC is calculated according to the COnsensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. This method divides the scores of physical and general ability and work-functioning difficulties based on the answering an anchor question, to avoid any change in the measurement from affecting the overall average.
Driving Test
Psychostimulant medication is a standard treatment for ADHD. It helps reduce symptoms and improves functioning in work and other areas, such as driving safety. The effects of severe, untreated ADHD can have profound psychosocial and financial consequences.
Psychotherapeutic interventions, such as cognitive behavior therapy (CBT) or "coaching" techniques have also been found to help improve symptoms and increase performance. These strategies can assist women in adjusting their routines, and use their coping abilities to minimize their ADHD's impact on work and other aspects.
All of these factors can be significant considerations in the decision to continue or stop psychostimulant therapy. As the most recent data available suggest, even though there are some concerns about the outcomes of pregnancy after in utero exposure to stimulant medication, the relative risks are small, and the results are confounded by other medication, health care utilization as well as physical and mental health, and comorbidities. medication for adhd and anxiety , Bliddal m., Skoglund cb., Larsson h., Munk-Olsen T., Hove Thomsen p., Bergink V. In-utero exposure to attention deficit/hyperactivity disorder medication and its effects on offspring.