ADHD Medication and Pregnancy
Physicians are unable to provide accurate information on the security of ADHD medications during pregnancy. In the absence of more research, doctors must weigh up the benefits and risks of taking medication during pregnancy.
A recent cohort study of the population followed 898 babies born to women who were taking ADHD medications throughout pregnancy (stimulants: methylphenidate, amphetamine dexamphetamine, methylphenidate; non-stimulants: modafinil, atomoxetine, and clonidine) until they were diagnosed with a developmental disorder, or passed away or left the country.
Risk/Benefit Discussion
CAP Smart Take:
Physicians are concerned about the long-term effects of exposure to drugs during the uterus, especially to centrally stimulating medications like those used to treat ADHD. It is important that women receive proper counseling from their doctors about the dangers and benefits of taking medication during pregnancy and prior to conception. In this CAP Smart Take, we review the most recent research in this area and how it could guide the practice of a physician.
Animal studies and illicit drug research suggest that stimulant medications enter the fetus via the placenta, and could negatively affect fetal growth and development. There aren't many data on the effects of prescription stimulant medications during pregnancy. The majority of the evidence comes from case-control studies with one arm, which aren't strong enough to detect any significant associations.
The study conducted by Cohen and colleagues4 is unique because it is the most thorough and well-controlled. The study comprised a representative sample of 364,012 pregnancies from the Danish Medical Registry, and information on medication use was gathered by analyzing prescriptions that were redeemed. The researchers specifically excluded women who reported taking SSRI medications or clonidine since these drugs can interact with the fetal NMDA receptor and increase the risk of developing neurodevelopmental disorders like autism and ADHD. The authors also adjusted their analysis to account for possible confounding factors and to account for the timing of in-utero exposure.
The results of this study as well as other small-scale trials suggest that the majority of women who continue using their stimulant medication prescribed for ADHD during pregnancy are not experiencing adverse effects on their fetuses. As a result, it is likely that a large number of women will continue to take their medications for ADHD during pregnancy. However, add adhd medications is crucial that doctors weigh the benefits and risks of these medications for their pregnant patients, as well as take into consideration the individual circumstances of each patient, before suggesting they stop their medication. Whatever decision they make, it is essential that pregnant women suffering from ADHD educate their spouses or partners, extended family members and employers about the choice they've made. This is because the symptoms of hyperactivity, inattention, and impulsivity will likely come back after the mother ceases taking her medications.
Pregnancy Tests
Preconception counseling should consist of a comprehensive program of management that incorporates both behavioral and pharmaceutical treatments, as well as ongoing monitoring throughout the perinatal period. The plan should include a discussion of current medication regimens, especially in the first trimester where risks of harm to the baby resulting from untreated ADHD are greatest. This should be a joint effort with obstetrics, psychiatry and primary care.
The risk/benefit discussion should also address how a woman plans to manage her symptoms of ADHD during pregnancy, as well as the impact on family functioning and how she would feel about stopping psychostimulant treatment in the beginning of the pregnancy. This should be based on an exhaustive review of the available evidence and be mindful of the individual needs and concerns.
The authors of a huge study that examined children who were exposed ADHD medications while in utero concluded that "continuation use of psychostimulants during early pregnancy did not cause adverse birth outcomes, and if it was, it was associated with reduced stress among mothers." However, their conclusion is not without a few limitations. The study did not take into account the significance of the dosage of stimulant medication and how long it was used, along with other sociodemographic and clinical variables. Furthermore, there is no controlled research examining the safety of continued psychostimulant use among nursing mothers.
There isn't a clear research-based evidence concerning the safety of ADHD medication during pregnancy. However, the majority of doctors have a general knowledge of what research suggests and can apply the best practices in consultation to the specific needs of each patient. For instance, it's known that there is a higher incidence of cardiac malformations among babies born to mothers who take methylphenidate within the first trimester of pregnancy (Cooper et al. 2018), while it is also important to note that this result was based on a small study and did not take into account variations in patient demographics or underlying psychiatric comorbidity.
In an earlier survey of ADDitude readers, they found that they are more likely than ever to quit taking their ADHD medication during early pregnancy. Women who stopped psychostimulants during the first trimester experienced an increase in depressive symptoms. They also reported being less capable of enjoying their pregnancy and rated their families functioning as being more difficult than women who continued or increased dosages of ADHD medication.
Work Functioning Test
The work functioning test is a vital component of the examination as it will determine if a patient is able to perform their duties. The test is designed to determine functional limitations. It will include materials handling that is graded (lifting to various levels, pushing and pulling) and positional tolerance exercises (sitting or standing in a balancing position, walking and stooping, kneeling and crawling) and other relevant specialized tests (hand manipulation). The examiner will analyse the results and formulate an appropriate return to the conclusion of the test. ROC curves are used to show the point at which there is a minimum misclassification (MIC) for both the general and physical working ability as well as the functional score for a particular problem.
The MIC is calculated using the COnsensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. see this divides the scores of physical and general ability and work-functioning issues based on an answer on an anchor question to prevent any change in the measure from affecting the overall average.
Driving Test
The gold standard for treating ADHD is psychostimulant medications. It improves driving safety and reduces symptoms. If not treated, severe ADHD can have severe financial and psychological consequences.
Psychotherapeutic treatments, like cognitive behavior therapy (CBT) or "coaching" methods have also been shown by research to help improve symptoms and increase function. These strategies could aid women in adjusting their routines and use their coping skills to minimize the impact of their ADHD on their work and other domains.
All of these aspects are crucial to take into consideration when deciding whether or not to continue with psychostimulant therapy. As the best available data show, while 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 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 to attention-deficit/hyperactivity medication and offspring outcomes.