ADHD Medication and Pregnancy
Physicians often struggle to advise patients about the safety of their ADHD medications during pregnancy. As long as research is not available, physicians must weigh the advantages of medication use during pregnancy against the possible dangers for children in each unique circumstance.
managing adhd without medication of the population tracked 898 infants born to women taking ADHD medications throughout their pregnancy (stimulants such as amphetamine, methylphenidate dexamphetamine, methylphenidate; non-stimulants: modafinil, atomoxetine and clonidine) until they were diagnosed with a developmental disorder or died or left the country.
Risk/Benefit Discussion
CAP Smart Take:
Physicians are concerned about the long-term consequences of exposure to drugs during utero, particularly to centrally stimulating drugs like those used to treat ADHD. It is therefore critical that women receive appropriate counseling from their physicians about the potential risks and benefits of using medications before conception and during pregnancy. In this CAP smart take we look at the most current data in this area and how they could inform the clinical practice.
Animal studies as well as illicit drug use research 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 on the response of the fetus to dosages of prescribed stimulant medication during pregnancy and most of this evidence comes from single-arm case-control studies that have not been sufficiently powered to identify significant associations.
The recent study by Cohen and colleagues is distinct from other studies because it is the biggest and most carefully controlled. The study comprised a sample of 364,012 births from the Danish Medical Registry, and information on medication use was obtained by analyzing redeemed prescriptions. Researchers excluded women who had taken SSRIs or clonidine as these drugs can interfere with the fetal NMDA and increase the risk of developing neurodevelopmental disorders like autism and ADHD. The authors adjusted their analyses to take into account the timing of exposure and to control for confounding factors.
The results of this study and other studies show that the vast number of women who continue to take their stimulant medications prescribed for ADHD during pregnancy don't experience adverse effects on their fetuses. It is therefore likely that a lot of pregnant women will continue to take their ADHD medication. However, it is important that doctors weigh the benefits and risks of these medications for pregnant patients, as well as take into consideration the individual circumstances of each patient, before suggesting they stop their medication. No matter what decision they make, it is essential that pregnant women suffering from ADHD inform their spouses or partners, extended family members as well as their employers about the decision they've made. It is because the signs of inattention, hyperactivity, and impulsivity are likely return when the mother stops taking medication.
Pregnancy Tests
Preconception counseling should comprise a comprehensive program of management that includes both behavioural and pharmaceutical treatments, as well as ongoing monitoring during the perinatal phase. The plan should include a discussion on the current treatment regimens, especially during the first trimester when the risks of harming the baby due to untreated ADHD are highest. This should be a joint effort with psychiatry, obstetrics, and primary care.
The discussion of risks and benefits should also cover how a woman will manage her ADHD symptoms during pregnancy, the impact of this on the family's functioning and her feelings about stopping psychostimulant therapy in the beginning. This should be based on a thorough review of evidence available, including consideration of the individual patient's needs and concerns.
In a recent study that examined children exposed to ADHD medications during utero, the authors concluded that "continuation of psychostimulant use during the early stages of pregnancy did not increase the risk of adverse birth outcomes and, if anything, was associated with less stress for mothers." However this conclusion isn't without its limitations. The study didn't consider the significance of the dosage of stimulant medication, nor the long it was used, as well as other sociodemographic and clinical variables. There is no controlled research that examines the safety of continued use of psychostimulants in nursing mothers.
There isn't any definitive evidence from a scientific study concerning the safety of ADHD medication during pregnancy. However, most doctors are aware of what the literature suggests and apply best practices in consultation with the specific needs of each patient. It is known, for instance that babies born to mothers who are taking methylphenidate during the first trimester are more likely have cardiac malformations (Cooper, et al. 2018). However, this finding is based on a small study that did not take into account the different the patient's demographics and underlying mental health conditions.
In a recent survey, ADDitude readers said that they were more likely to quit their ADHD medication during early pregnancy than in the past. However, you could try this out who stopped taking psychostimulants during the first trimester of pregnancy noticed a clinically significant increase in symptoms of depression. They also reported feeling less able to enjoy their pregnancy and rated their family functioning as more challenging than those who remained on their dose of ADHD medication or increased it.
Work Functioning Test
The work function test is an important component of the exam to determine if an individual is able to carry out their duties. The test is intended for the evaluation of functional limitations. It includes a variety of graded material handling tasks (lifting at different heights pulling and pushing), positional tolerance exercises (sitting and standing, balancing and walking, stooping and kneeling) as well as tests that are specialized. The evaluator will analyze the results and draw a return to the conclusion of the test. ROC curves can be used to determine the point of minimal classification (MIC) in the general work capability and physical work ability and the work-functioning issues score.
The MIC is calculated using the COnsensus Standards for the Selection of Health Measurement Instruments Checklist (COSMIN). This method separates the scores of the physical and general ability and work-functioning problems score by answer on an anchor question to prevent changes in the metric from biasing the overall average.
Driving Test
The gold standard for treating ADHD is a psychostimulant drug. It reduces symptoms and improves functioning in work and other areas, including driving safety. Untreated severe ADHD can have severe financial and psychosocial consequences.
Psychotherapeutic interventions, such as cognitive behavior therapy (CBT) or "coaching" methods have also been proven by research to improve symptoms and enhance function. These strategies can help women tailor their daily routines and employ their coping skills in ways that reduce the impact of ADHD on their work and other aspects.
All of these aspects are important to take into account when deciding whether or not to continue psychostimulant therapy. As the best available data show, while there are some concerns about the outcomes of pregnancy after in utero exposure to stimulant medications the risks are minimal, and the results are confounded by other medications, maternal health care utilization and 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 disorder medication and the effects on offspring.