ADHD Medication and Pregnancy
Physicians often struggle to inform patients about the security of their ADHD medications during pregnancy. Until more research is available, physicians must weigh the advantages of medication use during pregnancy against the potential risks for offspring in each individual situation.
A recent cohort study of the population followed 898 babies born to mothers 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 passed away or left the country.
Risk/Benefit Discussion
CAP Smart Take
Physicians are concerned about the long-term consequences of exposure to drugs in the uterus, especially to centrally stimulating medications like those prescribed for ADHD. It is important that women receive adequate counseling from their doctors about the dangers and benefits of taking medication during pregnancy and before conception. In this Smart Take on CAP, we look at the most current research in this field and how it can influence clinical practice.
Animal studies and illicit drug research have suggested that stimulant medication passes to the fetus through the placenta, and may negatively impact fetal growth and development. There aren't many data on the effects of prescription stimulant medications during pregnancy. adhd anxiety medication of evidence comes from studies conducted in case-control with a single arm, which isn't powerful enough to identify any significant correlations.
The study conducted by Cohen and colleagues4 is distinctive because it is the most thorough and meticulously controlled. The study comprised a sample of 364,012 pregnancies from the Danish Medical Registry, and information on medication use was obtained by analyzing redeemed prescriptions. The researchers specifically excluded women who had reported taking SSRI drugs or clonidine because these medications can interfere with the fetal NMDA receptor and increase the risk of developing neurodevelopmental disorders such as autism and ADHD. adhd and anxiety medication adjusted their analyses to control for potential confounding factors as well as to take into account the timing of the in utero exposure.
The results of this study as well as other small-scale trials suggest that the vast number of women who continue to use their stimulant medications prescribed for ADHD during pregnancy are not experiencing adverse effects on their fetuses. It is therefore likely that many pregnant women will continue to take their ADHD medication. It is essential for doctors to weigh the risks and benefits of these drugs prior to advising their pregnant patients to stop taking the medications. It is essential that women who are pregnant with ADHD inform their spouses, extended families, and employers of the choice they've made. This is because the symptoms of hyperactivity, inattention, and impulsivity are likely to return once the mother stops taking her medications.
Pregnancy Tests
Preconception counseling for women suffering from ADHD who want to become pregnant should focus on a comprehensive management plan that incorporates both pharmacologic and behavioral treatment and ongoing monitoring throughout the perinatal period. 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 the highest. This should be a coordinated effort with psychiatry, obstetrics and primary care.
The discussion of the risks and benefits should also include how a woman intends to manage her ADHD symptoms during pregnancy, the impact of this on family functioning and her feelings about a decision to stop psychostimulant treatment in the early stages. This should be based upon a thorough evaluation of the evidence available and be mindful of the patient's individual needs and concerns.
In a recent study that followed children exposed to ADHD medications during pregnancy, the authors concluded that "continuation of psychostimulant use during the early stages of pregnancy didn't increase the risk of adverse birth outcomes and if anything, it was associated with reduced maternal stress." However this conclusion isn't without its limitations. The study did consider other factors such as the length of time that stimulant medication was used in addition to the dose and sociodemographics. Furthermore, there is no controlled research examining the safety of continued psychostimulant use in nursing mothers.
There is no clear scientific data regarding the safety of ADHD medication during pregnancy. However, most doctors have a general knowledge of what the literature suggests and apply best practices in consultation with each patient's specific needs. It is known, for instance that infants born to mothers taking methylphenidate during the first trimester are more likely have cardiac malformations (Cooper, et al. 2018). However this conclusion is based on a tiny study that did not take into account differences in patient demographics and underlying psychiatric conditions.
In a recent survey, ADDitude readers found that they were more likely to quit their ADHD medication during early pregnancy than in previous. Women who stopped taking psychostimulants during the first trimester showed an increase in depressive symptoms. They also reported feeling less than able to enjoy their pregnancy and described their family functioning as more difficult than those who continued or increased dosages of ADHD medications.
Work Functioning Test
The test of work function is an essential element of the test as it will determine if a patient is able to carry out their tasks. The test is designed to assist in testing functional limitations. It includes a variety of graded material handling tasks (lifting at different levels, pulling and pushing) as well as tests for positional tolerance (sitting and standing, balancing and walking in a stoop, kneeling and stoop) and tests that are specialized. The test evaluator will review the results and come up with the return to a conclusion of the work. ROC curves are used to illustrate the point at which there is a minimum misclassification (MIC) for both physical and general work capability as well as the work-functioning score for a particular problem.
The MIC is calculated using the COnsensus Standards for the Selection of Health Measurement Instruments Checklist (COSMIN). This method divides the scores of physical and general work abilities and work-functioning problems score by answer on an anchor question, to avoid any change in the measurement from affecting the overall average.
Driving Test
The most effective treatment for ADHD is psychostimulant medications. It helps reduce symptoms and improves performance in other areas, including driving safety. Impairment due to severe untreated ADHD can have significant psychosocial and financial consequences.
Psychotherapeutic treatments, like cognitive behavior therapy (CBT) or "coaching" techniques have also been proven by research to help improve symptoms and increase performance. These strategies can assist women in adjusting their schedules and utilize their coping skills in ways that minimize their ADHD's impact on work and other aspects.
All of these aspects are crucial to take into consideration when deciding whether or not to continue psychostimulant therapy. The most reliable data show, while there is some concern about the outcomes of pregnancy after in utero exposure to stimulant medication, the relative risks are small and the outcomes are affected by other medications, maternal health care utilization as well as physical and mental health, and the comorbidities. Bang Madsen K, Bliddal M, Skoglund CB, Larsson H, Munk-Olsen, Hove Thomsen P, Bergink V. In utero exposure to attention deficit hyperactivity disorder medication and long-term effects on offspring.