ADHD Medication and Pregnancy
Physicians often struggle to inform patients about the security of their ADHD medications during pregnancy. In the meantime, until more research is available, doctors must weigh the advantages of medication use during pregnancy against the potential dangers for children in each unique circumstance.
A population-based study has tracked 898 babies who were born to mothers who had taken ADHD medications during pregnancy (stimulants amphetamine methylphenidate dexamphetamine ; non-stimulants modafinil atomoxetine clonidine), 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 during pregnancy can have, especially for centrally stimulating drugs like those used to treat ADHD. It is crucial that women receive appropriate advice from their doctors regarding the dangers and benefits of taking medication during pregnancy and before conception. In this CAP Smart Take, we review the most recent research in this field and how it can guide the practice of a physician.
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. The majority of the evidence comes from case-control studies using a single arm which is not powerful enough to detect any significant associations.
The study conducted by Cohen and colleagues4 is unique because it is the most comprehensive and carefully controlled. The study included a sample of 364,012 pregnancies from the Danish Medical Registry, and data on the use of medication was gathered through the analysis of prescriptions that were redeemed. The researchers specifically excluded women who reported receiving SSRI medications or clonidine because these medications can interfere with the fetal NMDA receptor and increase the risk of neurodevelopmental disorders such as autism and ADHD. The authors modified their analysis in order to account for the timing of exposure as well as control for confounding factors.
The findings from this study, along with the results of other studies, show that the vast majority of women who continue to take the stimulant medications prescribed for ADHD during pregnancy do not experience any adverse effects on their fetuses. This means it is likely that many women will continue to use their medications for ADHD during pregnancy. It is important for doctors to consider the risks and benefits of these medications before advising their pregnant patients to stop taking these medications. Whatever decision they make, it is essential that pregnant women with ADHD inform their spouses or their partners, extended family members and employers about the choice they have made. This is because the symptoms of hyperactivity, inattention, and impulsivity will likely be recurred after the mother ceases taking her medication.
Pregnancy Tests
Preconception counseling for women with ADHD who want to become pregnant should concentrate on a comprehensive management plan that involves both pharmacologic and behavioral treatments and ongoing monitoring throughout the perinatal period. The plan should include a discussion of the current treatment regimens, specifically in the first trimester, when the risks of harming the baby because of untreated ADHD are the highest. This should be a collaborative effort with psychiatry, obstetrics 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 effect of this on family functioning, and how she feels about discontinuing psychostimulant treatment in the beginning. This should be based upon an exhaustive review of the available evidence and consider the individual needs of the patient and concerns.
In a recent large study that followed children exposed to ADHD medications during utero The authors concluded that "continuation of use of psychostimulants in the early stages of pregnancy did not increase the risk of adverse birth outcomes, and if anything was associated with reduced maternal stress." However, this conclusion is not without its limitations. The study did not take into account other factors, such as the length of time that stimulant medication was used as well as the dose and sociodemographics. There is also adhd medication adults uk that examines the safety of a continued use of psychostimulants by nursing mothers.
Although there is a dearth of evidence-based research on the safety of ADHD medication during pregnancy, most physicians are aware of what the current research suggests and apply the best practices while collaborating with the individual needs of each patient. It is known, for example, that infants born to mothers who are taking methylphenidate in the first trimester are more likely have cardiac malformations (Cooper and co. 2018). However this is based on a small study that did not take into account the different patient demographics and underlying psychiatric conditions.
In a recent survey of ADDitude readers, they found that they are more likely than ever before to stop taking their ADHD medication during early pregnancy. However, women who discontinued psychostimulants during the first trimester of their pregnancy experienced a clinically significant increase in symptoms of depression. They also felt less able to enjoy pregnancy and rated family functioning as more challenging than those who remained on their dose of ADHD medication or increased it.
Work Functioning Test
The work functioning test is an essential part of the examination as it will determine if the patient can perform their job duties. The test is designed to evaluate functional limitations. It will include graded material handling (lifting to various levels, pushing and pulling) and positional tolerance exercises (sitting in a chair, standing and walking, balancing and stooping, kneeling and crawling) as well as other relevant tests for specialized testing (hand manipulation). The evaluator analyzes the results to form the return-to-work conclusions. ROC curves can be used to determine the point of minimal classification (MIC) in the general ability to work physical work capability and the work-functioning problem score.
The MIC is calculated by 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 most effective treatment for ADHD is psychostimulant medication. It improves driving safety and decreases symptoms. The effects of severe, untreated ADHD can have significant financial and psychosocial effects.
Psychotherapeutic treatments such as cognitive behavioral therapy (CBT) and "coaching" strategies have also been proven to improve symptoms and enhance functioning. These strategies could assist women in tailoring their routines and use their coping skills in ways that minimize the effects of their ADHD on work and other areas.
All of these factors are important to take into account when deciding whether or not to continue with psychostimulant therapy. As the best available data suggest, even though there is some concern about the effects of pregnancy on outcomes after in-utero exposure to stimulant medications the risks are minimal and the results are influenced by other medications, maternal health treatment as well as physical and mental health and the comorbidities. Bang Madsen K, Bliddal M, Skoglund CB, Larsson H, Munk-Olsen TL, Hove Thomsen P, Bergink V. In utero exposure to attention deficit hyperactivity disorder medication and long-term effects on offspring.