ADHD Medication and Pregnancy
Physicians often struggle to advise patients on the safety of their ADHD medication during pregnancy. Until more research is available, physicians must weigh the benefits of medication use during pregnancy against the potential risks for offspring in each unique circumstance.
A study of a population-based sample has followed 898 babies who were born to mothers who took ADHD medications during pregnancy (stimulants amphetamine methylphenidate dexamphetamine ; non-stimulants modafinil atomoxetine clonidine) until they were identified as having a developmental disorder, 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 be a source of harm, particularly for centrally stimulating medications like those used to treat ADHD. It is crucial that women receive adequate advice from their doctors regarding the risks and benefits of using medication during pregnancy and prior to conception. In this Smart Take on CAP, we examine the latest data in this field and how it can guide the clinical practice.
Animal studies and illicit drug research suggest that stimulant medication passes to the fetus through the placenta, and could adversely affect the growth of the fetus and development. There aren't many studies on the effects of prescription stimulant medications during pregnancy. Most of the evidence comes from studies conducted in case-control with a single arm, which is not powerful enough to detect any significant connections.
The study by Cohen and colleagues4 is unique because it is the most thorough and meticulously controlled. The study included 364,012 pregnancies collected from the Danish Medical Registry. Information on medication use was gathered by analyzing the redeemed medication. The researchers specifically excluded women who reported taking SSRI drugs or clonidine since these drugs can interfere with the fetal NMDA receptor and increase the risk of neurodevelopmental disorders such as autism and ADHD. The authors also modified their studies to take into account potential confounding factors as well as to account for the timing of in-utero exposure.
The results of this study and other studies show that the vast number of women who continue using their stimulant medication prescribed for ADHD during pregnancy do not experience adverse effects on their foetuses. This means it is likely that many women will continue to use their medications for ADHD during pregnancy. It is crucial for doctors to carefully weigh the benefits and risks of these medications before giving their pregnant patients the advice to stop taking the medications. It is essential that pregnant women suffering from ADHD inform their parents as well as extended families and employers of the decision they've taken. This is because signs of hyperactivity, inattention and impulsivity will likely come back once the mother stops taking her medications.
Pregnancy Tests
Preconception counseling should consist of an extensive management plan that includes both behavioural and medical treatment and continuous monitoring during the perinatal phase. The plan should include a discussion about the current treatment regimens, especially in the first trimester, when the chances of harming the baby because of untreated ADHD are highest. This should be a joint effort between psychiatry and primary care and Obstetrics.
The discussion of risk/benefit should also address how a woman plans to manage her symptoms of ADHD during pregnancy, including the effects on family functioning and what she might feel about stopping psychostimulant treatment in the early stages of pregnancy. This should be based upon an exhaustive review of the available evidence and be mindful of the patient's individual needs and concerns.
The authors of a massive study that examined children who were exposed ADHD medication during pregnancy concluded that "continuation use of psychostimulants during early pregnancy was not associated with adverse birth outcomes and, if it was, it was associated with lower stress levels among mothers." However their conclusion isn't without a few limitations. The study did not take into account the importance of the dosage of stimulant medication and how long it was used, in addition to other sociodemographic and clinical factors. Additionally, there isn't any controlled research examining the safety of continuing psychostimulant use among nursing mothers.
Although there is a dearth of clear scientific data on the safety of ADHD medications during pregnancy, the majority of doctors have a general understanding of what the existing research suggests and apply the best practices while collaborating with the specific needs of each patient. It is known, for example that infants born to mothers taking methylphenidate during the first trimester are more likely suffer from cardiac malformations (Cooper, et al. 2018). However this is based on a comparatively small study that did not take into account the different the demographics of patients and the underlying psychiatric conditions.
In adhd otc medication , ADDitude readers said that they were more likely to stop their ADHD medication during early pregnancy than they were in the past. Women who stopped taking psychostimulants during the first trimester showed an increase in depressive symptoms. They also reported that they were less able to enjoy their pregnancy and rated their families functioning as more difficult than those who continued or increased dosages of ADHD medication.
Work Functioning Test
The test for work function is an essential part of the examination as it determines if a patient is able to perform their duties. The test is designed to evaluate functional limitations and include the use of graded material handling (lifting to various heights, pulling and pushing) and positional tolerance exercises (sitting or standing and walking, balancing or stooping, kneeling, crawling) as well as other relevant specialized tests (hand manipulation). The test evaluator will review the results and come up with the return to the conclusion of the test. ROC curves are used to illustrate the point of minimum misclassification (MIC) for both physical and general 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. This method is able to separate the scores of physical and general ability and work-functioning problems score by answer on an anchor question to prevent any change in the measurement from affecting the overall average.
Driving Test
Psychostimulant medication is a gold standard treatment for ADHD. It eases symptoms and enhances performance in other areas, such as driving safety. The effects of severe, untreated ADHD can have profound financial and psychosocial effects.
Psychotherapeutic treatments, like cognitive behavior therapy (CBT) or "coaching" techniques have also been shown by research to reduce symptoms and improve performance. These strategies can help women to tailor their daily routines and employ their coping skills in ways that minimize their ADHD's impact on work and other aspects.
All of these factors could be crucial considerations when making the decision to continue or end psychostimulant therapy. The most reliable data available show that, despite concerns about pregnancy outcomes when in utero stimulant medication is utilized, the risk-benefit ratios of this are low. Also, the results are complicated by other medications, maternal healthcare utilization, maternal mental and physically health and the 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 its effects on offspring.