ADHD Medication and Pregnancy
Physicians are unable to provide accurate information on the safety of ADHD medications during pregnancy. In the absence of further research, physicians must weigh the advantages and risks of taking medication during pregnancy.
A recent population-based cohort study 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
Doctors are concerned about the long-term effects that drug exposure during pregnancy can have, especially for centrally stimulating drugs such as those used to treat ADHD. It is crucial 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 approach, we examine the most recent research on this topic and how they could guide clinical practices.
Animal studies as well as studies on illicit drug use indicate that stimulant medication passes to the fetus via the placenta, and could adversely affect the development of the fetus and growth. There aren't many data on the effects of prescription stimulant drugs during pregnancy. Most of the evidence comes from studies conducted in case-control with one arm, which aren't strong enough to identify any significant associations.
The study by Cohen and colleagues4 is unique because it is the most comprehensive and carefully controlled. The study included 364,012 pregnancies that were retrieved from the Danish Medical Registry. Information about the use of medications was gathered by analyzing redeemed medications. The researchers specifically excluded women who reported receiving SSRI drugs or clonidine since these drugs can interact with the fetal NMDA receptor and increase the risk of developing neurodevelopmental disorders such as autism and ADHD. The authors also modified their analyses to control for potential confounding factors as well as to account for the timing of in-utero exposure.
The results of this study and other small-scale trials suggest that the majority of women who continue to take their stimulant medications prescribed to treat ADHD during pregnancy are not experiencing adverse effects on their foetuses. It is therefore likely that many women who are pregnant will continue to take their ADHD medication. However, it is crucial that physicians carefully evaluate the advantages and risks of these medications for their pregnant patients, and also be aware of the unique circumstances of each patient before suggesting they stop their medications. No matter what decision they make, it is crucial that pregnant women suffering from ADHD inform their spouses or partners, extended family members as well as their employers about the choice they have made. It is because the symptoms of inattention, hyperactivity, and impulsivity are likely be re-present when the mother stops taking their medication.
Pregnancy Tests
Preconception counseling should include a comprehensive program of management that includes both behavioural and medical treatment, as well as ongoing monitoring during the perinatal phase. The plan should include a review of current medication regimens, especially during the first trimester, when risks of harm to the baby resulting from untreated ADHD are greatest. This should be a collaborative effort with obstetrics, psychiatry, and primary care.
The discussion of risk/benefit should also discuss how a woman intends to manage her symptoms of ADHD during pregnancy, as well as the impact on family functioning as well as what she might feel about discontinuing psychostimulant therapy during the initial stages of pregnancy. This should be based on a thorough review of evidence available, including consideration of the specific patient's needs and concerns.
In a recent large study which followed children who were 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, it was associated with reduced maternal stress." However, this conclusion is not without its flaws. The study didn't consider the significance of the dosage of stimulant medication and how long it was used for, as well as other sociodemographic and clinical factors. Additionally, there isn't any controlled research that evaluates the safety of continued use of psychostimulants in nursing mothers.
There isn't any definitive scientific data on the safety of ADHD medication during pregnancy. However, the majority of doctors have a general knowledge of what the literature suggests and will apply best practices in consultation to each patient's individual needs. It is known, for example, that infants born to mothers who are taking methylphenidate in the first trimester are more likely suffer from cardiac malformations (Cooper and co. 2018). However, this finding is based on a small study that did not take into account differences in the demographics of patients and the underlying psychiatric conditions.
In a recent survey of ADDitude readers, they found that they are more likely than ever to stop taking their ADHD medication in the early stages of pregnancy. Women who stopped taking psychostimulants in the first trimester showed an increase in depression symptoms. They also reported feeling less able to enjoy their pregnancy and rated their family functioning as more challenging than those who continued to take their dose of ADHD medication or increased it.
Work Functioning Test
The test of work function is an essential part of the exam since it will determine if the patient is able to carry out their duties. The test is designed to evaluate functional limitations. It will include materials handling that is graded (lifting to various levels pulling and pushing) as well as positional tolerance tests (sitting in a chair, standing and walking, balancing, stooping, kneeling, crawling) along with other relevant specialized tests (hand manipulation). The evaluator evaluates the results to form a return-to-work conclusion. 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 problem score.
The MIC is calculated using the COnsensus Standards for the Selection of Health Measurement Instruments Checklist (COSMIN). 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 avoid any change in the metric from biasing the overall average.
Driving Test
Psychostimulant medication is a gold standard treatment for ADHD. adhd medication list eases symptoms and enhances performance in other areas, including driving safety. If not treated, severe ADHD can have serious financial and psychological consequences.
Psychotherapeutic treatments such as cognitive behavioral therapy (CBT) and "coaching" strategies have also been proven to improve symptoms and enhance functioning. These strategies can help women tailor their routines, and use their coping abilities in ways that reduce their ADHD's impact on work and other areas.
All of these factors can be crucial considerations when making the decision to continue or stop psychostimulant treatment. The most reliable data indicate, although there are some concerns about the outcomes of pregnancy after in utero exposure to stimulant medications, the risks are minimal and the results are influenced by other treatments, maternal health care utilization and physical and mental health and 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 offspring outcomes.