ADHD Medication and Pregnancy
Physicians often struggle to advise patients about the safety of their ADHD medications during pregnancy. In the absence of more research, doctors must weigh up the benefits and risks of using medication during pregnancy.
A recent population-based cohort study followed 898 babies born to women taking ADHD medications throughout their pregnancy (stimulants 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 effects of drug exposure in utero, particularly to centrally stimulating medications such as those used for ADHD. It is therefore critical that women receive proper counseling from their physicians about the risk/benefit of using medication prior to conception and throughout pregnancy. In this CAP smart take, we examine the most recent research in this area and how they can influence the practice of a physician.
Animal studies and illicit drug research suggests that stimulant drugs enter the fetus through the placenta, and could negatively affect fetal growth and development. There aren't many studies on the effects of prescription stimulant medications during pregnancy. Most of the evidence comes from case-control studies with one arm, which aren't strong enough to identify any significant connections.
The study conducted by Cohen and colleagues4 is distinctive because it is the most complete 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 through the analysis of redeemed medications. Researchers excluded women who had taken SSRIs or clonidine as these drugs could interfere with fetal NMDA and increase the risk of developing neurodevelopmental disorders, such as autism and ADHD. The authors adjusted their analyses in order to account for the timing of exposure as well as control for confounding factors.
The findings from this study, as well as the results from other studies, suggest that the majority of women who continue to take the stimulant medications prescribed for ADHD during pregnancy do not experience adverse effects on their fetuses. Therefore, it is likely that many pregnant women will continue to use their ADHD medication. However, it is important that physicians carefully weigh the risks and benefits of these medications for their pregnant patients, and consider each patient's unique situation prior to suggesting that they stop taking their medication. It is essential that women who are pregnant with ADHD inform their partners, extended families, and employers of the choice they've taken. This is because the symptoms of hyperactivity, inattention and impulsivity will likely return once the mother stops taking her medication.
Pregnancy Tests
Preconception counseling for women suffering from ADHD who are planning to become pregnant should focus on a comprehensive treatment plan that includes both pharmacologic and behavioral treatments and continuous monitoring throughout the postnatal period. The plan should include a discussion of the current treatment regimens, especially during the first trimester when the risks of harming the baby due to untreated ADHD are the highest. This should be a co-operative effort between primary care and psychiatry and Obstetrics.
adhd medication pregnancy of risks and benefits should also include how a woman intends to manage her ADHD symptoms during pregnancy, the effect of this on family functioning, and how she feels about discontinuing psychostimulant treatment in the early stages. This should be based on a thorough evaluation of the available evidence and be mindful of the individual needs of the patient and concerns.
The authors of a huge study that followed children who were exposed ADHD medications while in utero 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 the conclusion they reached is not without limitations. The study didn't consider the importance of the dosage of stimulant medication or the long it was used along with other sociodemographic and clinical variables. Additionally, there isn't any controlled research that evaluates the safety of continuing use of psychostimulants in nursing mothers.
There is no clear research-based evidence on the safety of ADHD medication during pregnancy. However, most doctors have a general knowledge of what research suggests and will apply best practices in consultation with each patient's specific needs. For instance, it is known that there is a higher risk of cardiac malformations in babies born to mothers who have taken methylphenidate in the first trimester of pregnancy (Cooper and co., 2018) It is important to note that this result was based on one small study and did not consider differences in patient demographics or underlying psychiatric co-morbidity.
In an earlier 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 during the first trimester noticed an increase in depression symptoms. They also reported being less capable of enjoying their pregnancy and rated their family functioning as less than those who maintained or increased their dosages of ADHD medications.
Work Functioning Test
The test of work function is an important part of the examination in that it determines whether the candidate is able to perform their duties. The test is intended for testing functional limitations. It includes graded material handling activities (lifting at different levels, pulling and pushing) as well as tests for positional tolerance (sitting and standing, balancing and walking or stooping, kneeling and stooping) and tests that are specialized. The evaluator analyzes the results to formulate an appropriate 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 by 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 issues based on an answering an anchor question to prevent any change in the metric from biasing the overall average.
Driving Test
Psychostimulant medication is a treatment for ADHD. It improves safety while driving and decreases symptoms. If not treated, severe ADHD can have serious financial and psychological consequences.
Psychotherapeutic interventions, such as cognitive behavior therapy (CBT) or "coaching" techniques have been shown by research to help improve symptoms and increase function. These strategies can help women tailor their schedules and utilize their coping abilities to minimize their ADHD's impact on work and other areas.
All of these factors could be important considerations in the decision of whether to continue or stop psychostimulant treatment. The best available data show that, despite concerns about the outcomes of pregnancy when in utero stimulant medications are utilized, the risk-benefit ratios of this are minimal. The results are affected by other medications, maternal healthcare utilization, maternal mental and physically health and comorbidities. best adhd medication for adults with anxiety , Bliddal m., Skoglund cb., Larsson h., Munk-Olsen T., Hove Thomsen p., Bergink V. In-utero exposure of attention-deficit/hyperactivity disorder medication and its effects on offspring.