ADHD Medication and Pregnancy
Physicians are unable to provide accurate information on the safety of ADHD medications during pregnancy. Until more research is available, physicians must weigh the benefits of medication use during pregnancy against the potential risks for the offspring in each unique circumstance.
A population-based study has tracked 898 babies who were born to mothers who were taking ADHD medications during pregnancy (stimulants methylphenidate amphetamine dexamphetamine ; non-stimulants modafinil atomoxetine clonidine) until they were identified 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 that exposure to drugs during pregnancy can be a source of harm, particularly for centrally stimulating drugs like those used to treat ADHD. It is crucial that women receive appropriate advice from their doctors about the risk/benefit of using medication prior to conception and throughout pregnancy. In this CAP Smart Take we review the most recent research in this field and how it might inform the practice of a physician.
Animal studies and illicit drug research have suggested that stimulant medications enter the fetus via the placenta, and could negatively impact fetal growth and development. There aren' concerta adhd medication on the effects of prescription stimulant medications during pregnancy. The majority of the evidence comes from case-control studies with a single arm, which is not powerful enough to reveal any significant correlations.
The study by Cohen and colleagues4 is unique because it is the most comprehensive and carefully controlled. The study included a sample of 364,012 pregnant women from the Danish Medical Registry, and information about the use of medications was obtained by analyzing prescriptions that were redeemed. Researchers excluded women who had taken SSRIs or clonidine because these drugs can interfere with fetal NMDA and increase the risk of developing neurodevelopmental disorders such as autism and ADHD. The authors also modified their analysis to account for potential confounding factors as well as to account for the timing of in utero exposure.
The results of this study as well as other limited trials indicate that the vast number of women who continue using their stimulant medications prescribed to treat ADHD during pregnancy do not experience adverse effects on their foetuses. Therefore, it is likely that a lot of pregnant women will continue to take their ADHD medication. It is crucial for doctors to consider the risks and benefits of these drugs prior to telling their patients during pregnancy to stop taking these medications. Whatever decision they make, it is essential that pregnant women suffering from ADHD inform their spouses or their partners, extended family members as well as their employers about the decision they've made. This is because the signs of inattention, hyperactivity, and impulsivity are likely to return when the mother stops taking medication.
Pregnancy Tests
Preconception counseling for women suffering from ADHD who are planning to become pregnant should concentrate on a comprehensive plan of management that incorporates both pharmacologic and behavioral treatment and continuous monitoring throughout the perinatal period. The plan should include a review of the current treatment regimens, particularly during the first trimester, when risks of harm to the baby due to untreated ADHD are the highest. This should be a joint effort between primary care and psychiatry, as well as the obstetrics department.
The risk/benefit discussion should also address how a woman plans to manage her symptoms of ADHD during pregnancy, as well as the effects on family functioning and how she feels about stopping psychostimulant treatment in the beginning of pregnancy. This should be based on a thorough review of the available evidence, and consideration of the individual patient's needs and concerns.
The authors of a large study that examined children who were exposed ADHD medication during pregnancy concluded that "continuation psychostimulant usage during early pregnancy was not associated with adverse birth outcomes and if anything, it was associated with reduced stress among mothers." However, their conclusion is not without a few limitations. The study did not consider the importance of the dose of stimulant medication, nor the long it was used for, as well as other sociodemographic and clinical variables. There is also no research controlled that studies the safety of continued psychostimulant usage in nursing mothers.
While there is a lack of clear scientific data on the safety of ADHD medication during pregnancy, most physicians are aware of what the current research suggests and apply the best practices in consultation with each patient's unique needs. 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, et al. 2018). However this conclusion is based on a tiny study that didn't take into account the different the demographics of patients and the underlying psychiatric conditions.
In a recent survey ADDitude readers said that they were more likely to quit their ADHD medication during the early stages of pregnancy than in the past. Women who stopped taking psychostimulants during the first trimester showed an increase in depressive symptoms. They also felt less able to enjoy pregnancy and described 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 determines if a patient is able to carry out their tasks. The test is designed to evaluate functional limitations and include materials handling that is graded (lifting to different levels, pulling and pushing) as well as positional tolerance tests (sitting in a chair, standing in a balancing position, walking or stooping, kneeling, crawling) as well as other relevant specialized tests (hand manipulation). The test evaluator will review the results and formulate an appropriate return to work conclusion. ROC curves are used to show the point at which there is a minimum misclassification (MIC) for both physical and general work ability and the work-functioning score for a particular problem.
The MIC is calculated by using the COnsensus Standards for the Selection of Health Measurement Instruments Checklist (COSMIN). the full report is able to separate the scores of general and physical work ability and work-functioning difficulties based on the answer on an anchor question to prevent a change in measure from affecting the overall average.
Driving Test
The most effective treatment for ADHD is a psychostimulant drug. It reduces symptoms and improves functioning in other areas, including driving safety. If not treated, severe ADHD can have significant financial and psychosocial consequences.
Psychotherapeutic interventions such as cognitive behavioral therapy (CBT) and "coaching" strategies have also been shown to improve symptoms and enhance functioning. These strategies can help women to tailor their daily routines and employ their coping abilities in ways that reduce their ADHD's impact on work and other aspects.
All of these factors can be crucial considerations when making the decision of whether to continue or discontinue psychostimulant therapy. The most reliable data available show that although there are concerns about pregnancy outcomes when in utero stimulant medication is employed, the risks of this are small. Also, the results are complicated by other medication, the use of maternal healthcare, 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 the effects on offspring.