ADHD Medication and Pregnancy
Physicians often struggle to inform patients on the safety of their ADHD medications 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 particular situation.
A population-based study has followed 898 infants who were born to mothers who were taking 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
Physicians are concerned about the long-term effects of drug exposure in the uterus, especially to centrally stimulating drugs like those prescribed for ADHD. It is therefore critical that women receive appropriate medical advice from their doctors regarding the risk/benefit of using medication before conception and during pregnancy. In this Smart Take on CAP, we examine the latest data in this field and how it might influence clinical practice.
Animal studies and illicit drug research suggests that stimulant medications enter the fetus via the placenta and can adversely affect the growth of the fetus and development. However, there is a lack of information on the response of the fetus to therapeutic doses of prescription stimulant medications during pregnancy, and the majority of this evidence comes from single-arm case-control studies that have been underpowered to determine if there are significant associations.
The study by Cohen and colleagues4 is unique because it is the most comprehensive and well-controlled. The study comprised a representative sample of 364,012 pregnancies from the Danish Medical Registry, and data on the use of medication was obtained by analyzing redeemed prescriptions. The researchers specifically excluded women who reported taking SSRI drugs or clonidine as these drugs may interfere with the fetal NMDA receptor and increase the risk of neurodevelopmental disorders like autism and ADHD. The authors adjusted their analyses in order to account for the timing of exposure as well as take into account confounding factors.
The results of this study and other limited trials indicate 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. Therefore, it is likely that many women who are pregnant will continue to take their ADHD medication. It is crucial for doctors to weigh the benefits and risks of these medications prior to advising their pregnant patients to stop taking the medications. Regardless of which choice they make, it is vital that pregnant women with ADHD inform their spouses or their partners, extended family members, and employers about the decision they've made. This is because the signs of hyperactivity, inattention and impulsivity are likely be re-present when the mother stops taking medication.
Pregnancy Tests
Preconception counseling for women with ADHD who wish to become pregnant should concentrate on a comprehensive plan of management that involves both pharmacologic and behavioral treatment and ongoing monitoring throughout the perinatal period. The plan should include a discussion of current medication regimens, especially in the first trimester when dangers to the baby due to untreated ADHD are greatest. This should be a collaborative effort with obstetrics, psychiatry 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 impact of this on family functioning, and how she feels about stopping psychostimulant therapy in the initial stages. This should be informed by a thorough review of evidence available, including consideration of the individual patient's requirements and concerns.
buy adhd medication uk of a large study that followed children who were exposed to ADHD medications while in utero concluded that "continuation use of psychostimulants during early pregnancy did not cause adverse birth outcomes and, if anything, it was associated with reduced stress among mothers." However their conclusion isn't without a few limitations. The study did take into consideration other factors, such as the length of time that stimulant medication was taken in addition to the dose and sociodemographics. There is also no controlled research that examines the safety of continued psychostimulant usage in nursing mothers.
There isn't a clear evidence from a scientific study on the safety of ADHD medication during pregnancy. However, most doctors have a general knowledge of the research findings and can apply the best practices in consultation to each patient's specific needs. It is known, for instance that babies born to mothers 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 patient demographics and underlying psychiatric conditions.
In a recent study, ADDitude readers said that they were more likely to discontinue their ADHD medication in early pregnancy than in the past. Women who stopped taking psychostimulants in the first trimester experienced an increase in depressive symptoms. They also reported that they were less than able to enjoy their pregnancy and described their family functioning as more difficult than those who continued or increased dosages of ADHD medication.
Work Functioning Test
The work functioning test is an essential part of the exam since it will determine if a patient can perform their job tasks. The test is designed for evaluating functional limitations. It includes graded material handling activities (lifting at different levels, pulling and pushing), tests for positional tolerance (sitting and standing while walking, balancing and walking or stooping, kneeling and stooping) and specialized tests. The evaluator will analyze the results and come up with an appropriate return to a conclusion of the work. ROC curves are used to show the point of minimum misclassification (MIC) for both the general and physical work capability as well as 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). This method divides scores for general physical work capabilities and work-functioning issues by answering an anchor question. This prevents any change in metrics from biasing the average.
Driving Test
Psychostimulant medication is a gold treatment for ADHD. It eases symptoms and enhances performance in other areas, such as driving safety. Impairment due to severe untreated ADHD can have profound psychosocial and financial consequences.
Psychotherapeutic interventions such as cognitive behavioral therapy (CBT) and "coaching" strategies have also been proven to reduce symptoms and enhance functioning. These strategies can help women to tailor their schedules and utilize their coping skills in ways that minimize their ADHD's impact on work and other areas.
All of these factors are crucial to take into consideration when deciding whether or not to continue with psychostimulant therapy. The most recent data available indicate that although there are some concerns about pregnancy outcomes when in utero stimulant medications are utilized, the risk-benefit ratios of this are small. The results are muddled by other medication, the use of maternal healthcare as well as physical and mental health and 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.