ADHD Medication and Pregnancy
Physicians are unable to provide accurate information regarding the security of ADHD medications during pregnancy. Until more research is available, doctors must weigh the advantages of taking medication during pregnancy against the potential dangers for children 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 diagnosed as having a developmental disorder, died or left the country.
Risk/Benefit Discussion
CAP Smart Take:
Physicians are concerned about the long-term consequences of exposure to drugs during the uterus, specifically to centrally stimulating medications like those prescribed for ADHD. It is therefore critical that women receive appropriate advice from their doctors about the risks and benefits of taking medication prior to conception and throughout pregnancy. In this CAP Smart Take we review the most recent research in this field and how it can inform clinical practice.
Animal studies as well as research on illicit drugs indicate that stimulant medication passes to the fetus via the placenta and may negatively affect fetal development and growth. However, there are limited information on how the fetus responds to therapeutic doses of prescription stimulant medication during pregnancy, and the majority of this data comes from single-arm case-control studies that have not been sufficiently powered to detect possible significant connections.
The study by Cohen and colleagues4 is distinctive because it is the most comprehensive and meticulously controlled. The study comprised a sample of 364,012 pregnant women from the Danish Medical Registry, and data on the use of medication was gathered by analyzing prescriptions that were redeemed. The researchers specifically excluded women who reported taking SSRI drugs or clonidine because these medications can interfere with the fetal NMDA receptor and increase the risk of developing neurodevelopmental disorders like autism and ADHD. The authors also adjusted their analysis to account for potential confounding factors and to account for the timing of in utero exposure.
The results of this study as well as other small-scale trials suggest that the vast number of women who continue to take their stimulant medications 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 prior to advising their pregnant patients to stop taking them. It is important that pregnant women with ADHD inform their parents as well as extended families and employers of the choice they've taken. This is because the signs of hyperactivity, inattention, and impulsivity could be re-present when the mother stops taking her 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 includes both pharmacologic and behavioral treatment and ongoing monitoring throughout the postnatal period. The plan should include a review of the current treatment regimens, specifically in the first trimester where the risks of harm to the baby due to untreated ADHD are greatest. This should be a collaborative effort between 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 stopping psychostimulant treatment 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 study that examined children exposed to ADHD medications during utero and concluded that "continuation of psychostimulant use during the early stages of pregnancy didn't increase the risk of adverse birth outcomes, and if anything was associated with less stress for mothers." However, this conclusion is not without its flaws. The study did not consider the importance of the dose of stimulant medication, nor the long it was used in addition to other factors related to sociodemographics and clinical. There is no research controlled that studies the safety of a continued use of psychostimulants in nursing mothers.
There isn't any definitive evidence from a scientific study on the safety of ADHD medication during pregnancy. However, most doctors have a general knowledge of what the literature suggests and can apply the best practices when assessing each patient's specific needs. It is known, for example that babies born to mothers taking methylphenidate during the first trimester are more likely have cardiac malformations (Cooper, et al. 2018). However this conclusion is based on a comparatively small study that did not take into account the different patient demographics and underlying psychiatric conditions.
In a recent survey of ADDitude readers, they found that they are more likely than ever before to quit taking their ADHD medication during early pregnancy. treating adhd without medication who stopped taking psychostimulants in the first trimester noticed a clinically significant rise in depression symptoms. They also reported that they were less able to enjoy their pregnancy and rated their family functioning as more difficult than those who continued or increased dosages of ADHD medications.
Work Functioning Test
The test for work function is a vital component of the test as it will determine if a patient can perform their job duties. The test is designed to evaluate functional limitations. It includes materials handling that is graded (lifting to various heights, pulling and pushing), positional tolerance activities (sitting or standing in a balancing position, walking or stooping, kneeling, crawling) and other relevant tests for specialized testing (hand manipulation). The test evaluator will review the results and come up with a return to work conclusion. ROC curves are used to determine the point of minimal misclassification (MIC) for both the general and physical work ability and the work-functioning score for a particular problem.
The MIC is calculated according to the COnsensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. This method divides the scores of physical and general ability and work-functioning difficulties based on the answering an anchor question, to avoid a change in measure from affecting the overall average.
Driving Test
The gold standard for treating ADHD is psychostimulant medications. It increases safety for drivers and reduces symptoms. 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 assist women in adjusting their routines, and use their coping abilities in ways that minimize the effects of ADHD on work and other aspects.
All of these factors could be crucial considerations when making the decision whether to continue or discontinue psychostimulant therapy. As the best available data suggest, even though there is some concern regarding the outcomes of pregnancy after in utero exposure to stimulant medications, the risk is minimal and the results are confounded by other medication, health treatment as well as physical and mental health and other 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.