ADHD Medication and Pregnancy
Physicians often struggle to inform patients on the safety of their ADHD medication during pregnancy. In the absence of further research, physicians must weigh up the benefits and risks of using medications during pregnancy.
A population-based study has followed 898 babies who were born to mothers who had taken ADHD medications during pregnancy (stimulants amphetamine methylphenidate ; dexamphetamine non-stimulants modafinil, atomoxetine, and clo), 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 medications such as those used for ADHD. It is essential that women receive the appropriate advice from their doctors about the risks and benefits of taking medication prior to conception and during pregnancy. In this CAP smart take, we look at the most current data in this area and how they can inform the practice of a physician.
Animal studies and illicit drug research suggests that stimulant medication passes to the fetus via the placenta, and could negatively impact fetal growth and development. There is however, a limited amount of information on how the fetus responds to dosages of prescribed stimulant medication 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 correlations.
The most recent study by Cohen and co. stands out from the rest as it is the biggest and most carefully controlled. The study covered 364,012 pregnancies that were retrieved from the Danish Medical Registry. Information on medication use was gathered by analyzing redeemed medications. Researchers excluded women who had taken SSRIs or clonidine because these drugs could interact with fetal NMDA and increase the risk of developing neurodevelopmental disorders like autism and ADHD. The authors modified their analysis to take into account the timing of exposure and to make sure that they control for confounding factors.
The data from this study, along with the results of other trials, indicate that the majority of women who continue to take their prescribed stimulant medications for ADHD throughout pregnancy do not experience adverse effects on their fetuses. Therefore, it is likely that many women who are pregnant will continue to use their ADHD medication. However, medication for adhd is important that physicians carefully weigh the risks and benefits of these medications for their pregnant patients, as well as consider each patient's unique situation prior to suggesting that they stop taking their medication. No matter what decision they make, it is vital that pregnant women with ADHD inform their spouses, partners, extended family members as well as their employers about the decision they've made. It is because the signs of inattention, hyperactivity, and impulsivity are likely to return when the mother stops taking medication.
Pregnancy Tests
Preconception counseling should include an extensive management plan that incorporates both behavioral and medical treatment and continuous monitoring throughout the perinatal period. The plan should include a review of the current treatment regimens, particularly in the first trimester where dangers to the baby due to untreated ADHD are greatest. This should be a joint effort between psychiatry and primary care and Obstetrics.
The discussion of the risks and benefits should also include how a woman will manage her ADHD symptoms during pregnancy, the effects of this on the family's functioning and her feelings about a decision to stop psychostimulant treatment in the beginning. This should be based on an exhaustive review of the available evidence and consider the patient's individual needs and concerns.
In a recent large study that examined children exposed to ADHD medications in utero, the authors concluded that "continuation of use of psychostimulants in early pregnancy did not increase the risk of adverse birth outcomes and, if anything, was associated with decreased stress on the mother." However this conclusion isn't without its flaws. The study did take into consideration other factors such as the duration for which stimulant medication was used as well as the dose and sociodemographics. There is no research controlled that studies the safety of a continued psychostimulant usage in nursing mothers.
There isn't a clear scientific data concerning the safety of ADHD medication during pregnancy. However, most doctors are aware of what research suggests and apply best practices in consultation to the specific needs of each patient. It is well-known, for instance that infants born to mothers who are taking methylphenidate during the first trimester are more likely to have cardiac malformations (Cooper, et al. 2018). However this is based on a tiny study that did not take into account differences in patient demographics and underlying psychiatric conditions.
In a recent survey, ADDitude readers reported that they were more likely to discontinue their ADHD medication during the early stages of pregnancy than they were in the past. Women who stopped taking psychostimulants during the first trimester experienced a clinically significant rise in depression symptoms. They also reported that they were less than able to enjoy their pregnancy and described their family functioning as being more difficult than women who maintained or increased their dosages of ADHD medication.
Work Functioning Test
The test of work function is a vital component of the exam in that it determines whether a person can perform their job. The test is designed to assess functional limitations. It includes graded material handling (lifting to various levels, pushing and pulling) as well as positional tolerance tests (sitting in a chair, standing in a balancing position, walking and stooping, kneeling and crawling) as well as other relevant specialized tests (hand manipulation). The evaluator evaluates the results to formulate the return-to-work conclusions. ROC curves are used to illustrate the point at which there is a minimum misclassification (MIC) for both the general and physical working ability as well as the functional score for a particular problem.
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 difficulties based on the answering an anchor question, to avoid a change in metric from biasing the overall average.
Driving Test
Psychostimulant medication is a standard treatment for ADHD. It increases safety for drivers and decreases symptoms. The effects of severe, untreated ADHD can have profound financial and psychosocial effects.
Psychotherapeutic interventions, such as cognitive behavior therapy (CBT) or "coaching" techniques have also been proven by research to reduce symptoms and improve performance. These strategies can help women to tailor their routines and use their coping skills to minimize the impact of their ADHD on work and other areas.
All of these factors can be crucial considerations when making the decision whether to continue or stop psychostimulant therapy. The most reliable data show, while there is some concern regarding the effects of pregnancy on outcomes after in-utero exposure to stimulant medication, the risks are minimal and the results are affected by other medication, health care utilization, maternal mental and physical 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 its effects on offspring.