ADHD Medication and Pregnancy
Physicians often struggle to advise patients on the security of their ADHD medication during pregnancy. In the absence of further research, physicians must weigh up the benefits and risks of taking medication during pregnancy.
A recent study on a population-based cohort monitored 898 babies born to women taking ADHD medications throughout pregnancy (stimulants such as amphetamine, methylphenidate dexamphetamine, methylphenidate; non-stimulants: modafinil, atomoxetine and clonidine) until they were diagnosed with a developmental disorder or died or left the country.
Risk/Benefit Discussion
CAP Smart Take
Doctors are concerned about the long-term effects that drug exposure in utero can have, especially for centrally stimulating drugs like those used to treat 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 throughout pregnancy. In this Smart Take on CAP, we examine the latest data in this field and how it might guide clinical practice.
Animal studies and illicit drug research suggests that stimulant medication passes to the fetus through the placenta, and could negatively impact fetal growth and development. There aren't many studies on the effects of prescription stimulant drugs during pregnancy. The majority of evidence comes from studies conducted in case-control with a single arm, which aren't strong enough to detect any significant correlations.
The study conducted by Cohen and colleagues stands out from the others, as it is the biggest and most tightly controlled. The study involved 364,012 births collected from the Danish Medical Registry. Information on medication use was gathered through the analysis of redeemed medications. The researchers specifically excluded women who had reported receiving SSRI drugs or clonidine because these medications can interfere with the fetal NMDA receptor 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 and to take into account confounding factors.
Visit Homepage from this study, as well as the results of other limited trials, indicate that the majority of women who continue to take the stimulant medications prescribed for ADHD during pregnancy do not experience any adverse effects on their fetuses. Therefore, it is likely that many pregnant women will continue to take their ADHD medication. It is important for doctors to consider the risks and benefits of these medications before advising their pregnant patients to stop taking them. Regardless of which most effective adhd medication for adults make, it is crucial that pregnant women suffering from ADHD inform their spouses, partners, extended family members, and employers about the choice they've made. This is because the signs of inattention, hyperactivity, and impulsivity are likely be re-present when the mother stops taking their medication.
Pregnancy Tests
Preconception counseling for women with ADHD who are planning to become pregnant should concentrate on a comprehensive treatment plan that involves both pharmacologic and behavioral treatment and ongoing monitoring throughout the perinatal period. The plan should include a review of current medication regimens, especially during the first trimester, when the risks of harm to the baby resulting from untreated ADHD are greatest. This should be a collaborative effort between obstetrics, psychiatry, and primary care.
The discussion of the risks and benefits should also include how a woman intends to manage her ADHD symptoms during pregnancy, the effects of this on family functioning and her feelings about a decision to stop psychostimulant treatment in the early stages. This should be based on an exhaustive review of the evidence available and consider the individual needs of the patient and concerns.
The authors of a large study that followed children who were exposed to ADHD medications during utero concluded that "continuation psychostimulant use during the early stages of pregnancy did not cause adverse birth outcomes and, if it was, it was associated with reduced stress among mothers." However the conclusion they reached is not without a few limitations. The study did take into consideration other factors, such as the duration for which stimulant medications were used as well as the dose and sociodemographics. Moreover, there is no controlled research examining the safety of continuing use of psychostimulants in nursing mothers.
While there is a lack of scientifically substantiated evidence regarding the safety of ADHD medications in pregnancy, most physicians have a basic understanding of what the current research suggests and employ the best practices, in consultation with the specific needs of each patient. For instance, it is recognized that there is a higher rate of cardiac malformations among babies born to mothers who have taken methylphenidate in the first trimester of pregnancy (Cooper and colleagues. (2018)) However, it is also important to note that this finding was based on one small study that did not account for differences in patient demographics or underlying psychiatric comorbidity.
In a recent study, ADDitude readers said that they were more likely to quit their ADHD medication during the early stages of pregnancy than they were in the past. However, women who discontinued psychostimulants within the first trimester of pregnancy noticed an increase in symptoms of depression. They also reported being less capable of enjoying their pregnancy and rated their families functioning as less than those who maintained or increased their dosages of ADHD medication.
Work Functioning Test
The work functioning test is a vital component of the examination as it determines if a patient can perform their job duties. The test is designed to assess functional limitations. It includes the use of graded material handling (lifting to different heights, pulling and pushing) as well as positional tolerance tests (sitting, standing in a balancing position, walking or stooping, kneeling, crawling) and other relevant tests for specialized testing (hand manipulation). The test evaluator analyses the results to formulate the return-to-work conclusions. ROC curves can be used to determine the point of minimal classification (MIC) in the general ability to work physical work capability, and the work-functioning problems score.
The MIC is calculated using the COnsensus Standards for the Selection of Health Measurement Instruments Checklist (COSMIN). This method separates scores for general and physical work abilities and work-functioning issues by answering an anchor question. This will prevent a change in metrics from affecting the average.
Driving Test
Psychostimulant medication is a standard treatment for ADHD. It helps reduce symptoms and improves functioning in other areas, including driving safety. If left untreated, severe ADHD can have severe psychosocial and financial implications.
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 tailor their routines, and use their coping skills to minimize the impact of ADHD on their work and other aspects.
All of these aspects are important to consider when deciding whether or not to continue with psychostimulant therapy. As the most recent data available suggest, even though there are some concerns about the effects of pregnancy on outcomes after in-utero exposure to stimulant medications, the risks are minimal and the results are confounded by other treatments, maternal health care utilization, maternal mental and physical health and 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 offspring outcomes.