ADHD Medication and Pregnancy
Physicians often struggle to counsel patients on the security of their ADHD medications during pregnancy. In the absence of further research, doctors must weigh up the benefits and risks of using medications during pregnancy.
A recent population-based cohort study monitored 898 babies born to mothers who were taking ADHD medications throughout pregnancy (stimulants such as amphetamine, methylphenidate, dexamphetamine; non-stimulants: modafinil, atomoxetine, and clonidine) until they were diagnosed with a developmental disorder, or passed away or left the country.
Risk/Benefit Discussion
CAP Smart Take
Physicians are concerned about the long-term consequences of exposure to drugs during utero, particularly to centrally stimulating medications such as those used for ADHD. It is essential that women receive the appropriate medical advice from their doctors regarding the potential risks and benefits of using medications prior to conception and during pregnancy. In this CAP Smart Take, we look at the most current research in this area and how it could influence clinical practice.
Animal studies as well as research on illicit drugs suggest that stimulant drugs are passed to the fetus via the placenta and may negatively impact fetal development and growth. There is however, a limited amount of data on the response of the fetus to therapeutic doses of prescription stimulant medications during pregnancy, and most of this evidence is based on single-arm studies that have been underpowered to determine if there are significant connections.
The study by Cohen and colleagues4 is unique because it is the most thorough and meticulously controlled. The study involved 364,012 births taken from the Danish Medical Registry. Information regarding medication use was collected by analyzing the redeemed medication. The researchers specifically excluded women who had reported taking SSRI drugs or clonidine since these drugs can interfere with the fetal NMDA receptor and increase the risk of neurodevelopmental disorders such as autism and ADHD. The authors also modified their analyses to control for potential confounding factors as well as to account for the timing of in utero exposure.
The results of this study, as well as the results of other studies, suggest that the majority of women who continue to use their prescribed stimulant medications for ADHD during pregnancy do not experience any adverse effects on their fetuses. Therefore, it is likely that a large number of women will continue to use their medication for ADHD during pregnancy. But it is essential that doctors weigh the risks and benefits of these medications for their pregnant patients, and be aware of the unique circumstances of each patient, before suggesting they stop their medications. Whatever decision they make, it is essential that pregnant women suffering from ADHD educate their spouses or partners, extended family members as well as their employers about the decision they've made. This is because the signs of hyperactivity, inattention and impulsivity are likely to return if the mother ceases taking medication.
Pregnancy Tests
Preconception counseling for women suffering from ADHD who are planning to become pregnant should focus on a comprehensive plan of management that incorporates both pharmacologic and behavioral treatment and ongoing monitoring throughout the period of perinatal care. The plan should include a discussion of the current treatment regimens, specifically in the first trimester when risks of harm to the baby from 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 how a woman will manage her ADHD symptoms during pregnancy, the effect of this on family functioning and her feelings about stopping psychostimulant therapy in the beginning. This should be informed by a thorough review of the available evidence, and consideration of the individual patient's requirements and concerns.
In a recent study which followed children who were exposed to ADHD medications in utero The authors concluded that "continuation of psychostimulant use during the early stages of pregnancy did not increase the risk of adverse birth outcomes and if anything, it was associated with decreased stress on the mother." However, this conclusion is not without its limitations. The study did not take into account the significance of the dosage of stimulant medication, nor the long it was used, as well as other factors related to sociodemographics and clinical. There is also no research controlled that studies the safety of a continued psychostimulant usage in nursing mothers.
Although there is a lack of scientifically substantiated evidence regarding the safety of ADHD medications during pregnancy, many doctors are aware of what the current research suggests and employ the best practices in consultation with the individual needs of each patient. For instance, it's well-known that there is a higher risk of cardiac malformations in babies born to mothers who take methylphenidate within the first trimester of pregnancy (Cooper and colleagues., 2018) It is important to remember that this result was based on a single study that did not take into take into account variations in patient demographics or underlying psychiatric co-morbidity.
In a recent survey of ADDitude readers, they reported that they are more likely than ever before to stop taking their ADHD medication during the first trimester of pregnancy. Women who stopped taking psychostimulants during the first trimester experienced a clinically significant rise in depression symptoms. They also felt less able to enjoy their pregnancy and rated their family functioning as more difficult than those who remained on their dose of ADHD medication or increased it.
Work Functioning Test
The test for work function is an important aspect of the test in that it determines whether a person can perform their job. The test is intended for the evaluation of functional limitations. It includes graded material handling exercises (lifting at various levels, pulling and pushing) and positional tolerance exercises (sitting and standing, balancing and walking in a stoop, kneeling and stoop), as well as specific tests. The test evaluator will review the results and draw an appropriate return to a conclusion of the work. ROC curves can be used to determine the point of minimal classification (MIC) in the general work capability, the physical work ability and the work-functioning problem score.
The MIC is calculated based on the COnsensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. dealing with adhd without medication separates the scores of the general and physical work ability and work-functioning issues based on an answer on an anchor question, to avoid any change in the measurement from affecting the overall average.
Driving Test
The most effective treatment for ADHD is a psychostimulant drug. It improves driving safety and decreases symptoms. If left untreated, severe ADHD can have severe financial and psychological consequences.
Psychotherapeutic treatments such as cognitive behavioral therapy (CBT) and "coaching" strategies have also been shown to improve symptoms and enhance functioning. These strategies can assist women in adjusting their schedules and utilize their coping abilities in ways that reduce the impact of ADHD on their work and other areas.
All of these factors are important to take into account when deciding whether or not to pursue psychostimulant therapy. The most recent data available indicate that, despite concerns regarding the outcome of pregnancy when in utero stimulant medication is utilized, the risk-benefit ratios of this are low. Additionally, the results are complicated by other medication, the use of maternal healthcare as well as physical and mental 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 its effects on offspring.