ADHD Medication and Pregnancy
GPs might prescribe stimulants to treat ADHD (methylphenidate dexamfetamine, methylphenidate, and Lisdexamfetamine) and non-stimulants like modafinil and atomoxetine. These medications can improve the ability of patients to manage their ADHD symptoms and keep regular appointments with a GP and specialist.
Most studies of the pregnancy safety of ADHD medication limit their outcomes to live births, thus underestimating the severity of teratogenic effects that cause terminations and abortions. This study is the first to include these data.
Risk/Benefit Discussion
Many women suffering from ADHD have a problem when they are taking stimulants during pregnancy. On the one hand, many women with ADHD function well when they are taking their medication. If they stop, it could lead to marital conflict, problems at work or school and other serious repercussions. On the other hand, they do not want to expose their child to drugs whose long-term effects are unknown.
While some doctors counsel their patients to quit using ADHD medications prior to becoming pregnant, other doctors have found a way to strike a balance between the assumed safety and the needs of the individual patient. The latter usually arrive at the decision after consulting with their spouse and/or physician in order to strike an equilibrium between the mother's desire for her medication and the possibility of developing severe symptoms, such as agitation, depression, and difficulty staying awake when discontinuing the drug.
Most studies on ADHD medication and pregnancy are focused on the effects of the first trimester stimulant exposure on the growth of fetal malformations. However, the research available is inconclusive. This is partly because most of the studies that are available don't include information on outcomes other than live births (eg terminations, miscarriages, terminations, and stillbirths) and also because they fail to consider a range of confounding factors, including the calendar year pregnant characteristics, maternal sociodemographics as well as indications for the drugs as well as physical and mental health status, and proxies for other mental and medical ailments.
However, the findings of some of the available studies suggest that there isn't a significant increase in risk for the fetus due to the use of the most frequently prescribed stimulant medications prior to or during the first trimester. The warning signs for certain cardiac malformations are clear. This is especially true for VSD (ventricular defect). However these findings need to be confirmed by larger studies that provide more precise information.
There is also insufficient evidence to support a link between the use of methylphenidate (MPH) and Atomoxetine (ATO) and a higher rate of gastroschisis, omphalocele and transverse limb deficiencies. These birth defects may also be caused by other medications, but the risks remain unclear due to the limited data available.
Do not take knowing it .
Women with ADHD who are pregnant face a difficult choice to make: Should they continue taking their ADHD medication or stop taking it? This is a major shift in the life of both the mother and the fetus. Many doctors believe that the ideal time to discuss this subject is when a woman informs her doctor she is planning to start a new family. This will provide her with the necessary information to make a decision prior to when she becomes pregnant. However, this is not always possible and women often discover that they are pregnant at a later point during the pregnancy, when it's too late to stop taking medication.
There are a few studies on the safety of stimulants during pregnancy and breastfeeding. The majority of studies are based upon retrospective data analyses and do not consider factors like the age of the mother at the time of first exposure or chronic conditions, stimulant warnings, cotreatment with pain and psychiatric medications, as well as other factors that can affect the risk. Several studies have shown an increase in the chance of preeclampsia or premature birth when psychostimulants are administered during pregnancy. However these findings should be taken with caution.
Some behavioral problems in infants have been caused by the use of stimulants in pregnancy. The most frequently reported issue is the development of tics (abnormal muscle movements) in a few children. Other behavioral problems that have been identified include increased impulsivity, irritability, and defiance. The good news is that these signs generally improve after the medication is taken off.
Some medications that are prescribed for ADHD interact with other drugs and can cause dangerous side effects when they are combined especially with alcohol or other CNS stimulants (methylphenidate, amphetamine salts). These medications should not be taken with antidepressants or narcotics, including pain relievers. They should be avoided by people who are using illegal drugs or nicotine products.
Some patients are able to reduce or eliminate ADHD medication during pregnancy without significant functional impairment. In these instances, it is important to educate the patient and her spouse or partner about the decision and solicit their assistance in minimizing symptom recurrence. This may include locating local support resources, soliciting assistance from friends or family members, or seeking accommodations at work that address impairments related to symptoms. It is also helpful to know about cognitive-behavioral therapy and coaching for ADHD that can be provided by trained professionals.
Medicines to Take into
Both patients and doctors have a difficult time deciding whether or not to continue taking ADHD medication during pregnancy. It's a difficult choice for those who suffer from co-occurring disorders of substance use due to the fact that many of the medications that treat addiction may have the same effects as the most common ADHD medications, such as the possibility of causing high blood pressure and a recurrence of chest pain.
Unfortunately, there aren't a lot of options for these people and their physicians. The lack of research into how to treat a person with ADHD and addiction disorders can cause some doctors to err to the side of caution and recommend that patients discontinue their medications during pregnancy.
It is best to discuss the question of whether or not you should continue taking ADHD medications before deciding to start making plans for a baby. Many women suffering from ADHD are shocked to learn that they are pregnant. This usually happens during the first trimester of pregnancy, when the development of the fetus is vulnerable to exposure to medications.
If the patient and doctor decide to continue taking medication during the first trimester, they should choose the lowest dosage possible and closely monitor any symptoms. The doctor may suggest that the woman take an immediate-release medication during the middle hours of the day in order to lower the fluctuation in medication levels in the bloodstream.
In the near future we hope that more research will be conducted on how to manage both ADHD and substance use disorders in people who are nursing or pregnant. In the meantime women who are expecting or planning to become pregnant, should speak to their GP about the options they may have, such as psychotherapy that targets ADHD symptoms and how it differs from a treatment-only approach. They should be informed that if they do not decide to take medication, they may be more difficult at work and school, and could even struggle to maintain a relationship. This will also have a major impact on their children.
Incorporate Medications
Women who suffer from ADHD may take medication to manage symptoms like inattention, hyperactivity and an impulsiveness. Recent research has shown that these medications do not harm the fetus and can be used throughout pregnancy.
This is good news for women who are planning to become mothers and rely on their ADHD medication. Many women are concerned that they should not continue taking their medication while pregnant, especially if they take stimulant medications like amphetamines and methylphenidate. These women and their healthcare providers should discuss the risks and benefits of medication use based on the most current research and guidelines.
Methylphenidate is among the most frequently prescribed ADHD medication and has been found to be safe for pregnant women when under the supervision of a medical professional. Other commonly prescribed stimulant medications such as amphetamine and atomoxetine are also considered safe for pregnant women. However, it is important to keep in mind that both non-stimulant and stimulant medications must be closely monitored during pregnancy.
A recent study of data from the Danish national registers showed that children born to mothers who took ADHD medication during pregnancy did not have adverse effects on their child's neurological development or long-term growth. These findings are significant because they cover a larger population of patients than previous studies, and take into consideration numerous confounding factors.
Additionally, the results show that the use of ADHD medication during pregnancy is not associated with an higher risk of maternal complications such as anemia and iron deficiency, hyperemesis gravidarum, or TORCH infections. These findings represent a major improvement in our understanding of how obstetricians can safely manage the use of ADHD medication during pregnancy.
It is vital that women suffering from ADHD continue to follow their treatment plans and work closely with their healthcare providers throughout their pregnancy. This will help to ensure that symptoms are treated correctly, allowing women maximize their pregnancy. If you are unable or are unable to stop medication, there are many non-pharmacological options that can improve symptoms and promote overall well-being during pregnancy. These include: