ADHD Medication and Pregnancy
Physicians are unable to provide accurate information about the safety of ADHD medications during pregnancy. In the absence of more research, doctors must weigh the benefits and risks of taking medication during pregnancy.
A study that was based on a population-based approach has followed 898 infants who were born to mothers who were taking ADHD medications during pregnancy (stimulants amphetamine methylphenidate dexamphetamine ; non-stimulants modafinil, atomoxetine, and clo) until they were identified as having a developmental disorder, passed away or left the country.
Risk/Benefit Discussion
CAP Smart Take
Physicians are concerned about the long-term effects of drug exposure in the uterus, specifically to centrally stimulating medications like those used for ADHD. It is crucial that women receive proper medical advice from their doctors regarding the risk/benefit of using medication prior to conception and throughout pregnancy. In this Smart Take on CAP, we review the most recent research in this field and how it can influence the clinical practice.
Previous animal studies and illicit drug use research suggest that stimulant drugs are passed to the fetus via the placenta and can negatively affect fetal development and growth. There is however, a limited amount of information on the response of the fetus to the therapeutic doses of prescription stimulant medication during pregnancy and the majority of this data comes from single-arm studies that have been underpowered to detect possible significant connections.
The most recent study by Cohen and colleagues stands out from the others because it is the largest and most tightly controlled. The study involved 364,012 births that were retrieved from the Danish Medical Registry. Information regarding medication use was collected by analyzing the redeemed medication. Researchers excluded women who had taken SSRIs or clonidine because these drugs can interfere with fetal NMDA and increase the risk of developing neurodevelopmental disorders, such as autism and ADHD. The authors also modified their studies to take into account potential confounding factors and to account for the timing of the in utero exposure.
The data from this study, in addition to 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 adverse effects on their fetuses. It is therefore likely that a lot of pregnant women will continue to use their ADHD medication. But it is essential that doctors weigh the benefits and risks of these medications for their pregnant patients, as well as consider each patient's unique situation, before advising them to discontinue their medication. Whatever decision they make, it is vital that pregnant women with ADHD inform their spouses, relatives, partners, and employers about the choice they have made. This is because signs of hyperactivity, inattention, and impulsivity are likely to return after the mother ceases taking her medications.
Pregnancy Tests
Preconception counseling should comprise a comprehensive management program that includes both behavioral and pharmaceutical treatment and ongoing monitoring during the perinatal stage. The plan should include a discussion of the current treatment regimens, specifically in the first trimester where dangers to the baby due to untreated ADHD are greatest. This should be a joint effort between obstetrics, psychiatry and primary care.
The risk/benefit discussion should also discuss how a woman intends to manage her symptoms of ADHD during pregnancy, including the effects on family functioning and what she might feel about a decision to stop psychostimulant therapy in the beginning of pregnancy. This should be guided by a thorough analysis of evidence available, including consideration of the individual patient's needs and concerns.
The authors of a massive study that examined children who were exposed to ADHD medications while in utero concluded that "continuation use of psychostimulants during early pregnancy did not cause adverse birth outcomes and if it was, it was associated with lower stress levels among mothers." However their conclusion isn't without a few limitations. The study did take into consideration other factors, such as the duration of time stimulant medication was taken in addition to the dose and sociodemographics. Moreover, there is no controlled research examining the safety of continuing use of psychostimulants in nursing mothers.
There isn't any definitive scientific data on the safety of ADHD medication during pregnancy. However, the majority of doctors have a basic understanding of the research findings and can apply the best practices in consultation to each patient's specific needs. For example, it is known that there is a higher risk of cardiac malformations among infants born to mothers who take methylphenidate during the first trimester of pregnancy (Cooper and colleagues., 2018), while it is important to note that this conclusion was based on a small study and did not account for differences in patient demographics or underlying psychiatric comorbidity.
In an earlier survey of ADDitude readers, they reported that they are more likely than ever before to quit taking their ADHD medication during the first trimester of pregnancy. However, women who stopped psychostimulants in the first trimester of their pregnancy experienced a clinically significant increase in the severity of depressive symptoms. They also found themselves less able enjoy pregnancy and rated family functioning as more difficult than those who continued to take their dose of ADHD medication or increased it.
Work Functioning Test
The test for work function is a vital component of the test as it will determine if a patient is able to perform their tasks. The test is designed to evaluate functional limitations. It includes the use of graded material handling (lifting to different levels, pushing and pulling) as well as positional tolerance tests (sitting or standing and walking, balancing or stooping, kneeling, crawling) along with other relevant specialized tests (hand manipulation). The test evaluator will review the results and draw the 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 using 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 answer on an anchor question to prevent changes in the measurement from affecting the overall average.
Driving non prescription adhd medication uk are a gold treatment for ADHD. It helps reduce symptoms and improves functioning in work and other areas, such as driving safety. Untreated severe ADHD can have severe financial and psychosocial consequences.
Psychotherapeutic treatments, like cognitive behavior therapy (CBT) or "coaching" methods have also been found to help improve symptoms and increase functioning. These strategies can assist women in adjusting their routines, and use their coping abilities to minimize the effects of ADHD on work and other aspects.
All of these aspects can be crucial considerations when making the decision of whether to continue or discontinue psychostimulant therapy. The most reliable data indicate, although there is some concern about the effects of pregnancy on outcomes after in-utero exposure to stimulant medication, the risks are minimal and the outcomes are affected 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 its effects on offspring.