ADHD Medication and Pregnancy
Physicians are unable to provide accurate information regarding the security of ADHD medications during pregnancy. As long as research is not available, physicians must weigh the advantages of medication use during pregnancy against the possible risks for offspring in each individual situation.
A recent population-based cohort study tracked 898 infants born to mothers who were taking ADHD medications throughout pregnancy (stimulants such as amphetamine, methylphenidate dexamphetamine, methylphenidate; non-stimulants: modafinil, atomoxetine, 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 drug exposure in the uterus, especially to centrally stimulating medications such as those used to treat ADHD. It is crucial that women receive proper advice from their doctors regarding the risks and benefits of using medication during pregnancy and before conception. In this CAP smart approach, we look at the most current data in this area and how they might guide the practice of a physician.
Animal studies and illicit drug research have suggested that stimulant medications enter the fetus via the placenta and can adversely affect the growth of the fetus and development. However, there is a lack of data regarding the way that the fetus reacts to the therapeutic doses of prescription stimulant medications during pregnancy, and most of this evidence comes from single-arm case-control studies that have been underpowered to detect possible significant associations.
The study by Cohen and colleagues4 is unique because it is the most thorough and well-controlled. adhd medications covered 364,012 pregnancies taken from the Danish Medical Registry. Information on medication use was gathered by analyzing 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 like autism and ADHD. The authors re-analyzed their findings in order to account for the timing of exposure as well as make sure that they control for confounding factors.
The results of this study, as well as the results of other studies, show that the majority of women who continue to use the stimulant medications prescribed for ADHD during pregnancy do not experience adverse effects on their foetuses. Therefore, it is likely that a lot of pregnant women will continue to take their ADHD medication. It is important for doctors to weigh the risks and benefits of these drugs prior to advising their pregnant patients to stop taking them. It is essential that pregnant women suffering from ADHD inform their parents family members, extended families, and employers of the decision they've taken. This is because the symptoms of hyperactivity, inattention and impulsivity are likely to be recurred when the mother stops taking her medication.
Pregnancy Tests
Preconception counseling should consist of an extensive management plan that includes both behavioral and pharmaceutical treatment and continuous monitoring throughout the perinatal period. The plan should include a discussion about the current treatment regimens, specifically in the first trimester, when the risks of harming the baby because of untreated ADHD are the highest. This should be a joint effort between obstetrics, psychiatry, and primary care.
The discussion on risk and benefits should discuss how a woman intends to manage her symptoms of ADHD during pregnancy, including the effects on family functioning and how she feels about a decision to stop psychostimulant therapy during the initial stages of pregnancy. This should be based on a thorough review of evidence available, including consideration of the specific patient's needs and concerns.
The authors of a huge study that examined children 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 anything, was associated with reduced stress among mothers." However their conclusion isn't without limitations. The study did take into consideration other factors, such as the duration for which stimulant medications were used, the dose and the sociodemographics. Moreover, there is no controlled research that evaluates the safety of continuing psychostimulant use among nursing mothers.
There isn't any definitive scientific data regarding the safety of ADHD medication during pregnancy. However, most doctors are aware of the research findings and can apply the best practices when assessing each patient's specific needs. For example, it is well-known that there is a higher risk of cardiac malformations in infants born to mothers who took methylphenidate in the first trimester of pregnancy (Cooper et al., 2018), while it is important to note that this conclusion was based on a single study that did not consider differences in patient demographics or underlying psychiatric comorbidity.
In a recent survey, ADDitude readers found that they were more likely to stop their ADHD medication in early pregnancy than in previous. Women who stopped psychostimulants during the first trimester experienced an increase in depression symptoms. They also reported feeling less than able to enjoy their pregnancy and described their family functioning as less than those who continued or increased their dosages of ADHD medications.
Work Functioning Test
The test for work function is a vital aspect of the test to determine if an individual is able to carry out their job. The test is intended for testing functional limitations. It includes a variety of graded material handling tasks (lifting at different heights pulling and pushing) as well as positional tolerance exercises (sitting and standing while walking, balancing and walking, stooping and kneeling) and specific tests. The evaluator evaluates the results to formulate an appropriate return-to-work conclusion. ROC curves are used to illustrate the point of minimum misclassification (MIC) for both the general and physical work ability and the work-functioning score for a particular problem.
The MIC is calculated according to the COnsensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. This method separates the scores of the physical and general work abilities and work-functioning issues based on an answer on an anchor question to prevent any change in the metric from biasing the overall average.
Driving Test
The gold standard for treating ADHD is a psychostimulant drug. It eases symptoms and enhances performance in other areas, including driving safety. Impairment due to severe untreated ADHD can have serious psychosocial and financial consequences.
Psychotherapeutic interventions such as cognitive behavioral therapy (CBT) and "coaching" strategies have also been shown to reduce symptoms and improve functioning. These strategies can assist women in adjusting their schedules and utilize their coping skills in ways that minimize the effects of ADHD on work and other aspects.
All of these aspects are important to take into account when deciding whether or not to continue with psychostimulant therapy. The most recent data available indicate that although there are some concerns about the outcomes of pregnancy when in utero stimulant medication is used, the relative risks of this are small. Also, the results are muddled by other medications, maternal healthcare utilization and physical and mental health and comorbidities. Read Home Page , Bliddal m., Skoglund cb., Larsson h., Munk-Olsen t., Hove Thomsen p., Bergink V. In-utero exposure to attention deficit/hyperactivity disorder medication and the effects on offspring.