The Lesser-Known Benefits Of ADHD Medication And Pregnancy
ADHD Medication and Pregnancy
Physicians often struggle to inform patients about the safety of their ADHD medications during pregnancy. In the absence of more research, doctors must weigh the advantages and risks of using medication during pregnancy.
A recent study on a population-based cohort tracked 898 infants 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 died or left the country.
Risk/Benefit Discussion
CAP Smart Take:
Doctors are concerned with the long-term effects exposure to drugs in utero can result in, especially for centrally stimulating medications such as those used to treat ADHD. It is important that women receive appropriate advice from their doctors regarding the potential risks and benefits of using medications during pregnancy and prior to conception. In this CAP Smart Take, we examine the latest data in this area and how it might influence the practice of a physician.
Animal studies as well as illicit drug use research suggest that stimulant drugs are passed to the fetus through the placenta and can negatively affect fetal development and growth. There aren't many studies on the effects of prescription stimulant medications during pregnancy. The majority of the evidence comes from studies conducted in case-control with one arm, which isn't powerful enough to identify any significant associations.
The recent study by Cohen et al4 is distinct from other studies because it is the largest and most tightly controlled. The study comprised a representative sample of 364,012 pregnancies from the Danish Medical Registry, and data on the use of medication was obtained by analyzing prescriptions that were redeemed. Researchers excluded women who had taken SSRIs or clonidine as these drugs can interfere with fetal NMDA and increase the risk for neurodevelopmental disorders, such as autism and ADHD. The authors also adjusted their analyses to control for potential confounding factors and to take into account the timing of in-utero exposure.
The results of this study and other studies show that the majority of women who continue using their stimulant medication prescribed for ADHD during pregnancy are not experiencing adverse effects on their foetuses. As a result, it is likely that a large number of women will continue to take their medication for ADHD during pregnancy. However, it is crucial that doctors evaluate the advantages and risks of these medications for pregnant patients, as well as be aware of the unique circumstances of each patient, before suggesting they stop their medication. It is essential that pregnant women suffering from ADHD inform their spouses as well as extended families and employers of the decision they've made. This is because the signs of inattention, hyperactivity, and impulsivity could return if the mother ceases taking her medication.
Pregnancy Tests
Preconception counseling for women suffering from ADHD who want to become pregnant should focus on a comprehensive management plan that includes both behavioral and pharmacologic treatment and ongoing monitoring throughout the postnatal period. The plan should include a discussion of the current treatment regimens, specifically during the first trimester, when risks of harm to the baby from untreated ADHD are the highest. This should be a joint effort between primary care and psychiatry and Obstetrics.
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 the family's functioning, and how she feels about stopping psychostimulant therapy in the early stages. This should be guided by a thorough analysis of the available evidence, and consideration of the specific patient's needs 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, was associated with less stress for mothers." However this conclusion isn't without its flaws. The study did not take into account other factors such as the length of time that stimulant medication was used, the dose and the sociodemographics. Furthermore, there is no controlled study that examines the safety of continuing psychostimulant use among nursing mothers.
Although there is a lack of scientifically substantiated evidence regarding the safety of ADHD medications during pregnancy, most physicians are aware of what the literature suggests and use best practices in consultation with each patient's unique needs. For instance, it's well-known that there is a higher rate of cardiac malformations in infants born to mothers who took methylphenidate within the first trimester of pregnancy (Cooper and colleagues. (2018)), while it is also important to note that this conclusion was based on one small study that did not take into account for variations in the demographics of patients or the underlying psychiatric co-morbidity.
In a recent survey ADDitude readers reported that they were more likely to stop their ADHD medication during the early stages of pregnancy than they were in the past. Women who stopped psychostimulants during the first trimester experienced an increase in depression symptoms. Our Site reported feeling less able to enjoy pregnancy and rated family functioning as more challenging than those who maintained their dosage of ADHD medication or increased it.
Work Functioning Test
The work function test is a vital component of the exam, as it determines if a person can perform their job. The test is designed for evaluating functional limitations. It includes graded material handling exercises (lifting at different heights pulling and pushing), tests for positional tolerance (sitting and standing as well as walking and balancing in a stoop, kneeling and stoop) and specialized tests. The evaluator evaluates the results to formulate an appropriate return-to-work conclusion. 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-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. This method separates scores for general and physical work abilities and work-functioning problems by answering an anchor question. This will prevent a change in metrics from affecting the average.
Driving Our Site is a standard treatment for ADHD. It improves driving safety and reduces symptoms. If left untreated, severe ADHD can have serious psychosocial and financial implications.
Psychotherapeutic interventions, such as cognitive behavior therapy (CBT) or "coaching" methods have also been proven by research to reduce symptoms and improve function. These strategies can help women tailor their schedules and utilize their coping abilities in ways that minimize the effects of ADHD on work and other aspects.
All of these factors can be significant considerations in the decision to continue or discontinue psychostimulant treatment. As the best available data indicate, although there is some concern regarding pregnancy outcomes with in utero exposure to stimulant medication, the risk is minimal, and the results are affected by other medication, health treatment, maternal mental and physical 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 offspring outcomes.