What Is ADHD Medication And Pregnancy And Why Is Everyone Speakin' About It?
ADHD Medication and Pregnancy
Physicians often struggle to inform patients about the safety of their ADHD medication during pregnancy. In the absence research, physicians must weigh the benefits and risks of taking medication during pregnancy.
A recent study on a population-based cohort followed 898 babies born to mothers taking ADHD medications throughout their pregnancy (stimulants such as amphetamine, methylphenidate, dexamphetamine; non-stimulants: modafinil, atomoxetine, clonidine) until they were diagnosed with a developmental disorder, or died or left the country.
Risk/Benefit Discussion
CAP Smart Take:
Doctors are concerned about the long-term effects that exposure to drugs during pregnancy can be a source of harm, particularly for centrally stimulating drugs like those used to treat ADHD. It is crucial that women receive the appropriate medical advice from their doctors regarding the risk/benefit of using medication before conception and during pregnancy. In this CAP smart approach, we examine the most recent research in this area and how they could influence clinical practices.
Previous animal studies and research on illicit drugs indicate that stimulant medication passes to the fetus through the placenta and can adversely affect the development of the fetus and growth. There are few data on the effects of prescription stimulant medications during pregnancy. The majority of evidence comes from case-control studies with a single arm, which aren't strong enough to detect any significant associations.
The study conducted by Cohen et al4 is distinct from other studies, as it is the biggest and most meticulously controlled. The study involved 364,012 births taken from the Danish Medical Registry. Information regarding medication use was collected by analyzing redeemed medications. Researchers excluded women who had taken SSRIs or clonidine as these drugs could interact with fetal NMDA and increase the risk for neurodevelopmental disorders such as autism and ADHD. The authors modified their analysis to take into account the timing of exposure as well as make sure that they control for confounding factors.
The data from this study, in addition to the results from other studies, suggest that the majority of women who continue to take the stimulant medications prescribed 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. However, it is crucial that physicians carefully weigh the risks and benefits of these medications for their pregnant patients, as well as be aware of the unique circumstances of each patient prior to suggesting that they stop taking their medication. It is crucial that women who are pregnant with ADHD inform their partners, extended families, and employers of the choice they've taken. It is because the symptoms of inattention, hyperactivity, and impulsivity are likely to be re-present when the mother stops taking medication.
Pregnancy Tests
Preconception counseling for women with ADHD who want to become pregnant should concentrate on a comprehensive treatment plan that includes both pharmacologic and behavioral treatments and continuous monitoring throughout the postnatal period. The plan should include a discussion of the current treatment regimens, specifically in the first trimester where the chances of harming the baby because of untreated ADHD are the highest. This should be a collaborative effort with psychiatry, obstetrics and primary care.
The discussion of the risks and benefits should also include how a woman will manage her ADHD symptoms during pregnancy, the effects of this on family functioning, and how she feels about discontinuing psychostimulant treatment in the initial stages. This should be based upon a thorough evaluation of the available evidence and be mindful of the patient's individual needs and concerns.
The authors of a massive study that examined children who were exposed to ADHD medications during utero concluded that "continuation use of psychostimulants during early pregnancy did not cause adverse birth outcomes, and if it was, it was associated with less stress among mothers." However, their conclusion is not without a few limitations. The study did consider other aspects, including the length of time that stimulant medication was taken, the dose and the sociodemographics. Additionally, there isn't any controlled research examining the safety of continuing psychostimulant use among nursing mothers.
Although there is a lack of scientifically substantiated evidence regarding the safety of ADHD medication during pregnancy, the majority of doctors are aware of what the current literature suggests and use best practices, in consultation with each patient's unique needs. It is well-known, for instance, that infants born to mothers who take methylphenidate in the first trimester are more likely have cardiac malformations (Cooper, et al. 2018). However this conclusion is based on a small study that did not take into account the different the demographics of patients and the underlying psychiatric conditions.
In an earlier survey of ADDitude readers, they reported that they are more likely than ever before to quit taking their ADHD medication during early pregnancy. Women who stopped taking psychostimulants in the first trimester showed an increase in depressive symptoms. They also felt less able to enjoy their pregnancy and rated their family functioning as more challenging than those who continued to take their dose of ADHD medication or increased it.
Work Functioning Test
The test of work function is a vital component of the test as it determines if a patient can perform their job tasks. The test is designed for the evaluation of 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 in a stoop, kneeling and stoop) as well as tests that are specialized. The test evaluator analyses the results to form the return-to-work conclusions. ROC curves are used to show the point of minimal misclassification (MIC) for both the general and physical work ability and the work-functioning problem score.
The MIC is calculated by using the COnsensus Standards for the Selection of Health Measurement Instruments Checklist (COSMIN). This method divides the scores of physical and general work abilities and work-functioning problems score by answering an anchor question, to avoid changes in the measure from affecting the overall average.
Driving Test
Psychostimulant medication is a gold standard treatment for ADHD. It improves safety while driving and reduces symptoms. adhd and medication of severe, untreated ADHD can have serious psychosocial and financial consequences.
Psychotherapeutic treatments, like cognitive behavior therapy (CBT) or "coaching" techniques have also been proven by research to reduce symptoms and improve functioning. These strategies can assist women in tailoring their routines and apply their coping skills in ways that minimize the effects of their ADHD on work and other domains.
All of these factors could be important considerations in the decision whether to continue or stop psychostimulant therapy. As the most recent data available indicate, although there is some concern regarding the outcomes of pregnancy after in utero exposure to stimulant medication, the risks are minimal and the outcomes are confounded 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 disorder medication and long-term outcomes for offspring.