Why ADHD Medication And Pregnancy Is Your Next Big Obsession
how does medication for adhd work and Pregnancy
Physicians often struggle to advise patients on the security of their ADHD medication during pregnancy. In the meantime, until more research is available, doctors must weigh the benefits of medication use during pregnancy against the possible dangers for children in each individual situation.
A study that was based on a population-based approach has followed 898 babies who were born to mothers who had taken ADHD medications during pregnancy (stimulants amphetamine methylphenidate ; dexamphetamine non-stimulants modafinil, atomoxetine, and clo), until they were identified as having an underlying disorder of development, passed away, 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 result in, especially for centrally stimulating drugs like those used to treat ADHD. It is essential that women receive proper advice from their doctors regarding the risks and benefits of using medications during pregnancy and prior to conception. In this CAP smart take we examine the most recent research on this topic and how they might guide the practice of a physician.
Animal studies and illicit drug research suggest that stimulant medication passes to the fetus via the placenta, and may negatively impact fetal growth and development. There are few data 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 is not powerful enough to reveal any significant connections.
The study by Cohen and colleagues4 is distinctive because it is the most comprehensive and meticulously controlled. The study involved 364,012 births collected from the Danish Medical Registry. Information on medication use was gathered through the analysis of redeemed medications. The researchers specifically excluded women who reported receiving SSRI medications or clonidine, since these drugs 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 to take into account timing of exposure and control for confounding factors.
The results of this study as well as other small-scale trials suggest that the majority of women who continue to take their stimulant medications prescribed to treat ADHD during pregnancy don't experience adverse effects on their foetuses. It is therefore likely that a lot of pregnant women will continue to use their ADHD medication. However, it is crucial that doctors carefully evaluate the advantages and risks of these medications for their pregnant patients, as well as consider each patient's unique situation prior to suggesting that they stop taking their medication. Whatever decision they make, it is vital that pregnant women with ADHD inform their spouses, partners, extended family members and employers about the choice they've made. It is because the symptoms of hyperactivity, inattention, and impulsivity are likely to return if the mother ceases taking their medication.
Pregnancy Tests
Preconception counseling should comprise a comprehensive program of management that incorporates both behavioral and medical treatment and continuous monitoring throughout the perinatal period. The plan should include a discussion of current medication regimens, particularly in the first trimester, when the risks of harming the baby due to untreated ADHD are the highest. This should be a joint effort with obstetrics, psychiatry, and primary care.
The risk/benefit discussion should also discuss how a woman intends to manage her symptoms of ADHD during pregnancy, as well as the impact on family functioning as well as what she might feel about a decision to stop psychostimulant therapy in the early stages of the pregnancy. This should be based on a thorough evaluation of the available evidence and take into account the patient's individual needs and concerns.
The authors of a large study that examined children who were exposed to ADHD medications during utero concluded that "continuation use of psychostimulants during early pregnancy was not associated with adverse birth outcomes and if anything, it was associated with less stress among mothers." However their conclusion isn't without a few limitations. The study did not take into account other aspects, including the duration of time stimulant medication was taken in addition to the dose and sociodemographics. There is no controlled research that examines the safety of continued psychostimulant usage in nursing mothers.
There isn't a clear scientific data regarding the safety of ADHD medication during pregnancy. However, the majority of doctors have a general knowledge of what the literature suggests and will apply best practices in consultation to each patient's individual needs. It is known, for example, that infants born to mothers taking methylphenidate during the first trimester are more likely have cardiac malformations (Cooper, et al. 2018). However this conclusion is based on a tiny study that did not take into account differences in patient demographics and underlying psychiatric conditions.
In a recent survey of ADDitude readers, they reported that they are more likely than ever to stop taking their ADHD medication in the early stages of pregnancy. However, women who discontinued psychostimulants within the first trimester of pregnancy noticed a clinically significant increase in depressive symptoms. They also reported being less able to enjoy their pregnancy and rated their family functioning as more difficult than those who continued or increased dosages of ADHD medication.
Work Functioning Test
The test for work function is an essential part of the test as it will determine if the patient is able to perform their duties. The test is designed to evaluate functional limitations and include the use of graded material handling (lifting to different heights, pulling and pushing), positional tolerance activities (sitting or standing, balancing, walking or stooping, kneeling, crawling) as well as other relevant tests for specialized testing (hand manipulation). The evaluator evaluates the results to form a return-to-work conclusion. ROC curves can be used to determine the point of minimal classification (MIC) in the general ability to work and physical work ability and the work-functioning problem score.
The MIC is calculated using the COnsensus Standards for the Selection of Health Measurement Instruments Checklist (COSMIN). This method separates scores for general and physical work abilities and work-functioning issues, by answering an anchor question. This will prevent a change in metrics from affecting the average.
Driving Test
Psychostimulant medication is a standard treatment for ADHD. It eases symptoms and enhances functioning in work and other areas, including driving safety. Impairment due to severe untreated ADHD can have profound financial and psychosocial effects.
Psychotherapeutic interventions such as cognitive behavioral therapy (CBT) and "coaching" strategies have also been proven to improve symptoms and enhance functioning. These strategies may aid women in adjusting their routines and use their abilities to cope in ways that minimize the impact of their ADHD on work and other domains.
All of these factors can be significant considerations in the decision whether to continue or end psychostimulant treatment. The most recent data available indicate that although there are some concerns about the outcomes of pregnancy when in utero stimulant medication is employed, the risks of this are minimal. The results are muddled by other medication, the use of maternal healthcare, maternal mental and physically health, and other 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.