ADHD Medication and Pregnancy
Physicians often struggle to counsel patients on the safety of their ADHD medication during pregnancy. In the absence of more research, doctors must weigh the advantages and risks of using medication during pregnancy.
A study that was based on a population-based approach has followed 898 babies who were born to mothers who took 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:
Physicians are concerned about the long-term effects of exposure to drugs in the uterus, especially to centrally stimulating drugs like those used for ADHD. It is therefore critical that women receive appropriate medical advice from their doctors regarding the potential risks and benefits of using medications prior to conception and throughout pregnancy. In this Smart Take on CAP, we review the most recent research in this field and how it could guide clinical practice.
Animal studies as well as studies on illicit drug use indicate that stimulant medication passes to the fetus through the placenta and can negatively affect fetal development and growth. However, there are limited information on the response of the fetus to therapeutic doses of prescription stimulant medications during pregnancy, and most of this evidence comes from single-arm studies that have been underpowered to determine if there are significant associations.
The study conducted by Cohen and colleagues4 is unique because it is the most thorough and meticulously controlled. just click the next document involved 364,012 births taken from the Danish Medical Registry. Information on medication use was gathered through the analysis of redeemed medications. Researchers excluded women who had taken SSRIs, clonidine or clonidine since these drugs can interact with the fetal NMDA and increase the risk for neurodevelopmental disorders like autism and ADHD. The authors modified their analysis in order to account for timing of exposure and take into account confounding factors.
The results of this study as well as other limited trials indicate that the majority of women who continue to use their stimulant medications prescribed for ADHD during pregnancy are not experiencing adverse effects on their fetuses. Therefore, it is likely that a lot of pregnant women will continue to take their ADHD medication. It is essential for doctors to consider the benefits and risks of these medications before telling their patients during pregnancy to stop taking these medications. No matter what decision they make, it is vital that pregnant women suffering from ADHD inform their spouses or their partners, extended family members as well as their employers about the decision they have made. This is because the symptoms of hyperactivity, inattention, and impulsivity will likely be recurred once the mother stops taking her medication.
Pregnancy Tests
Preconception counseling should comprise an extensive management plan that includes both behavioural and medical treatment, as well as ongoing monitoring during the perinatal phase. The plan should include a discussion of current medication regimens, especially in the first trimester where risks of harm to the baby from untreated ADHD are greatest. This should be a collaborative effort between obstetrics, psychiatry, and primary care.
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 her feelings about discontinuing psychostimulant treatment in the initial stages. This should be guided by a thorough analysis of the available evidence, and consideration of the individual patient's needs and concerns.
In a study of recent magnitude that examined children exposed to ADHD medications in utero The authors concluded that "continuation of use of psychostimulants in early pregnancy did not increase the risk of adverse birth outcomes and, if anything, was associated with reduced maternal stress." However, this conclusion is not without its limitations. The study did take into consideration other aspects, including the duration for which stimulant medication was used as well as the dose and sociodemographics. Moreover, there is no controlled study that examines the safety of continued use of psychostimulants in nursing mothers.
While there is a lack of evidence-based research on the safety of ADHD medications in pregnancy, the majority of doctors have a general understanding of what the research suggests and apply the best practices, in consultation with the individual needs of each patient. For instance, it's well-known that there is a higher rate of cardiac malformations among infants born to mothers who took methylphenidate in the first trimester of pregnancy (Cooper and colleagues., 2018), while it is important to note that this result was based on a single study that did not take into account for variations in the demographics of patients or underlying psychiatric comorbidity.
In a recent survey of ADDitude readers, they revealed that they are more likely than ever to quit taking their ADHD medication during the first trimester of pregnancy. Women who stopped psychostimulants during the first trimester showed a clinically significant rise in depression symptoms. They also felt less able to enjoy their pregnancy and rated their family functioning as more difficult than those who continued to take their dose of ADHD medication or increased it.
Work Functioning Test
The work functioning test is a vital component of the examination as it will determine if a patient can perform their job tasks. The test is designed to assist in the evaluation of functional limitations. It includes a variety of graded material handling tasks (lifting at different heights, pulling and pushing), positional tolerance exercises (sitting and standing, balancing and walking in a stoop, kneeling and stoop), as well as specific tests. The examiner will analyse the results and come up with a return to a conclusion of the work. ROC curves can be used to determine the point of minimal classification (MIC) in the general ability to work, the physical work ability and the work-functioning problem score.
The MIC is calculated based on the COnsensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. This method divides scores for general physical work abilities and work-functioning problems by answering an anchor question. This prevents a change in metrics from affecting the average.
Driving Test
Psychostimulant medications are a gold standard treatment for ADHD. It improves safety while driving and reduces symptoms. Impairment due to severe untreated ADHD can have serious financial and psychosocial effects.
Psychotherapeutic interventions, such as cognitive behavior therapy (CBT) or "coaching" methods have also been found to help improve symptoms and increase performance. These strategies can help women to tailor their daily routines and employ their coping abilities in ways that minimize the impact of ADHD on their work and other areas.
All of these factors are important to take into account when deciding whether or not to continue with psychostimulant therapy. As the best available data indicate, although there is some concern about the effects of pregnancy on outcomes after in-utero exposure to stimulant medications the relative risks are small and the outcomes are confounded by other medications, 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.