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 benefits of taking medication during pregnancy against the possible risks for offspring in each particular situation.
A recent population-based cohort study followed 898 babies born to mothers who were taking ADHD medications throughout their pregnancy (stimulants: methylphenidate, amphetamine, dexamphetamine; non-stimulants: modafinil, atomoxetine and clonidine) until they were diagnosed with a developmental disorder, or passed away or left the country.
Risk/Benefit Discussion
CAP Smart Take:
Doctors are concerned about the long-term effects that exposure to drugs in utero may result in, especially for centrally stimulating drugs 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 take we look at the most current research in this area and how they could inform clinical practices.
Animal studies as well as research on illicit drugs indicate that stimulant medication passes to the fetus through the placenta, and could 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 the evidence comes from case-control studies with one arm, which is not powerful enough to detect any significant associations.
The most recent study by Cohen et al4 stands out from the others because it is the largest and most carefully controlled. The study comprised a representative sample of 364,012 births from the Danish Medical Registry, and information about the use of medications was gathered by analyzing prescriptions that were redeemed. medication for adhd excluded women who had reported taking SSRI drugs or clonidine since these drugs can interfere with the fetal NMDA receptor and increase the risk of neurodevelopmental disorders like autism and ADHD. The authors also adjusted their analysis to account for possible confounding factors and to account for the timing of the in utero exposure.
The results of this study as well as other small-scale trials suggest that the vast number of women who continue using their stimulant medications prescribed for ADHD during pregnancy are not experiencing adverse effects on their foetuses. Therefore, it is likely that a large number of women will continue to use their medication for ADHD during pregnancy. It is crucial for doctors to consider the risks and benefits of these medications before telling their patients during pregnancy to stop taking these medications. It is essential that pregnant women suffering from ADHD inform their partners as well as extended families and employers of the decision they've taken. It is because the symptoms of inattention, hyperactivity, and impulsivity are likely return when the mother stops taking her medication.
Pregnancy Tests
Preconception counseling should comprise a comprehensive management program that incorporates both behavioral and medical treatment and continuous monitoring during the perinatal stage. The plan should include a discussion about the current treatment regimens, specifically in the first trimester, when the risk of harming the baby due to untreated ADHD are the highest. This should be a joint effort between primary care and psychiatry, as well as Obstetrics.
The discussion of the risks and benefits should also cover the way a woman plans to manage her ADHD symptoms during pregnancy, the effects of this on family functioning and her feelings about discontinuing psychostimulant treatment in the beginning. This should be informed by a thorough review of available evidence, with consideration of the specific patient's needs and concerns.
In a recent large study that examined children exposed to ADHD medications during utero and concluded that "continuation of use of psychostimulants during the early stages of pregnancy didn't increase the risk of adverse birth outcomes and if anything was associated with reduced maternal stress." However, this conclusion is not without its flaws. The study did take into consideration other aspects, including the duration for which stimulant medication was used as well as the dose and sociodemographics. There is also no research conducted that is controlled and examines the safety of continued use of psychostimulants in nursing mothers.
Although there is a dearth of scientifically substantiated evidence regarding the safety of ADHD medications in pregnancy, the majority of doctors have a general understanding of what the existing literature suggests and use best practices while collaborating with the individual needs of each patient. It is known, for example, that infants born to mothers taking methylphenidate during the first trimester are more likely to have cardiac malformations (Cooper, et al. 2018). However this conclusion is based on a tiny study that didn't consider the differences in the demographics of patients and the underlying psychiatric conditions.
In a recent survey of ADDitude readers, they found that they are more likely than ever to stop taking their ADHD medication during early pregnancy. Women who stopped psychostimulants during the first trimester noticed a clinically significant rise in depression symptoms. They also reported that they were less able to enjoy their pregnancy and rated their families functioning as more difficult than those who continued or increased their dosages of ADHD medications.
Work Functioning Test
The work functioning test is an essential part of the test as it will determine if a patient is able to perform their 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 levels pulling and pushing) as well as postureal tolerance exercises (sitting and standing, balancing and walking or stooping, kneeling and stooping), as well as specific tests. The examiner will analyse the results and formulate 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 problems score.
The MIC is calculated using the COnsensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. This method differentiates scores for general physical work abilities and work-functioning issues by answering an anchor question. This prevents a change in metrics from affecting the average.
Driving Test
Psychostimulant medication is a treatment for ADHD. It reduces symptoms and improves functioning in other areas, such as driving safety. Impairment due to severe untreated ADHD can have serious financial and psychosocial consequences.
Psychotherapeutic treatments, like cognitive behavior therapy (CBT) or "coaching" techniques have also been shown by research to help improve symptoms and increase function. These strategies may help women to tailor their routines and use their abilities to cope to minimize the impact of their ADHD on their work and other areas.
All of these aspects are important to consider when deciding whether or not to continue psychostimulant therapy. As the best available data show, while there is some concern about the outcomes of pregnancy after in utero exposure to stimulant medications the risk is minimal and the results are affected by other medications, maternal health treatment, maternal mental and physical health, and other comorbidities. Bang Madsen K, Bliddal M, Skoglund CB, Larsson H, Munk-Olsen TL, Hove Thomsen P, Bergink V. In utero exposure to attention deficit hyperactivity disorder medication and long-term outcomes for offspring.