ADHD Medication and Pregnancy
Physicians often struggle to counsel patients about the safety of their ADHD medications during pregnancy. In the absence of more research, physicians must weigh up the benefits and risks of using medication during pregnancy.
A population-based study has followed 898 infants 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 a developmental disorder, passed away or left the country.
Risk/Benefit Discussion
CAP Smart Take:
Doctors are concerned about the long-term effects that drug exposure in utero can result in, especially for centrally stimulating drugs like those used to treat ADHD. It is crucial that women receive appropriate counseling from their physicians about the risks and benefits of taking medication before conception and during pregnancy. In this Smart Take on CAP, we review the most recent research in this field and how it could guide clinical practice.
Previous animal studies and studies on illicit drug use suggest that stimulant drugs are passed to the fetus via the placenta and can negatively impact fetal development and growth. However, there is a lack of information regarding the way that the fetus reacts to dosages of prescribed stimulant medications during pregnancy, and most of this evidence comes from single-arm studies that are not sufficiently powered to determine if there are significant associations.
The study by Cohen and colleagues4 is unique because it is the most thorough and carefully controlled. The study included 364,012 pregnancies collected from the Danish Medical Registry. Information regarding medication use was collected by analyzing redeemed medications. Researchers excluded women who had taken SSRIs, clonidine or clonidine since these drugs could interact with the fetal NMDA and increase the risk of developing neurodevelopmental disorders such as autism and ADHD. The authors modified their analysis to take into account the timing of exposure and to control for confounding factors.
The results of this study, as well as the results of other limited studies, suggest that the majority of women who continue to take their prescribed stimulant medications for ADHD throughout pregnancy do not experience any 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 important that physicians carefully weigh the risks and benefits of these medications for pregnant patients, as well as consider each patient's unique situation prior to suggesting that they stop taking their medications. It is crucial that pregnant women suffering from ADHD inform their partners family members, extended families, and employers of the choice they've taken. This is because the symptoms of hyperactivity, inattention, and impulsivity could be recurred once the mother stops taking her medication.
Pregnancy Tests
Preconception counseling should comprise an extensive management plan that incorporates both behavioral and medical treatment and continuous monitoring during the perinatal phase. The plan should include a discussion of the current treatment regimens, particularly during the first trimester, when risks of harm to the baby due to untreated ADHD are the highest. This should be a coordinated effort with obstetrics, psychiatry and primary care.
The discussion of risks and benefits should also cover how a woman will manage her ADHD symptoms during pregnancy, the effect of this on the family's functioning and her feelings about a decision to stop psychostimulant treatment in the beginning. This should be informed by a thorough review of available evidence, with consideration of the individual patient's requirements and concerns.
In a study of recent magnitude that examined children exposed to ADHD medications during pregnancy, the authors concluded that "continuation of use of psychostimulants during the early stages of pregnancy did not increase the risk of adverse birth outcomes and if anything, it was associated with less stress for mothers." However, this conclusion is not without its flaws. The study did not take into account other factors such as the duration for which stimulant medications were used as well as the dose and sociodemographics. There is also no research conducted that is controlled and examines the safety of a continued use of psychostimulants by nursing mothers.
There isn't a clear research-based evidence regarding the safety of ADHD medication during pregnancy. However, most doctors are aware of the research findings and will apply best practices in consultation to the specific needs of each patient. 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 comparatively small study that didn't consider the differences in patient demographics and underlying psychiatric conditions.
In a recent study, ADDitude readers found that they were more likely to stop their ADHD medication in early pregnancy than in previous. However, women who stopped psychostimulants in the first trimester of pregnancy experienced an increase in depressive symptoms. They also reported that they were less than able to enjoy their pregnancy and rated their family functioning as less than those who maintained or increased their dosages of ADHD medications.
Work Functioning Test
The test for work function is an essential element of the test as it will determine if a patient is able to carry out their duties. The test is designed to assess functional limitations. It will include the use of graded material handling (lifting to different levels pulling and pushing) as well as positional tolerance tests (sitting or standing and walking, balancing or stooping, kneeling, crawling) as well as other relevant specialized tests (hand manipulation). The test evaluator analyses the results to come up with the return-to-work conclusions. 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 issues score.
The MIC is calculated by using the COnsensus Standards for the Selection of Health Measurement Instruments Checklist (COSMIN). This method divides scores for general physical abilities and work-functioning problems by answering an anchor question. adhd without medication prevents a change in metrics from affecting the average.
Driving Learn Additional for treating ADHD is psychostimulant medications. It eases symptoms and enhances functioning in work and other areas, such as driving safety. Insufficiency due to severe, untreated ADHD can have serious financial and psychosocial consequences.
Psychotherapeutic treatments such as cognitive behavioral therapy (CBT) and "coaching" strategies have also been shown to reduce symptoms and improve functioning. These strategies can assist women in tailoring their routines and apply their abilities to cope in ways that reduce the effects of their ADHD on work and other areas.
All of these factors are crucial to take into consideration when deciding whether or not to continue psychostimulant therapy. The most reliable data available show that although there are concerns about pregnancy outcomes when in utero stimulant medication is utilized, the risk-benefit ratios of this are small. Also, the results are complicated by other medications, maternal healthcare utilization, 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 offspring outcomes.