ADHD Medication and Pregnancy
Physicians struggle to provide accurate information on the safety of ADHD medications during pregnancy. In the meantime, until more research is available, physicians must weigh the benefits of using medication during pregnancy against the potential risks for the offspring in each individual situation.
A population-based study has followed 898 infants 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 consequences of exposure to drugs in the uterus, specifically to centrally stimulating drugs like those used to treat ADHD. It is crucial that women receive proper counseling from their physicians about the risk/benefit of using medication before conception and during pregnancy. In this CAP Smart Take we look at the most current research in this area and how it could influence clinical practice.
Animal studies and illicit drug research suggests that stimulant medication passes to the fetus via the placenta and can negatively impact fetal growth and development. However, there are limited information on how the fetus responds to the therapeutic doses of prescription stimulant medication during pregnancy, and the majority of this data comes from single-arm case-control studies that have been underpowered to determine if there are significant associations.
over the counter adhd medication conducted by Cohen and colleagues4 is unique because it is the most thorough and meticulously controlled. The study included a sample of 364,012 births from the Danish Medical Registry, and information about the use of medications was gathered by analyzing redeemed prescriptions. Researchers excluded women who had taken SSRIs or clonidine because these drugs can interfere with fetal NMDA and increase the risk of developing neurodevelopmental disorders, such as autism and ADHD. The authors also modified their analysis to account for potential confounding factors and to account for the timing of the in utero exposure.
The results of this study and other studies show that the vast number of women who continue using their stimulant medications prescribed for ADHD during pregnancy do not experience adverse effects on their foetuses. As a result, it is likely that many women will continue to take their medications for ADHD during pregnancy. However, it is important that doctors carefully weigh the risks and benefits of these medications for their pregnant patients, and also consider each patient's unique situation prior to suggesting they stop their medications. It is important that pregnant women suffering from ADHD inform their spouses as well as extended families and employers of the choice they've made. This is because the signs of hyperactivity, inattention and impulsivity could be re-present when the mother stops taking her medication.
Pregnancy Tests
Preconception counseling for women with ADHD who want to become pregnant should concentrate on a comprehensive treatment plan that includes both behavioral and pharmacologic treatment and continuous monitoring throughout the postnatal period. The plan should include a discussion on the current treatment regimens, especially in the first trimester where the risk of harming the baby because of untreated ADHD are the highest. This should be a coordinated effort with psychiatry, obstetrics, and primary care.
The discussion of risks and benefits should also include how a woman intends to manage her ADHD symptoms during pregnancy, the effect of this on family functioning, and how she feels about discontinuing psychostimulant treatment in the beginning. This should be guided by a thorough analysis of evidence available, including consideration of the individual patient's needs and concerns.
In a recent large study which followed children who were exposed to ADHD medications in utero and concluded that "continuation of psychostimulant use during the early stages of pregnancy did not increase the risk of adverse birth outcomes, and if anything, it was associated with reduced maternal stress." However, this conclusion is not without its limitations. The study did not take into account other aspects, including the length of time that stimulant medications were used as well as the dose and sociodemographics. Moreover, there is visit my web site examining the safety of a continuous psychostimulant use in nursing mothers.
There is no clear research-based evidence regarding the safety of ADHD medication during pregnancy. However, the majority of doctors are aware of what research suggests and apply best practices in consultation to each patient's individual needs. It is known, for example that babies born to mothers taking methylphenidate during the first trimester are more likely suffer from cardiac malformations (Cooper, et al. 2018). However this conclusion is based on a tiny study that didn't take into account the different patient demographics and underlying psychiatric conditions.
In a recent study, ADDitude readers found that they were more likely to quit their ADHD medication in early pregnancy than they were in the past. However, women who discontinued psychostimulants in the first trimester of pregnancy experienced a clinically significant increase in the severity of depressive symptoms. They also reported feeling less able to enjoy pregnancy and described family functioning as more difficult than those who remained on their dose of ADHD medication or increased it.
Work Functioning Test
The test of work function is a vital part of the examination to determine if the candidate is able to perform their job. The test is designed to evaluate functional limitations. It will include the use of graded material handling (lifting to various heights pulling and pushing), positional tolerance activities (sitting in a chair, standing in a balancing position, walking or stooping, kneeling, crawling) along with other relevant tests for specialized testing (hand manipulation). The evaluator evaluates the results to come up with an appropriate return-to-work conclusion. ROC curves are used to show the point of minimal misclassification (MIC) for both physical and general work ability and the work-functioning problem score.
The MIC is calculated according to the COnsensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. This method is able to separate the scores of physical and general ability and work-functioning problems score by answering an anchor question to prevent a change in measurement from affecting the overall average.
Driving Test
Psychostimulant medication is a treatment for ADHD. It increases safety for drivers and decreases symptoms. Untreated severe ADHD can have significant financial and psychosocial consequences.
Psychotherapeutic treatments such as cognitive behavioral therapy (CBT) and "coaching" strategies have also been proven to reduce symptoms and improve functioning. These strategies can assist women in adjusting their schedules and utilize their coping abilities to minimize the effects of ADHD on work and other aspects.
All of these aspects are important to consider when deciding whether or not to continue psychostimulant therapy. The most recent data available indicate that although there are some concerns about pregnancy outcomes when in utero stimulant medication is employed, the risks of this are low. Also, the results are muddled by other medication, the use of maternal healthcare as well as physical and mental health and comorbidities. Bang Madsen K., Bliddal m., Skoglund cb., Larsson h., Munk-Olsen T., Hove Thomsen p., Bergink V. In-utero exposure of attention-deficit/hyperactivity disorder medication and its effects on offspring.