ADHD Medication and Pregnancy
Physicians often struggle to inform patients about the security of their ADHD medications during pregnancy. In the absence research, doctors must weigh the benefits and risks of using medication during pregnancy.
A recent cohort study of the population monitored 898 babies born to mothers who were taking ADHD medications throughout their pregnancy (stimulants amphetamine, methylphenidate, 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 drug exposure in utero may have, especially for centrally stimulating medications such as those used to treat ADHD. It is important that women receive proper advice from their doctors regarding the risks and benefits of using medication during pregnancy and before conception. In this Smart Take on CAP, we look at the most current research in this field and how it can guide the clinical practice.
Previous animal studies and illicit drug use research suggest that stimulant drugs are passed to the fetus through the placenta, and could negatively impact fetal development and growth. There aren't many studies on the effects of prescription stimulant medications during pregnancy. Most of the evidence comes from case-control studies with a single arm, which aren't strong enough to reveal any significant connections.
The study conducted by Cohen and co. stands out from the rest as it is the largest and most carefully controlled. The study covered 364,012 pregnancies taken from the Danish Medical Registry. Information regarding medication use was collected by analyzing the redeemed medication. The researchers specifically excluded women who reported taking SSRI medications or clonidine, as these drugs may interfere with the fetal NMDA receptor and increase the risk of developing neurodevelopmental disorders like autism and ADHD. The authors also adjusted their studies to take into account potential confounding factors and to account for the timing of the in utero exposure.
The results of this study and other limited trials indicate that the vast number of women who continue using their stimulant medications prescribed for ADHD during pregnancy are not experiencing adverse effects on their fetuses. It is therefore likely that many pregnant women will continue to use their ADHD medication. It is essential for doctors to consider the risks and benefits of these drugs prior to advising their pregnant patients to stop taking the medications. No matter what decision they make, it is vital that pregnant women with ADHD inform their spouses or their partners, extended family members and employers about the decision they've made. This is because the signs of hyperactivity, inattention and impulsivity are likely to return when the mother stops taking her medication.
Pregnancy Tests
Preconception counseling for women with ADHD who wish to become pregnant should concentrate on a comprehensive treatment plan that involves both pharmacologic and behavioral treatments and ongoing monitoring throughout the period of perinatal care. The plan should include a discussion of the current treatment regimens, especially in the first trimester, when the risks of harming the baby due to untreated ADHD are highest. This should be a collaborative effort between primary care and psychiatry, as well as obstetrics.
The discussion of risks and benefits should also include how a woman will manage her ADHD symptoms during pregnancy, the impact of this on family functioning, and how she feels about stopping psychostimulant therapy in the initial stages. This should be based upon an in-depth analysis of the available evidence and take into account the individual needs of the patient 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 in early pregnancy did not increase the risk of adverse birth outcomes, and if anything was associated with decreased stress on the mother." However this conclusion isn't without its limitations. The study did not take into account the significance of the dosage of stimulant medication, nor the long it was used, as well as other sociodemographic and clinical variables. There is adhd stimulant medication that examines the safety of continued psychostimulant usage in nursing mothers.
There isn't a clear research-based evidence on the safety of ADHD medication during pregnancy. However, the majority of doctors are aware of the research findings and will apply best practices when assessing each patient's specific needs. For instance, it's known that there is a higher risk of cardiac malformations in babies born to mothers who took methylphenidate within the first trimester of pregnancy (Cooper and colleagues. (2018)) It is important to remember that this conclusion was based on a small study that did not take into account differences in patient demographics or the underlying psychiatric co-morbidity.
In a recent survey ADDitude readers said that they were more likely to quit their ADHD medication in early pregnancy than in the past. However, women who stopped psychostimulants in the first trimester of pregnancy noticed an increase in symptoms of depression. They also felt less able to enjoy pregnancy and described family functioning as more challenging than those who continued to take their dose of ADHD medication or increased it.
Work Functioning Test
The test for work function is a vital part of the examination in that it determines whether an individual is able to carry out their job. The test is designed for the evaluation of functional limitations. It includes graded material handling exercises (lifting at various heights, pulling and pushing) and postureal tolerance exercises (sitting and standing as well as walking and balancing, stooping and kneeling) and specific tests. The evaluator analyzes the results to form the return-to-work conclusions. 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 problems score.
The MIC is calculated using the COnsensus Standards for the Selection of Health Measurement Instruments Checklist (COSMIN). buy adhd medication online divides the scores of physical and general work abilities and work-functioning difficulties based on the answering an anchor question to prevent any change in the metric from biasing the overall average.
Driving Test
The most effective treatment for ADHD is psychostimulant medications. It improves safety while driving and reduces symptoms. Untreated severe ADHD can have severe financial and psychological consequences.
Psychotherapeutic interventions, such as cognitive behavior therapy (CBT) or "coaching" techniques have been found to help improve symptoms and increase performance. These strategies could help women to tailor their routines and apply their strategies to cope to minimize the effects of their ADHD on their work and other domains.
All of these factors are important to take into account when deciding whether or not to continue psychostimulant therapy. The most recent data available indicate that although there are some concerns regarding the outcome of pregnancy when in utero stimulant medication is used, the relative risks of this are minimal. Also, the results are complicated by other medication, the use of maternal healthcare as well as physical and mental health and other 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 offspring outcomes.