ADHD Medication and Pregnancy
Physicians often struggle to counsel patients on the safety of their ADHD medication during pregnancy. As long as research is not available, doctors must weigh the advantages of medication use during pregnancy against the possible risks for the offspring in each particular situation.
A recent study on a population-based cohort monitored 898 babies born to mothers taking ADHD medications throughout pregnancy (stimulants: methylphenidate, amphetamine dexamphetamine, methylphenidate; non-stimulants: modafinil, atomoxetine, 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 with the long-term effects that exposure to drugs in utero may be a source of harm, particularly for centrally stimulating medications such as those used to treat ADHD. It is therefore critical that women receive appropriate advice from their doctors about the potential risks and benefits of using medications prior to conception and during pregnancy. In this Smart Take on CAP, we review the most recent research in this area and how it could guide the practice of a physician.
Animal studies and illicit drug research suggest that stimulant drugs enter the fetus through the placenta, and could adversely affect the growth of the fetus and development. There is however, a limited amount of data on how the fetus responds to therapeutic doses of prescription stimulant medication during pregnancy, and the majority of this data is based on single-arm studies that have been underpowered to determine if there are significant correlations.
The study conducted by Cohen and colleagues4 is distinctive because it is the most comprehensive and well-controlled. The study covered 364,012 pregnancies taken from the Danish Medical Registry. Information on medication use was gathered by analyzing redeemed medications. The researchers specifically excluded women who had reported taking SSRI drugs or clonidine because these medications can interact with the fetal NMDA receptor and increase the risk of neurodevelopmental disorders such as autism and ADHD. The authors adjusted their analyses to take into account timing of exposure and make sure that they control for confounding factors.
The data from this study, along with the results of other limited studies, suggest that the vast majority of women who continue to take their prescribed stimulant medication for ADHD during pregnancy do not experience adverse effects on their foetuses. Therefore, it is likely that many women will continue to take their medications for ADHD during pregnancy. It is crucial for doctors to weigh the benefits and risks of these medications prior to advising their pregnant patients to stop taking these medications. Whatever decision they make, it is essential that pregnant women suffering from ADHD educate their spouses or their partners, extended family members and employers about the decision they've made. It is because the symptoms of hyperactivity, inattention and impulsivity are likely return when the mother stops taking medication.
Pregnancy Tests
Preconception counseling for women with ADHD who want to become pregnant should focus on a comprehensive management plan that incorporates both pharmacologic and behavioral treatments and continuous monitoring throughout the period of perinatal care. The plan should include a discussion on current medication regimens, particularly in the first trimester where the chances of harming the baby due to untreated ADHD are the highest. adhd medication online should be a joint effort between primary care and psychiatry, as well as Obstetrics.
The discussion of the 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 a decision to stop psychostimulant treatment in the early stages. This should be based on a thorough review of the available evidence, and consideration of the individual patient's requirements and concerns.
In a study of recent magnitude that followed children exposed to ADHD medications during utero and 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 flaws. The study didn't consider the significance of the dosage of stimulant medication, nor the long it was used for, in addition to other sociodemographic and clinical factors. Furthermore, there is no controlled research examining the safety of continuing psychostimulant use in nursing mothers.
There isn't any definitive research-based evidence regarding the safety of ADHD medication during pregnancy. However, the majority of doctors have a general knowledge of the research findings and will apply best practices in consultation with the specific needs of each patient. It is known, for example that babies born to mothers who take methylphenidate during the first trimester are more likely to suffer from cardiac malformations (Cooper and co. 2018). However this is based on a small study that did not take into account differences in the patient's demographics and underlying mental health conditions.
In an earlier survey of ADDitude readers, they revealed that they are more likely than ever before to quit taking their ADHD medication during early pregnancy. adhd medication online who stopped taking psychostimulants during the first trimester showed a clinically significant rise in depressive symptoms. They also reported feeling less than able to enjoy their pregnancy and rated their family functioning as more difficult than those who maintained or increased their dosages of ADHD medication.
Work Functioning Test
The test of work function is an essential part of the exam since it will determine if a patient can perform their job duties. The test is intended for testing functional limitations. It includes a variety of graded material handling tasks (lifting at different heights pulling and pushing), positional tolerance exercises (sitting and standing as well as walking and balancing, stooping and kneeling), as well as specific tests. The evaluator will analyze the results and come up with an appropriate return to work conclusion. ROC curves are used to show the point at which there is a minimum misclassification (MIC) for both the general and physical work ability and the work-functioning score for a particular problem.
The MIC is calculated using the COnsensus Standards for the Selection of Health Measurement Instruments Checklist (COSMIN). This method separates scores for general and physical abilities and work-functioning issues by answering an anchor question. This will prevent a change in metrics from affecting the average.
Driving Test
The gold standard for treating ADHD is psychostimulant medication. It improves driving safety and reduces symptoms. Untreated severe ADHD can have significant financial and psychological consequences.
Psychotherapeutic treatments such as cognitive behavioral therapy (CBT) and "coaching" strategies have also been proven to improve symptoms and enhance functioning. These strategies can assist women in tailoring their routines and apply their coping skills in ways that reduce the impact of their ADHD on their work and other areas.
All of these factors could be significant considerations in the decision to continue or end psychostimulant therapy. As the best available data show, while there are some concerns about the outcomes of pregnancy after in utero exposure to stimulant medications, the risk is minimal, and the results are influenced by other treatments, maternal health care utilization, maternal mental and physical health, and the 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.