ADHD Medication and Pregnancy
Physicians often struggle to inform patients about the security of their ADHD medications during pregnancy. In the absence research, physicians must weigh up the benefits and risks of using medications during pregnancy.
A recent study on a population-based cohort tracked 898 infants born to mothers who were who were taking ADHD medications throughout their pregnancy (stimulants: methylphenidate, amphetamine dexamphetamine, methylphenidate; and non-stimulants such modafinil, atomoxetine, clonidine) until they were diagnosed with a developmental disorder, or died or left the country.
Risk/Benefit Discussion
CAP Smart Take
Doctors are concerned about the long-term effects that exposure to drugs in utero can have, especially for centrally stimulating drugs such as those used to treat ADHD. It is crucial that women receive appropriate medical advice from their doctors regarding the potential risks and benefits of using medications prior to conception and during pregnancy. In Iampsychiatry Take we look at the most current research in this field and how it can guide the clinical practice.
Animal studies and illicit drug research suggest that stimulant medications enter the fetus through the placenta and can adversely affect the growth of the fetus and development. There are few data on the effects of prescription stimulant drugs during pregnancy. The majority of evidence comes from studies conducted in case-control with a single arm, which is not powerful enough to identify any significant associations.
The study conducted by Cohen et al4 stands out from the others because it is the biggest and most meticulously controlled. The study comprised a sample of 364,012 pregnant women from the Danish Medical Registry, and information on medication use was gathered by analyzing redeemed prescriptions. The researchers specifically excluded women who had reported receiving SSRI drugs or clonidine as these drugs may interfere with the fetal NMDA receptor and increase the risk of neurodevelopmental disorders such as autism and ADHD. The authors also modified their studies to take into account potential confounding factors and to account for the timing of in-utero exposure.
The results of this study and other small-scale trials suggest that the vast number of women who continue using their stimulant medications prescribed for ADHD during pregnancy do not experience adverse effects on their fetuses. Therefore, it is likely that a lot of women will continue to use their medications for ADHD during pregnancy. But it is essential that doctors weigh the risks and benefits of these medications for their pregnant patients, and be aware of the unique circumstances of each patient before suggesting that they stop taking their medication. Regardless of which choice they make, it is vital that pregnant women with ADHD inform their spouses, 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 to be re-present when the mother stops taking their medication.
Pregnancy Tests
Preconception counseling for women suffering from ADHD who wish to become pregnant should concentrate on a comprehensive treatment plan that includes both pharmacologic and behavioral treatment and continuous monitoring throughout the perinatal period. 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 collaborative effort with obstetrics, psychiatry, and primary care.
The discussion of risks and benefits should also cover the way a woman plans to manage her ADHD symptoms during pregnancy, the impact of this on family functioning and her feelings about stopping psychostimulant therapy in the beginning. This should be based on a thorough evaluation of the evidence available and consider the individual needs and concerns.
The authors of a huge study that examined children who were exposed to ADHD medication during pregnancy concluded that "continuation psychostimulant use during the early stages of pregnancy did not cause adverse birth outcomes, and if anything, was associated with reduced stress among mothers." However the conclusion they reached is not without a few limitations. The study did consider other factors, such as the duration for which stimulant medication was taken, the dose and the sociodemographics. Moreover, there is no controlled research examining the safety of a continuous psychostimulant use in nursing mothers.
There isn't any definitive evidence from a scientific study concerning the safety of ADHD medication during pregnancy. However, most doctors have a general knowledge of the research findings and will apply best practices when assessing the specific needs of each patient. It is known, for example that babies born to mothers taking methylphenidate in the first trimester are more likely have cardiac malformations (Cooper, et al. 2018). However this is based on a comparatively small study that did not take into account the different patient demographics and underlying psychiatric conditions.
In a recent survey of ADDitude readers, they revealed that they are more likely than ever before to quit taking their ADHD medication during early pregnancy. Women who stopped psychostimulants during the first trimester experienced a clinically significant rise in depression symptoms. They also found themselves less able enjoy pregnancy and described family functioning as more difficult than those who continued to take their dose of ADHD medication or increased it.
Work Functioning Test
The work functioning test is a vital component of the exam since it will determine if a patient is able to perform their tasks. The test is designed to assist in evaluating functional limitations. It includes a variety of graded material handling tasks (lifting at different levels, pulling and pushing) and postureal tolerance exercises (sitting and standing as well as walking and balancing in a stoop, kneeling and stoop) as well as tests that are specialized. The evaluator will analyze the results and come up with the return to the conclusion of the test. ROC curves can be used to determine the point of minimal classification (MIC) in both the general work ability physical work capability and the work-functioning issues score.
The MIC is calculated using the COnsensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. This method separates the scores of the physical and general ability and work-functioning problems score by answering an anchor question, to avoid any change in the measurement from affecting the overall average.
Driving Test
Psychostimulant medication is a treatment for ADHD. It increases safety for drivers and reduces symptoms. Untreated severe ADHD can have serious financial and psychosocial consequences.
Psychotherapeutic treatments, like cognitive behavior therapy (CBT) or "coaching" techniques have been proven by research to improve symptoms and enhance performance. These strategies may aid women in adjusting their routines and use their coping skills in ways that minimize the impact of their ADHD on work and other domains.
All of these factors could be significant considerations in the decision to continue or end psychostimulant therapy. The best available data show that although there are some concerns regarding the outcome of pregnancy when in utero stimulant medication is utilized, the risk-benefit ratios of this are minimal. The results are affected by other medication, the use of maternal healthcare and 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 to attention-deficit/hyperactivity medication and the effects on offspring.