ADHD Medication and Pregnancy
Physicians struggle to provide accurate information on the safety of ADHD medications during pregnancy. Until more research is available, doctors must weigh the advantages of medication use during pregnancy against the possible dangers for children in each particular situation.
A recent cohort study of the population monitored 898 babies born to mothers who were taking ADHD medications throughout pregnancy (stimulants such as amphetamine, methylphenidate dexamphetamine, methylphenidate; 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 with the long-term effects that drug exposure in utero may result in, especially for centrally stimulating medications like those used to treat ADHD. It is important that women receive appropriate advice from their doctors regarding the potential risks and benefits of using medication during pregnancy and prior to conception. In this CAP smart take we review the most recent research in this area and how they can inform the clinical practice.
Animal studies and illicit drug research suggests that stimulant medication passes to the fetus via the placenta, and may negatively impact fetal growth and development. However, there is a lack of data on how the fetus responds to the therapeutic doses of prescription stimulant medications during pregnancy, and the majority of this data comes from single-arm case-control studies that are not sufficiently powered to determine if there are significant correlations.
The study by Cohen and colleagues4 is distinctive because it is the most complete and meticulously controlled. The study included a sample of 364,012 pregnant women from the Danish Medical Registry, and information about the use of medications was gathered by analyzing prescriptions that were redeemed. The researchers specifically excluded women who reported receiving SSRI medications or clonidine because these medications can interfere with the fetal NMDA receptor and increase the risk of neurodevelopmental disorders such as autism and ADHD. The authors also adjusted their analyses to control for possible confounding factors and to account for the timing of the in utero exposure.
The results of this study and other small-scale trials suggest that the vast number of women who continue to use their stimulant medications prescribed to treat ADHD during pregnancy do not experience adverse effects on their fetuses. Therefore, it is likely that many women will continue to take their medications for ADHD during pregnancy. However, it is crucial that doctors weigh the risks and benefits of these medications for pregnant patients, and also take into consideration the individual circumstances of each patient prior to advising them to discontinue their medications. Whatever decision they make, it is essential that pregnant women with ADHD educate their spouses or partners, extended family members as well as their employers about the choice they've made. This is because signs of hyperactivity, inattention and impulsivity are likely to be recurred once the mother stops taking her medications.
Pregnancy Tests
Preconception counseling for women suffering from ADHD who want to become pregnant should concentrate on a comprehensive management plan that incorporates both pharmacologic and behavioral treatments and ongoing monitoring throughout the postnatal period. The plan should include a review of current medication regimens, especially in the first trimester where risks of harm to the baby from untreated ADHD are greatest. This should be a collaborative effort between primary care and psychiatry and obstetrics.
The discussion of the risks and benefits should also cover how a woman intends to manage her ADHD symptoms during pregnancy, the effects of this on the family's functioning, and how she feels about stopping psychostimulant therapy in the beginning. This should be based on a thorough evaluation of the evidence available and take into account the individual needs and concerns.
The authors of a massive study that followed children who were exposed 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 lower stress levels among mothers." However the conclusion they reached is not without limitations. The study didn't consider the importance of the dosage of stimulant medication, nor the long it was used for, as well as other sociodemographic and clinical factors. There is no research controlled that studies the safety of continued psychostimulant usage in nursing mothers.
There isn't a clear evidence from a scientific study on the safety of ADHD medication during pregnancy. However, the majority of doctors have a basic understanding of what the literature suggests and can apply the best practices when assessing each patient's specific needs. It is well-known, for instance, that infants born to mothers taking methylphenidate during the first trimester are more likely to suffer from cardiac malformations (Cooper, et al. 2018). However Full Post is based on a tiny study that did not consider the differences in patient demographics and underlying psychiatric conditions.
In an earlier survey of ADDitude readers, they revealed that they are more likely than ever before to quit taking their ADHD medication in the early stages of pregnancy. Women who stopped taking psychostimulants in the first trimester noticed an increase in depressive symptoms. They also found themselves less able enjoy their pregnancy and rated their family functioning as more difficult than those who maintained their dosage of ADHD medication or increased it.
Work Functioning Test
The test of work function is a vital part of the examination in that it determines whether the candidate is able to perform their duties. The test is intended for evaluating functional limitations. It includes a variety of graded material handling tasks (lifting at various heights, pulling and pushing) and tests for positional tolerance (sitting and standing while walking, balancing and walking or stooping, kneeling and stooping) and specific tests. The test evaluator will review the results and draw a 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, the physical work ability 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 is able to separate the scores of physical and general work abilities and work-functioning difficulties based on the answer on an anchor question, to avoid a change in measure from affecting the overall average.
Driving Test
The gold standard for treating ADHD is psychostimulant medication. It eases symptoms and enhances performance in other areas, including driving safety. Untreated severe ADHD can have serious financial and psychosocial consequences.
Psychotherapeutic interventions, such as cognitive behavior therapy (CBT) or "coaching" techniques have been proven by research to improve symptoms and enhance performance. These strategies can help women to tailor their schedules and utilize their coping abilities to minimize the effects of ADHD on work and other areas.
All of these aspects can be crucial considerations when making the decision to continue or stop psychostimulant therapy. The most recent data available indicate that although there are concerns about pregnancy outcomes when in utero stimulant medication is utilized, the risk-benefit ratios of this are low. Additionally, the results are affected by other medications, maternal healthcare utilization, maternal mental and physically health and 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.