ADHD Medication and Pregnancy
Physicians often struggle to counsel patients on the security of their ADHD medications during pregnancy. In the meantime, until more research is available, doctors must weigh the benefits of taking medication during pregnancy against the potential dangers for children in each unique circumstance.
A study of a population-based sample has followed 898 babies who were born to mothers who took ADHD medications during pregnancy (stimulants methylphenidate amphetamine dexamphetamine ; non-stimulants modafinil atomoxetine clonidine), until they were diagnosed as having a developmental disorder, died, or left the country.
Risk/Benefit Discussion
CAP Smart Take:
Physicians are concerned about the long-term consequences of exposure to drugs during the uterus, especially to centrally stimulating drugs like those used for ADHD. It is essential that women receive appropriate counseling from their physicians about the risks and benefits of taking medication prior to conception and throughout pregnancy. In this CAP Smart Take we examine the latest data in this field and how it can influence the practice of a physician.
Animal studies as well as illicit drug use research indicate that stimulant medication passes to the fetus through the placenta and may negatively impact fetal development and growth. However, there are limited information on the response of the fetus to dosages of prescribed stimulant medication during pregnancy, and the majority of this data comes from single-arm case-control studies that are not sufficiently powered to identify significant associations.
The study by Cohen and colleagues4 is distinctive because it is the most thorough and meticulously controlled. The study included 364,012 pregnancies that were retrieved from the Danish Medical Registry. Information about the use of medications was gathered by analyzing redeemed medications. The researchers specifically excluded women who reported receiving SSRI drugs or clonidine since these drugs can interact with the fetal NMDA receptor and increase the risk of developing neurodevelopmental disorders such as autism and ADHD. The authors also modified their analysis to account for possible confounding factors and to account for the timing of in utero exposure.
The results of this study as well as other studies show that the majority of women who continue to use their stimulant medication prescribed for ADHD during pregnancy do not experience adverse effects on their foetuses. Therefore, it is likely that many women who are pregnant will continue to use their ADHD medication. However, it is crucial that physicians carefully evaluate the advantages and risks of these medications for their pregnant patients, as well as be aware of the unique circumstances of each patient, before suggesting that they stop taking their medications. Whatever decision they make, it is crucial that pregnant women suffering from ADHD inform their spouses, relatives, partners and employers about the decision they have made. This is because the symptoms of hyperactivity, inattention, and impulsivity will likely come back once the mother stops taking her medications.
Pregnancy Tests
Preconception counseling should comprise an extensive management plan that includes both behavioral and medical treatment and ongoing monitoring during the perinatal phase. The plan should include a discussion of current medication regimens, especially during the first trimester, when risks of harm to the baby due to untreated ADHD are greatest. This should be a collaborative effort between psychiatry and primary care and Obstetrics.
The discussion of the 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 a decision to stop psychostimulant treatment in the early stages. This should be informed by a thorough review of available evidence, with consideration of the specific patient's needs and concerns.
The authors of a massive study that examined children who were exposed to ADHD medications while in utero concluded that "continuation use of psychostimulants during early pregnancy did not cause adverse birth outcomes and, if anything, it was associated with less stress among mothers." However, their conclusion is not without limitations. The study did not take into account other factors such as the duration of time stimulant medication was used in addition to the dose and sociodemographics. Furthermore, there is no controlled research examining the safety of a continuous use of psychostimulants in nursing mothers.
While there is a lack of clear scientific data on the safety of ADHD medications in pregnancy, most physicians are aware of what the existing research suggests and apply the best practices, in consultation with the specific needs of each patient. It is known, for instance that babies born to mothers taking methylphenidate in the first trimester are more likely to suffer from cardiac malformations (Cooper, et al. 2018). However this conclusion is based on a small study that did not consider the differences in the demographics of patients and the underlying psychiatric conditions.
In an earlier survey of ADDitude readers, they reported that they are more likely than ever to stop taking their ADHD medication during early pregnancy. Women who stopped psychostimulants during the first trimester showed an increase in depressive symptoms. They also reported being less capable of enjoying their pregnancy and rated their family functioning as less than those who continued or increased their dosages of ADHD medications.
Work Functioning Test
The test of work function is an important component of the exam in that it determines whether a person can perform their duties. The test is designed to assist in evaluating functional limitations. It includes graded material handling exercises (lifting at different levels, pulling and pushing) as well as positional tolerance exercises (sitting and standing while walking, balancing and walking in a stoop, kneeling and stoop), as well as specific tests. The examiner will analyse the results and formulate a return to work conclusion. ROC curves are used to determine the point of minimal misclassification (MIC) for both physical and general work capability as well as the work-functioning problem score.
The MIC is calculated based on the COnsensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. This method separates scores for general and physical work capabilities and work-functioning issues, by answering an anchor question. This prevents any change in metrics from biasing the average.
Driving Test
Psychostimulant medication is a standard treatment for ADHD. It improves safety while driving and decreases symptoms. The effects of severe, untreated ADHD can have significant financial and psychosocial effects.
Psychotherapeutic treatments, like cognitive behavior therapy (CBT) or "coaching" techniques have also been proven by research to improve symptoms and enhance performance. These strategies may help women to tailor their schedules and utilize their abilities to cope to minimize the impact of their ADHD on work and other areas.
All of these factors can be important considerations in the decision whether to continue or discontinue psychostimulant therapy. The most recent data available indicate that although there are some concerns regarding the outcome of pregnancy when in utero stimulant medications are used, the relative risks of this are small. Also, the results are complicated by other medications, maternal healthcare use and physical and mental health and other comorbidities. Bang Madsen K, Bliddal M, Skoglund CB, Larsson H, Munk-Olsen, Hove Thomsen P, Bergink V. In buy adhd medication uk to attention deficit hyperactivity disorder medication and long-term offspring outcomes.