ADHD Medication and Pregnancy
Physicians often struggle to advise patients about the security of their ADHD medications during pregnancy. In the meantime, until more research is available, doctors must weigh the advantages of medication use during pregnancy against the potential risks for the offspring in each individual situation.
A recent population-based cohort study tracked 898 infants born to women taking ADHD medications throughout pregnancy (stimulants amphetamine, methylphenidate, dexamphetamine; non-stimulants: 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 with the long-term effects that exposure to drugs in utero can have, especially for centrally stimulating drugs like those used to treat ADHD. It is important that women receive proper 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 look at the most current data in this area and how they can inform clinical practices.
Previous animal studies and research on illicit drugs suggest that stimulant drugs are passed to the fetus via the placenta and can adversely affect the development of the fetus and growth. There aren't many data on the effects of prescription stimulant drugs during pregnancy. The majority of evidence comes from studies conducted in case-control using a single arm which is not powerful enough to reveal any significant associations.
The study conducted by Cohen and colleagues is distinct from other studies, as it is the largest and most carefully controlled. The study involved 364,012 births taken from the Danish Medical Registry. Information regarding medication use was collected through the analysis of redeemed medications. The researchers specifically excluded women who reported receiving SSRI medications or clonidine as these drugs may interact with the fetal NMDA receptor and increase the risk of neurodevelopmental disorders like autism and ADHD. The authors adjusted their analyses to take into account timing of exposure and control for confounding factors.
The findings from this study, as well as the results of other limited studies, suggest that the vast majority of women who continue to take the stimulant medications prescribed for ADHD during pregnancy do not experience any adverse effects on their fetuses. It is therefore likely that many women who are pregnant will continue to use their ADHD medication. It is essential for doctors to consider the benefits and risks of these medications before giving their pregnant patients the advice to stop taking the medications. It is crucial that pregnant women suffering from ADHD inform their parents family members, extended families, and employers of the decision they've made. This is because signs of hyperactivity, inattention and impulsivity could come back after the mother ceases taking her medications.
Pregnancy Tests
Preconception counseling should include a comprehensive program of management that incorporates both behavioral and pharmaceutical treatment and ongoing monitoring during the perinatal phase. The plan should include a discussion about the current treatment regimens, especially during the first trimester when the risks of harming the baby due to untreated ADHD are highest. This should be a joint effort between primary care and psychiatry, as well as Obstetrics.
The risk/benefit discussion should also consider how a woman will plan to manage her symptoms of ADHD during pregnancy, including the impact on family functioning as well as how she feels about a decision to stop psychostimulant therapy in the beginning of the pregnancy. This should be based upon an in-depth analysis of the available evidence and consider the patient's individual needs 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 reduced maternal stress." However, this conclusion is not without its flaws. The study did consider other factors, such as the duration for which stimulant medication was used in addition to the dose and sociodemographics. Moreover, there is no controlled research examining the safety of a continuous psychostimulant use among nursing mothers.
Although there is a dearth of evidence-based research on the safety of ADHD medications during pregnancy, most physicians are aware of what the current literature suggests and use best practices in consultation with the specific needs of each patient. It is known, for instance that babies born to mothers who are taking methylphenidate during the first trimester are more likely to suffer from cardiac malformations (Cooper and co. 2018). However this conclusion is based on a tiny study that didn't consider the differences in the demographics of patients and the underlying psychiatric conditions.
In a recent survey ADDitude readers said that they were more likely to discontinue their ADHD medication during the early stages of pregnancy than in the past. Women who stopped taking psychostimulants during the first trimester experienced an increase in depression symptoms. They also felt less able to enjoy pregnancy and rated family functioning as more challenging than those who maintained their dosage of ADHD medication or increased it.
Work Functioning Test
The work function test is an important part of the examination in that it determines whether a person can perform their duties. The test is designed to assist in testing functional limitations. It includes graded material handling activities (lifting at different heights pulling and pushing) as well as tests for positional tolerance (sitting and standing while walking, balancing and walking or stooping, kneeling and stooping), as well as tests that are specialized. add adhd medications will analyse the results and draw an appropriate return to the conclusion of the test. ROC curves are used to determine the point of minimal misclassification (MIC) for both the general and physical work ability and 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 divides scores for general physical abilities and work-functioning issues, by answering an anchor question. This will prevent a change in metrics from affecting the average.
Driving Test
Psychostimulant medication is a gold standard treatment for ADHD. It reduces symptoms and improves performance in other areas, including driving safety. Untreated severe ADHD can have serious financial and psychological consequences.
Psychotherapeutic treatments, like cognitive behavior therapy (CBT) or "coaching" techniques have been proven by research to improve symptoms and enhance performance. These strategies can assist women in adjusting their schedules and utilize their coping abilities to minimize the impact of ADHD on their work and other areas.
All of these factors could be important considerations in the decision to continue or stop psychostimulant therapy. As the best available data show, while there is some concern regarding pregnancy outcomes with in utero exposure to stimulant medication, the relative risks are small and the results are confounded by other medications, maternal health treatment as well as physical and mental health, and the 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 disorder medication and long-term effects on offspring.