ADHD Medication and Pregnancy
Physicians often struggle to advise patients on the safety of their ADHD medication during pregnancy. In the absence research, doctors must weigh the advantages and risks of taking medication during pregnancy.
A study that was based on a population-based approach has followed 898 infants who were born to mothers who took ADHD medications during pregnancy (stimulants amphetamine methylphenidate ; dexamphetamine non-stimulants modafinil, atomoxetine, and clo) until they were identified as having an underlying disorder of development, passed away 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 be a source of harm, particularly for centrally stimulating medications like those used to treat ADHD. It is essential that women receive proper medical advice from their doctors regarding the risks and benefits of taking medication prior to conception and during pregnancy. In this CAP smart take we review the most recent research on this topic and how they might inform clinical practices.
Previous animal studies and illicit drug use research indicate that stimulant medication passes to the fetus via the placenta and may negatively affect fetal development and growth. There are few data on the effects of prescription stimulant drugs during pregnancy. Most of the evidence comes from case-control studies with a single arm, which isn't powerful enough to identify any significant correlations.
The recent study by Cohen et al4 stands out from the rest because it is the largest and most meticulously controlled. The study involved 364,012 births taken from the Danish Medical Registry. Information about the use of medications was gathered through the analysis of redeemed medications. Researchers excluded women who had taken SSRIs or clonidine as these drugs can interfere with fetal NMDA and increase the risk of developing neurodevelopmental disorders such as autism and ADHD. The authors re-analyzed their findings in order to account for timing of exposure and control for confounding factors.
The results of this study and other small-scale trials suggest that the vast number of women who continue using their stimulant medication prescribed for ADHD during pregnancy do not experience adverse effects on their fetuses. adhd medication for adults uk means it is likely that many women will continue to use their medications for ADHD during pregnancy. However, it is important that doctors weigh the benefits and risks of these medications for their pregnant patients, and also take into consideration the individual 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 educate their spouses or partners, extended family members as well as their employers about the choice they've made. It is because the signs of hyperactivity, inattention, and impulsivity are likely return when the mother stops taking medication.
Pregnancy Tests
Preconception counseling should consist of a comprehensive program of management that includes both behavioural and pharmaceutical treatments and continuous monitoring throughout the perinatal period. The plan should include a discussion about the current treatment regimens, especially in the first trimester where the risk of harming the baby because of untreated ADHD are the highest. This should be a coordinated effort between obstetrics, psychiatry, and primary care.
The discussion on risk and benefits should address how a woman plans to manage her symptoms of ADHD during pregnancy, as well as the impact on family functioning and how she feels about stopping psychostimulant treatment in the early stages of pregnancy. This should be based on a thorough review of available evidence, with consideration of the individual patient's requirements and concerns.
The authors of a massive study that followed children exposed to ADHD medications during utero concluded that "continuation use of psychostimulants during early 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 a few limitations. The study did take into consideration other aspects, including the duration for which stimulant medications were used, the dose and the sociodemographics. There is no controlled research that examines the safety of continued use of psychostimulants by nursing mothers.
There is no clear research-based evidence on the safety of ADHD medication during pregnancy. However, the majority of doctors are aware of the research findings and can apply the best practices in consultation with each patient's specific needs. It is known, for instance that babies born to mothers who take methylphenidate during the first trimester are more likely to suffer from cardiac malformations (Cooper, et al. 2018). However this is based on a tiny study that didn't take into account the different the patient's demographics and underlying mental health conditions.
In an earlier survey of ADDitude readers, they found that they are more likely than ever to quit taking their ADHD medication during early pregnancy. Women who stopped taking psychostimulants in the first trimester noticed an increase in depressive 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 test of work function is an essential element of the test as it will determine if a patient can perform their job duties. The test is designed to assist in evaluating functional limitations. It includes graded material handling activities (lifting at different levels pulling and pushing) as well as postureal tolerance exercises (sitting and standing while walking, balancing and walking, stooping and kneeling) and specific tests. The test evaluator will review the results and come up with the return to work conclusion. ROC curves can be used to determine the point of minimal classification (MIC) in the general work capability and physical work ability and the work-functioning issues score.
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 work capabilities and work-functioning problems by answering an anchor question. This prevents a change in metrics from biasing the average.
Driving Test
Psychostimulant medication is a gold standard treatment for ADHD. It reduces symptoms and improves functioning in other areas, such as driving safety. Untreated severe ADHD can have severe psychosocial and financial implications.
Psychotherapeutic treatments such as cognitive behavioral therapy (CBT) and "coaching" strategies have also been shown to improve symptoms and enhance functioning. These strategies may aid women in adjusting their routines and use their strategies to cope in ways that reduce the impact of their ADHD on their work and other domains.
All of these aspects can be crucial considerations when making the decision to continue or end psychostimulant treatment. As the most recent data available suggest, even though there is some concern regarding the outcomes of pregnancy after in utero exposure to stimulant medications the risk is minimal and the results are confounded by other medications, maternal health care utilization 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.