ADHD Medication and Pregnancy
Physicians struggle to provide accurate information regarding the safety of ADHD medications during pregnancy. In the absence of further research, physicians must weigh up the benefits and risks of taking medication during pregnancy.
A study of a population-based sample has tracked 898 babies who were born to mothers who were taking 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 effects of drug exposure in the uterus, specifically to centrally stimulating drugs like those used to treat ADHD. It is therefore critical that women receive appropriate counseling from their physicians about the risk/benefit of using medication before conception and during pregnancy. In this CAP Smart Take, we review the most recent research in this field and how it could inform the practice of a physician.
Previous animal studies and studies on illicit drug use suggest that stimulant drugs are passed to the fetus via the placenta and may adversely affect the development of the fetus and growth. There are few data on the effects of prescription stimulant drugs during pregnancy. Most of the evidence comes from studies conducted in case-control using a single arm which aren't strong enough to identify any significant connections.
The study by Cohen and colleagues4 is distinctive because it is the most complete and meticulously controlled. The study covered 364,012 pregnancies that were retrieved from the Danish Medical Registry. Information about the use of medications was gathered by analyzing the redeemed medication. The researchers specifically excluded women who reported receiving SSRI drugs or clonidine as these drugs may interfere with the fetal NMDA receptor and increase the risk of developing neurodevelopmental disorders like autism and ADHD. The authors adjusted their analyses in order to account for timing of exposure and make sure that they control for confounding factors.
The results of this study and other limited trials indicate that the majority of women who continue to use their stimulant medications prescribed for ADHD during pregnancy are not experiencing adverse effects on their foetuses. It is therefore likely that many women who are pregnant will continue to use their ADHD medication. It is essential for doctors to weigh the benefits and risks of these medications prior to advising their pregnant patients to stop taking them. It is important that women who are pregnant with ADHD inform their parents as well as extended families and employers of the decision they've taken. This is because the symptoms of hyperactivity, inattention, and impulsivity will likely return once the mother stops taking her medications.
Pregnancy Tests
Preconception counseling should comprise 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 of current medication regimens, especially in the first trimester where the risks of harm to the baby due to untreated ADHD are greatest. This should be a coordinated effort with obstetrics, psychiatry, and primary care.
The discussion of risks and benefits should also include how a woman will manage her ADHD symptoms during pregnancy, the effects of this on family functioning and her feelings about a decision to stop psychostimulant treatment in the initial stages. This should be based on an exhaustive review of the available evidence and take into account the patient's individual needs and concerns.
In a recent study that examined children exposed to ADHD medications in utero and concluded that "continuation of psychostimulant use during the early stages of pregnancy didn't increase the risk of adverse birth outcomes and if anything was associated with less stress for mothers." However this conclusion isn't without its limitations. The study didn't consider the importance of the dosage of stimulant medication or the long it was used along with other sociodemographic and clinical variables. There is also no research controlled that studies the safety of a continued use of psychostimulants by nursing mothers.
Although there is a lack of clear scientific data on the safety of ADHD medication during pregnancy, most physicians have a general understanding of what the existing research suggests and apply the best practices while collaborating with the individual needs of each patient. For example, it is recognized that there is a higher risk of cardiac malformations among babies born to mothers who have taken methylphenidate in the first trimester of pregnancy (Cooper and colleagues. 2018), while it is important to remember that this finding was based on a small study that did not take into consider differences in patient demographics or underlying psychiatric co-morbidity.
In a recent survey of ADDitude readers, they reported that they are more likely than ever before to stop taking their ADHD medication during the first trimester of pregnancy. Women who stopped taking psychostimulants in the first trimester experienced an increase in depressive symptoms. They also felt less able to enjoy pregnancy and described family functioning as more difficult than those who remained on their dose of ADHD medication or increased it.
Work Functioning Test
The work functioning test is an essential element of the examination as it will determine if the patient is able to carry out their tasks. The test is intended for evaluating functional limitations. It includes a variety of graded material handling tasks (lifting at different heights, pulling and pushing), positional tolerance exercises (sitting and standing while walking, balancing and walking in a stoop, kneeling and stoop), as well as specific tests. The evaluator will analyze the results and come up with the return to work conclusion. ROC curves are used to illustrate the point at which there is a minimum misclassification (MIC) for both physical and general working ability as well as the functional score for a particular problem.
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 difficulties based on the 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 improves driving safety and reduces symptoms. Insufficiency due to severe, untreated ADHD can have significant psychosocial and financial consequences.
Psychotherapeutic interventions like cognitive behavioral therapy (CBT) and "coaching" strategies have also been proven to improve symptoms and enhance functioning. These strategies can help women tailor their schedules and utilize their coping abilities in ways that minimize the effects of ADHD on work and other areas.
adhd medication ritalin of these factors can be significant considerations in the decision to continue or stop psychostimulant treatment. As the best available data indicate, although there is some concern regarding pregnancy outcomes with in utero exposure to stimulant medications, the relative risks are small and the results are affected by other treatments, maternal health care utilization and physical and mental 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 its effects on offspring.