ADHD Medication and Pregnancy
Physicians struggle to provide accurate information on the security of ADHD medications during pregnancy. As long as research is not available, doctors must weigh the benefits of taking medication during pregnancy against the possible risks for the offspring in each unique circumstance.
A recent study on a population-based cohort monitored 898 babies born to mothers who were taking ADHD medications throughout pregnancy (stimulants 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:
Physicians are concerned about the long-term effects of drug exposure in the uterus, especially to centrally stimulating medications like those used to treat ADHD. It is essential that women receive appropriate advice from their doctors about the risk/benefit of using medication prior to conception and during pregnancy. In this CAP Smart Take, we examine the latest data in this area and how it could inform clinical practice.
Previous animal studies and studies on illicit drug use indicate that stimulant medication passes to the fetus through the placenta and may negatively impact fetal development and growth. However, there is a lack of information on how the fetus responds to the therapeutic doses of prescription stimulant medications during pregnancy, and the majority of this evidence comes from single-arm case-control studies that are not sufficiently powered to detect possible significant correlations.
The study by Cohen and colleagues4 is unique because it is the most comprehensive and carefully controlled. The study involved 364,012 births 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 had reported receiving SSRI medications or clonidine, as these drugs may interfere with the fetal NMDA receptor and increase the risk of developing neurodevelopmental disorders such as autism and ADHD. The authors modified their analysis in order to account for the timing of exposure as well as take into account confounding factors.
The results of this study as well as other studies show that the majority of women who continue using their stimulant medications prescribed for ADHD during pregnancy don't experience adverse effects on their foetuses. As a result, it is likely that a lot of women will continue to use their medication for ADHD during pregnancy. It is crucial for doctors to carefully weigh the risks and benefits of these drugs prior to advising their pregnant patients to stop taking the medications. It is crucial that women who are pregnant with ADHD inform their parents, extended families, and employers of the decision they've made. It is because the symptoms of inattention, hyperactivity, and impulsivity are likely return when the mother stops taking medication.
Pregnancy Tests
Preconception counseling for women with ADHD who are planning to become pregnant should focus on a comprehensive treatment plan that incorporates both pharmacologic and behavioral treatment and continuous monitoring throughout the period of perinatal care. The plan should include a discussion of the current treatment regimens, particularly during the first trimester, when dangers to the baby due to untreated ADHD are the highest. This should be a joint effort between psychiatry and primary care, as well as the obstetrics department.
The discussion of risk/benefit should also address how a woman plans to manage her symptoms of ADHD during pregnancy, as well as the impact on family functioning as well as how she feels about stopping psychostimulant treatment in the beginning of pregnancy. This should be based upon an in-depth analysis of the available evidence and take into account the individual needs of the patient and concerns.
The authors of a massive study that followed children exposed to ADHD medications while in utero concluded that "continuation psychostimulant usage during early pregnancy was not associated with adverse birth outcomes and, if anything, was associated with lower stress levels among mothers." However their conclusion isn't without limitations. The study did not take into account other aspects, including the duration for which stimulant medication was used as well as the dose and sociodemographics. There is no research conducted that is controlled and examines the safety of continued use of psychostimulants in nursing mothers.
Although there is a lack of evidence-based research on the safety of ADHD medications during pregnancy, the majority of doctors are aware of what the current research suggests and apply the best practices in consultation with the specific needs of each patient. For instance, it's well-known that there is a higher incidence of cardiac malformations among babies born to mothers who have taken methylphenidate during the first trimester of pregnancy (Cooper and colleagues. (2018)), while it is also important to note that this result was based on one small study that did not take into account variations in the demographics of patients or underlying psychiatric comorbidity.
In a recent survey of ADDitude readers, they revealed that they are more likely than ever to stop taking their ADHD medication during the first trimester of pregnancy. However, women who discontinued psychostimulants in the first trimester of pregnancy experienced an increase in symptoms of depression. They also found themselves less able enjoy pregnancy and rated 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 perform their tasks. The test is designed to evaluate functional limitations. It will include the use of graded material handling (lifting to various levels pulling and pushing) and positional tolerance exercises (sitting in a chair, standing in a balancing position, walking, stooping, kneeling, crawling) and other relevant specialized tests (hand manipulation). medication for autism and adhd to form the return-to-work conclusions. 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 problem score.
The MIC is calculated by using the COnsensus Standards for the Selection of Health Measurement Instruments Checklist (COSMIN). This method separates the scores of the physical and general work abilities and work-functioning difficulties based on the answering an anchor question, to avoid changes in the measurement from affecting the overall average.
Driving Test
The gold standard for treating ADHD is psychostimulant medications. It helps reduce symptoms and improves functioning in other areas, including driving safety. If not treated, severe ADHD can have significant psychosocial and financial implications.
Psychotherapeutic interventions such as cognitive behavioral therapy (CBT) and "coaching" strategies have also been proven to reduce symptoms and enhance functioning. These strategies could aid women in adjusting their routines and apply their strategies to cope in ways that minimize the impact of their ADHD on work and other areas.
All of these aspects are important to consider when deciding whether or not to continue with psychostimulant therapy. The most recent data available indicate that although there are concerns regarding the outcome of pregnancy 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 as well as 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 disorder medication and long-term outcomes for offspring.