ADHD Medication and Pregnancy
Physicians struggle to provide accurate information about the security of ADHD medications during pregnancy. As long as research is not available, physicians must weigh the benefits of taking medication during pregnancy against the potential risks for offspring in each individual situation.
A recent study on a population-based cohort tracked 898 infants born to women taking ADHD medications throughout pregnancy (stimulants such as 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
Doctors are concerned about the long-term effects that exposure to drugs in utero may have, especially for centrally stimulating medications such as those used to treat ADHD. It is crucial that women receive the appropriate medical advice from their doctors regarding the risks and benefits of taking medication before conception and during pregnancy. In this CAP Smart Take, we examine the latest data in this field and how it can inform the practice of a physician.
Previous animal studies and studies on illicit drug use indicate that stimulant medication passes to the fetus via the placenta, and could negatively affect fetal development and growth. However, there are limited information on the response of the fetus to the therapeutic doses of prescription stimulant medication during pregnancy, and the majority of this evidence comes from single-arm case-control studies that have not been sufficiently powered to determine if there are significant associations.
The most recent study by Cohen and co. is distinct from other studies as it is the largest and most meticulously controlled. The study comprised a representative sample of 364,012 pregnancies from the Danish Medical Registry, and information on medication use was obtained by analyzing prescriptions that were redeemed. The researchers specifically excluded women who had reported taking 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 also modified their analysis to account for potential confounding factors and to take into account the timing of the in utero exposure.
The results of this study and other studies show that the majority of women who continue using their stimulant medication prescribed for ADHD during pregnancy don't experience adverse effects on their fetuses. It is therefore likely that many pregnant women will continue to take their ADHD medication. But it is essential that doctors carefully weigh the risks and benefits of these medications for their pregnant patients, as well as take into consideration the individual circumstances of each patient prior to suggesting they stop their medication. No matter what decision they make, it is vital that pregnant women suffering from ADHD inform their spouses, partners, extended family members as well as their employers about the choice they have made. This is because signs of inattention, hyperactivity, and impulsivity could be recurred after the mother ceases taking her medications.
Pregnancy Tests
Preconception counseling for women with ADHD who want to become pregnant should concentrate on a comprehensive treatment plan that includes both behavioral and pharmacologic treatment and continuous monitoring throughout the perinatal period. The plan should include a review of the current treatment regimens, specifically in the first trimester where dangers to the baby resulting from untreated ADHD are the highest. This should be a joint 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 as well as how she would feel about stopping psychostimulant treatment in the beginning of the pregnancy. This should be informed by a thorough review of the available evidence, and consideration of the individual patient's requirements and concerns.
The authors of a huge study that examined children exposed to ADHD medication during pregnancy concluded that "continuation psychostimulant usage during early pregnancy did not cause adverse birth outcomes and if it was, it was associated with lower stress levels among mothers." However, their conclusion is not without a few limitations. The study did consider other factors, such as the length of time that stimulant medication was taken in addition to the dose and sociodemographics. There is no research controlled that studies the safety of continued use of psychostimulants by nursing mothers.
There is no clear research-based evidence concerning the safety of ADHD medication during pregnancy. However, most doctors have a general knowledge of what research suggests and apply best practices in consultation to each patient's individual needs. For example, it is known that there is a higher risk of cardiac malformations in infants born to mothers who took methylphenidate during the first trimester of pregnancy (Cooper and co. (2018)) However, it is important to note that this result was based on a small study that did not account for variations in the demographics of patients or underlying psychiatric co-morbidity.
In a recent survey, ADDitude readers found that they were more likely to discontinue their ADHD medication in early pregnancy than in previous. Women who stopped taking psychostimulants in the first trimester showed a clinically significant rise in depression symptoms. They also reported that they were less able to enjoy their pregnancy and described their family functioning as being more difficult than women who maintained or increased their dosages of ADHD medications.
Work Functioning Test
The test of work function is a vital component of the examination as it determines if a patient can perform their job tasks. The test is designed to assess functional limitations. It will include the use of graded material handling (lifting to various heights pulling and pushing) as well as positional tolerance tests (sitting in a chair, standing, balancing, walking and stooping, kneeling and crawling) and other relevant tests for specialized testing (hand manipulation). The evaluator evaluates the results to formulate the return-to-work conclusions. ROC curves are used to determine the point of minimal misclassification (MIC) for both physical and general working ability as well as the functional problem score.
The MIC is calculated according to the COnsensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. adhd sleep medication for general physical abilities and work-functioning problems by answering an anchor question. This prevents any change in metrics from biasing the average.
Driving Test
The most effective treatment for ADHD is a psychostimulant drug. It eases symptoms and enhances functioning in work and other domains, notably driving safety. The effects of severe, untreated ADHD can have significant financial and psychosocial effects.
Psychotherapeutic interventions such as cognitive behavioral therapy (CBT) and "coaching" strategies have also been proven to reduce symptoms and improve functioning. These strategies can help women tailor their schedules and utilize their coping abilities in ways that minimize the impact of ADHD on their work and other areas.
All of these aspects can be crucial considerations when making the decision whether to continue or end psychostimulant treatment. The most reliable data suggest, even though there are some concerns about pregnancy outcomes with in utero exposure to stimulant medications, the risk is minimal and the results are confounded by other medication, health treatment, maternal mental and physical 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 offspring outcomes.