ADHD Medication and Pregnancy
Physicians are unable to provide accurate information regarding the safety of ADHD medications during pregnancy. In the meantime, until more research is available, doctors must weigh the advantages of taking medication during pregnancy against the possible risks for offspring in each particular situation.
A recent cohort study of the population tracked 898 infants born to women taking ADHD medications throughout pregnancy (stimulants: methylphenidate, amphetamine dexamphetamine, methylphenidate; and non-stimulants such 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 with the long-term effects exposure to drugs in utero can have, especially for centrally stimulating medications like those used to treat ADHD. It is essential that women receive the appropriate counseling from their physicians about the risks and benefits of taking medication prior to conception and throughout pregnancy. In this Smart Take on CAP, we review the most recent research in this field and how it can influence clinical practice.
Animal studies and illicit drug research suggests that stimulant drugs enter the fetus via the placenta, and may negatively impact fetal growth and development. There aren't many studies on the effects of prescription stimulant medications during pregnancy. The majority of evidence comes from studies conducted in case-control using a single arm which isn't powerful enough to reveal any significant correlations.
The most recent study by Cohen and co. stands out from the others because it is the largest and most carefully controlled. The study included a sample of 364,012 births from the Danish Medical Registry, and data on the use of medication was gathered through the analysis of prescriptions that were redeemed. adhd medication online excluded women who had reported receiving SSRI medications or clonidine as these drugs may interact with the fetal NMDA receptor and increase the risk of developing neurodevelopmental disorders such as autism and ADHD. The authors also modified their analyses to control for potential confounding factors as well as to take into account the timing of in-utero exposure.
The data from this study, as well as the results of other limited studies, suggest that the majority of women who continue to take their prescribed stimulant medications for ADHD throughout pregnancy do not experience any adverse effects on their foetuses. Therefore, it is likely that a lot of pregnant women will continue to take their ADHD medication. It is essential 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 important that pregnant women with ADHD inform their spouses as well as extended families and employers of the decision they've taken. This is because the symptoms of hyperactivity, inattention and impulsivity are likely to return once the mother stops taking her medications.
Pregnancy Tests
Preconception counseling for women suffering from ADHD who wish to become pregnant should focus on a comprehensive management plan that involves both behavioral and pharmacologic treatment and ongoing monitoring throughout the perinatal period. The plan should include a discussion of current medication regimens, especially in the first trimester when the risks of harm to the baby resulting from untreated ADHD are greatest. This should be a joint effort between primary care and psychiatry, as well as obstetrics.
The discussion of risk/benefit should also consider how a woman will plan to manage her symptoms of ADHD during pregnancy, as well as the effects on family functioning and how she feels about a decision to stop psychostimulant therapy in the beginning of the pregnancy. This should be based upon an exhaustive review of the evidence available and take into account the individual needs and concerns.
The authors of a massive study that followed children who were exposed to ADHD medications during utero concluded that "continuation psychostimulant usage during early pregnancy did not cause adverse birth outcomes and if anything, was associated with less stress among mothers." However the conclusion they reached is not without limitations. The study did not take into account the importance of the dose of stimulant medication and how long it was used, along with other sociodemographic and clinical factors. There is also no research controlled that studies the safety of continuing psychostimulant usage in nursing mothers.
Although there is a lack of evidence-based research on the safety of ADHD medications during pregnancy, many doctors have a basic understanding of what the current research suggests and employ the best practices in consultation with the specific needs of each patient. It is known, for instance that infants born to mothers taking methylphenidate during the first trimester are more likely have cardiac malformations (Cooper, et al. 2018). However this is based on a small study that did not take into account differences in the demographics of patients and the underlying psychiatric conditions.
In a recent survey of ADDitude readers, they reported that they are more likely than ever before to quit taking their ADHD medication in the early stages of pregnancy. However, women who discontinued psychostimulants during the first trimester of pregnancy experienced an increase in symptoms of depression. They also felt less able to enjoy pregnancy and rated family functioning as more difficult than those who continued to take their dose of ADHD medication or increased it.
Work Functioning Test
The work function test is a crucial component of the exam to determine if the candidate is able to perform their duties. The test is designed to determine functional limitations. It will include materials handling that is graded (lifting to different heights pulling and pushing) as well as positional tolerance tests (sitting in a chair, standing in a balancing position, walking and stooping, kneeling and crawling) as well as other relevant specialized tests (hand manipulation). The examiner will analyse the results and come up with an appropriate return to a conclusion of the work. ROC curves can be used to determine the point of minimal classification (MIC) in the general work capability physical work capability 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 differentiates scores for general physical work capabilities and work-functioning issues by answering an anchor question. This prevents any change in metrics from affecting the average.
Driving Test
The most effective treatment for ADHD is a psychostimulant drug. It improves safety while driving and reduces symptoms. Insufficiency due to severe, untreated ADHD can have profound psychosocial and financial consequences.
Psychotherapeutic interventions, such as cognitive behavior therapy (CBT) or "coaching" methods have also been shown by research to help improve symptoms and increase functioning. These strategies can help women to tailor their schedules and utilize their coping abilities in ways that minimize their ADHD's impact on work and other aspects.
All of these factors could be significant considerations in the decision to continue or end psychostimulant therapy. The most recent data available indicate that, despite concerns about the outcomes of pregnancy when in utero stimulant medication is employed, the risks of this are low. The results are affected by other medication, the use of maternal healthcare and physical and mental health, and the comorbidities. Bang Madsen K, Bliddal M, Skoglund CB, Larsson H, Munk-Olsen TL, Hove Thomsen P, Bergink V. In utero exposure to attention deficit hyperactivity disorder medication and long-term offspring outcomes.