ADHD Medication and Pregnancy
Physicians often struggle to inform patients on the security of their ADHD medications during pregnancy. Until more research is available, physicians must weigh the benefits of medication use during pregnancy against the potential risks for the offspring in each individual situation.
A recent study on a population-based cohort monitored 898 babies born to mothers 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 exposure to drugs in the uterus, especially to centrally stimulating medications such as those used to treat ADHD. It is crucial that women receive proper counseling from their doctors about the risks and benefits of using medication during pregnancy and prior to conception. In this Smart Take on CAP, we examine the latest data in this field and how it might guide clinical practice.
Animal studies and illicit drug research suggests that stimulant medication passes to the fetus via the placenta, and could adversely affect the growth of the fetus and development. There aren't many studies on the effects of prescription stimulant medications during pregnancy. The majority of the evidence comes from studies conducted in case-control using a single arm which is not powerful enough to detect any significant associations.
The study conducted by Cohen and colleagues4 is unique because it is the most thorough and carefully controlled. The study included a sample of 364,012 pregnant women from the Danish Medical Registry, and information about the use of medications was obtained by analyzing prescriptions that were redeemed. The researchers specifically excluded women who had reported taking SSRI medications or clonidine, since these drugs can interfere with the fetal NMDA receptor and increase the risk of neurodevelopmental disorders like autism and ADHD. The authors also adjusted 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, along with the results of other limited studies, suggest that the vast majority of women who continue to use their prescribed stimulant medications for ADHD throughout pregnancy do not experience any adverse effects on their fetuses. It is therefore likely that many pregnant women will continue to use their ADHD medication. However, it is crucial that doctors evaluate the advantages and risks of these medications for their pregnant patients, as well as take into consideration the individual circumstances of each patient, before suggesting that they stop taking their medication. It is essential that women who are pregnant with ADHD inform their parents as well as extended families and employers of the decision they've made. This is because symptoms of inattention, hyperactivity, and impulsivity could return after the mother ceases taking her medication.
medication for adhd should comprise an extensive management plan that includes both behavioral and pharmaceutical treatment and continuous monitoring during the perinatal phase. The plan should include a discussion of the current treatment regimens, specifically in the first trimester where dangers to the baby due to untreated ADHD are greatest. This should be a coordinated effort with psychiatry, obstetrics and primary care.
The discussion of the risks and benefits should also include how a woman intends to manage her ADHD symptoms during pregnancy, the effect of this on the family's functioning, and how she feels about a decision to stop psychostimulant treatment in the initial stages. This should be based on an in-depth analysis of the available evidence and be mindful of the individual needs and concerns.
The authors of a massive study that examined children who were exposed ADHD medications during utero 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 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 also no research controlled that studies the safety of continued use of psychostimulants by nursing mothers.
There isn't a clear evidence from a scientific study concerning the safety of ADHD medication during pregnancy. However, the majority of doctors have a general knowledge of what the literature suggests and can apply the best practices in consultation to each patient's individual needs. It is known, for instance that babies born to mothers who are taking methylphenidate during the first trimester are more likely have cardiac malformations (Cooper, et al. 2018). However, this finding is based on a comparatively small study that did not take into account differences in patient demographics and underlying psychiatric conditions.
In a recent study, ADDitude readers said that they were more likely to discontinue their ADHD medication during the early stages of pregnancy than they were in the past. Women who stopped taking psychostimulants during the first trimester showed an increase in depressive symptoms. They also reported feeling less capable of enjoying their pregnancy and rated their family functioning as being more difficult than women who maintained or increased their dosages of ADHD medications.
Work Functioning Test
The test for work function is an essential element of the examination as it determines if a patient is able to perform their tasks. The test is designed to determine functional limitations. It will include materials handling that is graded (lifting to various heights pulling and pushing), positional tolerance activities (sitting or standing and walking, balancing or stooping, kneeling, crawling) as well as other relevant specialized tests (hand manipulation). The test evaluator will review the results and come up with an appropriate return to a conclusion of the work. ROC curves are used to illustrate the point of minimum misclassification (MIC) for both physical and general work ability and the work-functioning 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 divides the scores of physical and general work abilities and work-functioning problems score by answer on an anchor question, to avoid any change in the measure from affecting the overall average.
Driving Test
The gold standard for treating ADHD is psychostimulant medication. It eases symptoms and enhances performance in other domains, notably driving safety. Insufficiency due to severe, untreated ADHD can have significant psychosocial and financial consequences.
Psychotherapeutic treatments, like cognitive behavior therapy (CBT) or "coaching" techniques have been shown by research to reduce symptoms and improve function. These strategies can assist women in adjusting their routines, and use their coping abilities in ways that minimize the effects of ADHD on work and other aspects.
All of these aspects can be significant considerations in the decision of whether to continue or discontinue psychostimulant treatment. As the best available data show, while there is some concern regarding 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 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.