Why ADHD Medication And Pregnancy Is Your Next Big Obsession
ADHD Medication and Pregnancy
Physicians are unable to provide accurate information regarding the safety of ADHD medications during pregnancy. In non stimulant adhd medication , doctors must weigh up the benefits and risks of taking medication during pregnancy.
A study that was based on a population-based approach has followed 898 infants who were born to mothers who had taken 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
Doctors are concerned with the long-term effects that exposure to drugs in utero can have, especially for centrally stimulating medications such as those used to treat ADHD. It is crucial that women receive proper counseling from their doctors about the potential risks and benefits of using medication during pregnancy and prior to conception. In this CAP Smart Take we examine the latest data in this area and how it might influence the clinical practice.
Animal studies as well as illicit drug use research suggest that stimulant drugs are passed to the fetus via the placenta and may adversely affect the development of the fetus and growth. There aren't many data on the effects of prescription stimulant medications during pregnancy. The majority of evidence comes from studies conducted in case-control with one arm, which is not powerful enough to reveal any significant correlations.
The study conducted by Cohen and colleagues4 is distinctive because it is the most thorough and carefully controlled. The study covered 364,012 pregnancies collected from the Danish Medical Registry. Information about the use of medications was gathered through the analysis of redeemed medications. Researchers excluded women who had taken SSRIs, clonidine or clonidine since these drugs can interact with the fetal NMDA and increase the risk of developing neurodevelopmental disorders like autism and ADHD. The authors also modified their analysis to account for potential confounding factors as well as to take into account the timing of in utero exposure.
The results of this study as well as other studies show that the majority of women who continue to take their stimulant medications prescribed to treat ADHD during pregnancy don't experience adverse effects on their fetuses. It is therefore likely that many women who are pregnant will continue to take their ADHD medication. However, it is important that doctors evaluate the advantages and risks of these medications for pregnant patients, as well as consider each patient's unique situation prior to suggesting that they stop taking their medication. No matter what decision they make, it is essential that pregnant women with ADHD educate their spouses or relatives, partners as well as their employers about the decision they've made. This is because the signs of hyperactivity, inattention, and impulsivity are likely return when the mother stops taking her medication.
Pregnancy Tests
Preconception counseling should consist of a comprehensive management program that includes both behavioural and pharmaceutical treatments, as well as ongoing monitoring during the perinatal phase. The plan should include a discussion about the current treatment regimens, specifically in the first trimester, when the risk of harming the baby due to untreated ADHD are the highest. This should be a co-operative effort between psychiatry and primary care and the obstetrics department.
The discussion on risk and benefits should consider how a woman will plan to manage her symptoms of ADHD during pregnancy, including the impact on family functioning as well as how she would feel about discontinuing psychostimulant therapy in the beginning of pregnancy. This should be based on a thorough review of available evidence, with consideration of the specific patient's needs and concerns.
In a recent large study that followed children exposed to ADHD medications in utero, the authors concluded that "continuation of use of psychostimulants in the early stages of pregnancy did not increase the risk of adverse birth outcomes and if anything was associated with reduced maternal stress." However this conclusion isn't without its flaws. The study did not consider the importance of the dosage of stimulant medication, nor the long it was used, in addition to other sociodemographic and clinical variables. There is also no controlled research that examines the safety of a continued use of psychostimulants by nursing mothers.
There isn't any definitive evidence from a scientific study concerning the safety of ADHD medication during pregnancy. However, the majority of doctors have a basic understanding of what the literature suggests and can apply the best practices in consultation with each patient's individual needs. For example, it is recognized that there is a higher rate of cardiac malformations among babies born to mothers who took methylphenidate in the first trimester of pregnancy (Cooper and co. 2018) It is important to remember that this finding was based on a small study and did not account for differences in patient demographics or the underlying psychiatric co-morbidity.
In a recent survey of ADDitude readers, they reported that they are more likely than ever to stop taking their ADHD medication during early pregnancy. However, women who stopped psychostimulants within the first trimester of their pregnancy experienced a clinically significant increase in the severity of depressive symptoms. They also reported that they were less capable of enjoying their pregnancy and described their family functioning as more difficult than those who continued or increased dosages of ADHD medication.
Work Functioning Test
The test of work function is an essential element of the examination as it determines if a patient is able to carry out their tasks. The test is intended for testing functional limitations. It includes graded material handling exercises (lifting at various heights pulling and pushing) and positional tolerance exercises (sitting and standing as well as walking and balancing or stooping, kneeling and stooping), as well as specialized tests. The test evaluator will review the results and formulate an appropriate return to a conclusion of the work. ROC curves are used to determine the point of minimum misclassification (MIC) for both physical and general work capability as well as the work-functioning score for a particular problem.
The MIC is calculated according to the COnsensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. This method differentiates scores for general physical work capabilities and work-functioning issues by answering an anchor question. This prevents a change in metrics from affecting the average.
Driving Test
Psychostimulant medication is a gold standard treatment for ADHD. It increases safety for drivers and decreases symptoms. If left untreated, 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 help women to tailor their routines and use their abilities to cope in ways that minimize the impact of their ADHD on work and other areas.
All of these aspects are crucial to take into consideration when deciding whether or not to continue with psychostimulant therapy. The most reliable data available show that although there are concerns about the outcomes of pregnancy when in utero stimulant medications are utilized, the risk-benefit ratios of this are minimal. Also, the results are complicated by other medication, the use of maternal healthcare, maternal mental and physically 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 effects on offspring.