ADHD Medication and Pregnancy
Physicians struggle to provide accurate information about the safety of ADHD medications during pregnancy. As long as research is not available, physicians must weigh the advantages of medication use during pregnancy against the possible dangers for children in each unique circumstance.
A recent study on a population-based cohort monitored 898 babies born to women taking ADHD medications throughout pregnancy (stimulants such as amphetamine, methylphenidate 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
Physicians are concerned about the long-term effects of drug exposure in utero, particularly to centrally stimulating medications like those used to treat ADHD. It is crucial that women receive appropriate advice from their doctors about the risks and benefits of taking medication prior to conception and throughout pregnancy. In this CAP smart take we examine the most recent research on this topic and how they could influence the clinical practice.
Animal studies as well as illicit drug use research indicate that stimulant medication passes to the fetus via the placenta and may negatively impact fetal development and growth. There are few data on the effects of prescription stimulant medications during pregnancy. The majority of evidence comes from case-control studies using a single arm which aren't strong enough to reveal any significant connections.
The study conducted by Cohen and colleagues4 is unique because it is the most comprehensive and meticulously controlled. The study comprised a representative 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. Researchers excluded women who had taken SSRIs, clonidine or clonidine since these drugs can interact with the fetal NMDA and increase the risk for 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 in-utero exposure.
The findings from this study, in addition to the results from other studies, suggest that the majority of women who continue to take their prescribed stimulant medication for ADHD throughout pregnancy do not experience any adverse effects on their fetuses. Therefore, it is likely that many women who are pregnant will continue to use their ADHD medication. However, it is important that doctors weigh the risks and benefits of these medications for pregnant patients, as well as be aware of the unique circumstances of each patient before suggesting they stop their medication. It is important that pregnant women suffering from ADHD inform their parents family members, extended families, and employers of the choice they've made. This is because the signs of hyperactivity, inattention and impulsivity are likely return when the mother stops taking their medication.
Pregnancy Tests
Preconception counseling should consist of a comprehensive program of management that includes both behavioural and pharmaceutical treatments, as well as ongoing monitoring throughout the perinatal period. 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 obstetrics, psychiatry and primary care.
The discussion of risk/benefit should also discuss how a woman intends 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 pregnancy. This should be based upon a thorough evaluation of the evidence available and consider the patient's individual needs and concerns.
The authors of a huge study that followed children who were exposed 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 reduced stress among mothers." However the conclusion they reached is not without limitations. The study did take into consideration other aspects, including the length of time that stimulant medication was used, the dose and the sociodemographics. There is also no research controlled that studies the safety of a continued use of psychostimulants in nursing mothers.
Although there is how to get adhd medication uk of evidence-based research on the safety of ADHD medications during pregnancy, many doctors have a basic understanding of what the research suggests and employ the best practices while collaborating with the individual needs of each patient. It is known, for example that infants born to mothers taking methylphenidate in the first trimester are more likely suffer from cardiac malformations (Cooper and co. 2018). However this conclusion is based on a tiny study that did not take into account the different patient demographics and underlying psychiatric conditions.
In a recent study, ADDitude readers found that they were more likely to quit their ADHD medication in early pregnancy than in the past. However, women who discontinued psychostimulants within the first trimester of their pregnancy experienced a clinically significant increase in depressive symptoms. They also reported that they were less able to enjoy their pregnancy and described their family functioning as more difficult than those who maintained or increased their dosages of ADHD medication.
Work Functioning Test
The test of work function is a vital part of the examination, as it determines if a person can perform their job. The test is designed for testing functional limitations. It includes a variety of graded material handling tasks (lifting at various levels, pulling and pushing), postureal tolerance exercises (sitting and standing as well as walking and balancing in a stoop, kneeling and stoop), as well as specialized tests. The test evaluator will review the results and draw the return to the conclusion of the test. ROC curves are used to show the point of minimal misclassification (MIC) for both physical and general work capability as well as the work-functioning problem score.
The MIC is calculated based on 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 a change in metric from biasing the overall average.
Driving Test
The gold standard for treating ADHD is psychostimulant medications. It improves safety while driving and reduces symptoms. Insufficiency due to severe, untreated ADHD can have serious financial and psychosocial consequences.
Psychotherapeutic interventions, such as cognitive behavior therapy (CBT) or "coaching" methods have also been found to improve symptoms and enhance performance. These strategies could assist women in tailoring their schedules and utilize their coping skills in ways that reduce the effects of their ADHD on their work and other domains.
All of these aspects can be crucial considerations when making the decision to continue or discontinue psychostimulant therapy. As the most recent data available suggest, even though there is some concern regarding the outcomes of pregnancy after in utero exposure to stimulant medication, the relative risks are small and the results are confounded by other treatments, maternal health treatment and 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 offspring outcomes.