ADHD Medication and Pregnancy
Physicians are unable to provide accurate information about the security of ADHD medications during pregnancy. In the meantime, until more research is available, physicians must weigh the benefits of taking medication during pregnancy against the potential dangers for children in each individual situation.
A recent cohort study of the population tracked 898 infants born to mothers who were who were taking ADHD medications throughout their pregnancy (stimulants: methylphenidate, amphetamine dexamphetamine, methylphenidate; non-stimulants: modafinil, atomoxetine and clonidine) until they were diagnosed with a developmental disorder or died 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, specifically to centrally stimulating drugs like those used for ADHD. It is crucial that women receive the appropriate advice from their doctors about the risks and benefits of taking medication prior to conception and during pregnancy. In this CAP Smart Take we review the most recent research in this field and how it can guide the practice of a physician.
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 data on the effects of prescription stimulant medications during pregnancy. Most of the evidence comes from studies conducted in case-control using a single arm which isn't powerful enough to detect any significant associations.
The most recent study by Cohen and colleagues stands out from the others as it is the largest and most tightly controlled. The study comprised 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. Researchers excluded women who had taken SSRIs or clonidine as these drugs can interfere with fetal NMDA and increase the risk for neurodevelopmental disorders such as autism and ADHD. The authors also modified their analyses to control for possible confounding factors and to account for the timing of in utero exposure.
The results of this study as well as other small-scale trials suggest that the vast number of women who continue to use their stimulant medication prescribed for ADHD during pregnancy are not experiencing adverse effects on their fetuses. As a result, it is likely that a large number of women will continue to use their medications for ADHD during pregnancy. But it is essential that physicians carefully weigh the benefits and risks of these medications for pregnant patients, and take into consideration the individual circumstances of each patient prior to suggesting that they stop taking their medication. It is important that women who are pregnant with ADHD inform their partners, extended families, and employers of the decision they've taken. This is because the symptoms of hyperactivity, inattention, and impulsivity will likely come back once the mother stops taking her medications.
Pregnancy Tests
Preconception counseling for women with ADHD who wish to become pregnant should concentrate on a comprehensive plan of management that includes both behavioral and pharmacologic treatment and ongoing monitoring throughout the perinatal period. The plan should include a discussion of the current treatment regimens, particularly in the first trimester where dangers to the baby from untreated ADHD are the highest. This should be a co-operative effort between primary care and psychiatry and obstetrics.
The discussion of the risks and benefits should also cover how a woman intends to manage her ADHD symptoms during pregnancy, the effects of this on family functioning, and how she feels about discontinuing psychostimulant treatment in the beginning. This should be based upon an exhaustive review of the available evidence and consider the patient's individual needs and concerns.
The authors of a large study that followed children who were exposed ADHD medications while in utero concluded that "continuation psychostimulant use during the early stages of pregnancy did not cause adverse birth outcomes, and if it was, it was associated with reduced stress among mothers." However, their conclusion is not without limitations. The study did consider other aspects, including the duration for which stimulant medication was used in addition to the dose and sociodemographics. Furthermore, there is no controlled research examining the safety of continued psychostimulant use among nursing mothers.
There isn't a clear research-based evidence concerning the safety of ADHD medication during pregnancy. However, most doctors have a basic understanding of what the literature suggests and can apply the best practices in consultation to each patient's specific needs. It is known, for instance, that infants born to mothers who are taking methylphenidate in the first trimester are more likely suffer from cardiac malformations (Cooper, et al. 2018). However this is based on a comparatively small study that didn't take into account differences in the demographics of patients and the underlying psychiatric conditions.
In a recent survey of ADDitude readers, they found that they are more likely than ever before to quit taking their ADHD medication during the first trimester of pregnancy. Women who stopped psychostimulants during the first trimester showed an increase in depressive symptoms. They also reported feeling less able to enjoy their pregnancy and rated their family functioning as more difficult than those who remained on their dose of ADHD medication or increased it.
Work Functioning Test
The test for work function is an important part of the examination in that it determines whether a person can perform their job. The test is designed to evaluate functional limitations. It will include materials handling that is graded (lifting to different levels pulling and pushing) as well as positional tolerance tests (sitting or standing, balancing, walking, stooping, kneeling, crawling) as well as other relevant specialized tests (hand manipulation). The evaluator analyzes the results to form the return-to-work conclusions. ROC curves are used to determine 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 using the COnsensus Standards for the Selection of Health Measurement Instruments Checklist (COSMIN). This method divides scores for general physical abilities and work-functioning issues, by answering an anchor question. This prevents any change in metrics from biasing the average.
Driving Test
The gold standard for treating ADHD is psychostimulant medications. It reduces symptoms and improves functioning in work and other domains, notably driving safety. If not treated, severe ADHD can have serious psychosocial and financial implications.
Psychotherapeutic interventions like cognitive behavioral therapy (CBT) and "coaching" strategies have also been shown to reduce symptoms and improve functioning. These strategies can assist women in adjusting their schedules and utilize their coping skills in ways that reduce their ADHD's impact on work and other areas.
All of these aspects can be important considerations in the decision of whether to continue or discontinue psychostimulant treatment. adhd uk medication that, despite concerns about pregnancy outcomes when in utero stimulant medication is used, the relative risks of this are small. The results are affected by other medication, the use of maternal healthcare and physical and mental health, and other 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 effects on offspring.