ADHD Medication and Pregnancy
Physicians often struggle to inform patients about the safety of their ADHD medications during pregnancy. Until more research is available, doctors must weigh the benefits of medication use during pregnancy against the potential risks for offspring in each particular situation.
A recent population-based cohort study tracked 898 infants born to women who were taking ADHD medications throughout their pregnancy (stimulants such as amphetamine, methylphenidate dexamphetamine, methylphenidate; and non-stimulants such modafinil, atomoxetine, 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 that drug exposure in utero may be a source of harm, particularly for centrally stimulating medications like those used to treat ADHD. It is essential that women receive appropriate counseling from their physicians about the risks and benefits of taking medication before conception and during pregnancy. In this CAP smart take we look at the most current research on this topic and how they might inform 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 negatively impact fetal development and growth. However, there are limited information regarding the way that the fetus reacts to dosages of prescribed stimulant medication during pregnancy and the majority of this data comes from single-arm studies that have been underpowered to determine if there are significant correlations.
The recent study by Cohen and co. stands out from the others, as it is the largest and most tightly 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 or clonidine as these drugs could interact with fetal NMDA and increase the risk of developing neurodevelopmental disorders such as autism and ADHD. The authors re-analyzed their findings in order to account for the timing of exposure as well as control for confounding factors.
The results of this study, as well as the results of other studies, show that the majority of women who continue to take the stimulant medications prescribed for ADHD throughout pregnancy do not experience any adverse effects on their fetuses. This means it is likely that many women will continue to take their medications for ADHD during pregnancy. However, it is important that doctors carefully weigh the benefits and risks of these medications for their pregnant patients, and also consider each patient's unique situation prior to advising them to discontinue their medications. Whatever decision they make, it is crucial that pregnant women suffering from ADHD inform their spouses or their partners, extended family members and employers about the decision they have made. This is because symptoms of hyperactivity, inattention and impulsivity will likely be recurred after the mother ceases taking her medications.
natural adhd medication for women with ADHD who are planning to become pregnant should concentrate on a comprehensive treatment plan that involves both pharmacologic and behavioral treatments and ongoing monitoring throughout the perinatal period. The plan should include a review of the current treatment regimens, specifically during the first trimester, when risks of harm to the baby resulting from untreated ADHD are the highest. This should be a collaborative effort between obstetrics, psychiatry, and primary care.
The discussion of risks and benefits should also include how a woman intends to manage her ADHD symptoms during pregnancy, the impact of this on the family's functioning, and how she feels about a decision to stop psychostimulant treatment in the early stages. This should be based upon an exhaustive review of the evidence available and take into account the individual needs of the patient and concerns.
In a recent study which followed children who were exposed to ADHD medications during pregnancy and concluded that "continuation of psychostimulant use during the early stages of pregnancy didn't increase the risk of adverse birth outcomes and if anything, it was associated with decreased stress on the mother." However this conclusion isn't without its limitations. The study did take into consideration other aspects, including the length of time that stimulant medication was used as well as the dose and sociodemographics. Furthermore, there is no controlled research examining the safety of continued use of psychostimulants in nursing mothers.
Although there is a lack of scientifically substantiated evidence regarding the safety of ADHD medications in pregnancy, many doctors have a general understanding of what the current literature suggests and use best practices in consultation with the specific needs of each patient. It is well-known, for instance, that infants born to mothers who are taking methylphenidate in the first trimester are more likely have cardiac malformations (Cooper, et al. 2018). However this is based on a tiny study that did not take into account differences in the demographics of patients and the underlying psychiatric conditions.
In a recent survey ADDitude readers said that they were more likely to discontinue their ADHD medication during the early stages of pregnancy than in previous. Women who stopped taking psychostimulants in the first trimester experienced an increase in depression symptoms. They also felt less able to enjoy pregnancy and described family functioning as more challenging than those who remained on their dose of ADHD medication or increased it.
Work Functioning Test
The test of work function is an essential element of the test as it will determine if a patient can perform their job duties. The test is designed to assist in evaluating functional limitations. It includes a variety of graded material handling tasks (lifting at various levels pulling and pushing) as well as postureal tolerance exercises (sitting and standing, balancing and walking, stooping and kneeling), as well as specialized tests. The examiner will analyse the results and come up with a return to work conclusion. ROC curves are used to determine the point at which there is a minimum 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. buy adhd medication online for general physical work capabilities and work-functioning issues, by answering an anchor question. This will prevent a change in metrics from biasing the average.
Driving adhd stimulant medication are a gold standard treatment for ADHD. It helps reduce symptoms and improves functioning in work and other areas, such as driving safety. The effects of severe, untreated ADHD can have significant financial and psychosocial effects.
Psychotherapeutic treatments, like cognitive behavior therapy (CBT) or "coaching" techniques have also been shown by research to reduce symptoms and improve functioning. These strategies may aid women in adjusting their routines and apply their abilities to cope in ways that reduce the impact of their ADHD on their work and other areas.
All of these factors are important to take into account when deciding whether or not to continue psychostimulant therapy. The most reliable data available show that although there are concerns regarding the outcome of pregnancy when in utero stimulant medication is used, the relative risks of this are minimal. 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 T., Hove Thomsen p., Bergink V. In-utero exposure to attention deficit/hyperactivity disorder medication and its effects on offspring.