ADHD Medication and Pregnancy
GPs may prescribe stimulants to treat ADHD (methylphenidate dexamfetamine, methylphenidate, and Lisdexamfetamine), as well as non-stimulants, such as modafinil or atomoxetine. These medications can aid patients in managing their ADHD symptoms and make regular appointments to see a GP or specialist.
Most studies of the pregnancy safety of ADHD medication limit their the outcomes to live births, thereby underestimating the serious teratogenic effects which can cause terminations and abortions. This is the first study to include these information.
Risk/Benefit Discussion
Many women with ADHD have a problem when using stimulants during pregnancy. On the one side, they perform well using their medication, and stopping it could result in marital conflict as well as difficulties at school or at work and a host of other negative consequences. On the other hand, they don't want to expose their child to substances about which little is known in terms of long-term effects.
While some doctors may advise their patients to stop using ADHD medications prior to becoming pregnant, other doctors have found a compromise between the presumed security and the needs of the individual patient. These patients usually consult their spouses and/or physicians before making a decision. They seek to strike a balance between a mother's need to take her medication and the possibility for severe symptoms, like depression and agitation, if she discontinues the medication.
Most studies of ADHD medication and pregnancy concentrate on the effect of first-trimester exposure to stimulant medication on the development of fetal malformations (eg, cardiac malformations). However, the current literature is inconsistent. This is partly because most of the studies that are available do not include data on outcomes other than live births (eg, terminations, miscarriages and stillbirths) and also since they do not take into account a variety of confounding factors, including the calendar year pregnant characteristics, maternal sociodemographics and indications for the medication, maternal mental and physical health status and proxies for other medical and psychiatric conditions.
However, the findings of a handful of studies suggest that there isn't a significant increase in risk for the fetus from the use of the most frequently used stimulant medications before or during the first trimester. The signals for certain cardiac abnormalities are strong. medication for adhd is particularly true for VSD (ventricular defect). However these findings should be confirmed by larger studies that provide more exact information.
There is also insufficient evidence to support a link between the use of methylphenidate (MPH) and Atomoxetine (ATO) and a higher prevalence of omphalocele, gastroschisis, and transverse limb deficiency. Other medications could also be a cause of an increased risk of these kinds of birth defects, however the risks are unclear from the limited evidence.
Treatments to Avoid
Women suffering from ADHD who become pregnant are often confronted with a dilemma: Should they continue or discontinue their ADHD medication? This is a major shift in the life of both the mother and fetus. Many physicians feel that the ideal time to talk about this is when the patient informs her doctor of her intention to have a baby and to provide her with the necessary information to make this decision before becoming pregnant. However, this is not always the case and women frequently discover they are pregnant at a later stage during the pregnancy, when it may be too late to safely stop taking medications.
Unfortunately, there are only a few studies on the safety of stimulants during pregnancy and breastfeeding. Most studies are based on retrospective analyses of data and do not adequately control for factors like the age of the mother at the time of first exposure to drug, chronic conditions, indications for stimulants, cotreatment with psychiatric or pain medications as well as other factors that affect risk. Several studies have shown a small increase in the risk of preeclampsia and premature birth if psychostimulants are used during pregnancy. However these findings should be taken with caution.
The use of stimulants during pregnancy has been linked with a number of issues with infants' behavior. The most commonly reported is the development of tics (abnormal muscle movements) in some children. Other behavioral issues that have been noted include increased aggression, irritability and defiance. The good news is that these symptoms generally improve once the medication is stopped.
Some ADHD medications can interact with other drugs which can cause adverse side effects that can be dangerous, especially when they are combined with alcohol or CNS stimulants such as methylphenidate and amphetamines salts. These medications should not include the following: antidepressants, narcotics and pain relief medications. They should also be avoided by those who take nicotine or illegal drugs.
Some patients are able to decrease or stop taking ADHD medications during pregnancy without significant impairment in their functioning. In these cases it is crucial to inform the patient and her partner about this decision. Ask them for their assistance in reducing symptoms recurrence. This could include identifying local resources, requesting assistance from family members or friends or seeking accommodations at work which address impairments resulting from symptoms. It is also helpful to learn about cognitive-behavioral treatment and coaching for ADHD which can be offered by professionals who are trained.
Considerations for Medications
The decision to continue taking ADHD medication during pregnancy is a difficult one for both physicians and patients. It is a particularly difficult choice for those who have co-occurring addiction disorders due to the fact that many of the medications used to treat their addictions may have the same effects as common ADHD medicines, including the possibility of increasing blood pressure and episodes of chest pain.
Unfortunately, these individuals and their physicians aren't given a lot of choices. The lack of research on how to properly manage the person who has both ADHD and a substance use disorder makes it easy for some physicians to err on the side of caution and advise their patients to quit their medication during pregnancy.
Ideal is to discuss the question of whether or not you should continue taking ADHD medications before deciding to start making plans for a baby. Many women with ADHD are shocked to learn that they are pregnant. This usually happens during the first trimester of pregnancy, when the development of the fetus is vulnerable to exposure to medications.
If the doctor and patient decide to continue with medication during the first trimester, they should select the lowest dosage possible and closely monitor symptoms. The doctor may suggest that the patient add an immediate-release medication taken in the middle of the day, which can help reduce the ups and downs that are caused by the fluctuating levels of medication in the bloodstream.
In the near future we hope that more research will be conducted on the best way to manage both ADHD and substance use disorders in people who are nursing or pregnant. In the meantime, women who are pregnant or attempting to get pregnant should be encouraged to talk with their doctor and psychiatrist about what options might be available for them such as psychotherapy geared towards ADHD symptoms and how these might differ from a medication-only approach. They should be informed that if they don't choose to take medication, they will likely be more difficult in school and at work, and could even struggle to keep a relationship. This could also have a major impact on their children.
Incorporate the use of medications
Women suffering from ADHD frequently rely on medications as part of their treatment plan to manage symptoms like inattention, hyperactivity and impulsivity. While research into how these medications can affect pregnancy has been minimal Recent studies have revealed that they don't appear to negatively affect the fetus and are safe for continued use during pregnancy.
This is good news for women who are planning to become mothers and rely on their ADHD medication. However many women are worried about the safety of sustaining their medication during pregnancy, especially those who are taking stimulant drugs such as amphetamines and methylphenidate. These women should talk to their healthcare professionals about the risks and benefits associated with taking medication, based on current research and recommendations.
Methylphenidate is one of the most frequently prescribed ADHD medications and has been found to be safe for pregnant women when under the supervision of a medical professional. Amphetamine and atomoxetine as well as other stimulant medications are safe for pregnant women. It is important to remember that both stimulant and other medications must be closely monitored in pregnancy.
A recent study of data from the Danish national registers revealed that children born to mothers who took ADHD medication during pregnancy did not suffer adverse effects on their child's neurodevelopment or long-term growth. These findings are significant as they cover a larger patient population than previous research and take into account several possible confounding factors.
The results also show that the use of ADHD medication during pregnancy does not increase the risk of maternal complications, like iron deficiency, anemia or hyperemesis. These findings are a significant advancement in our understanding of how ADHD medications during pregnancy can be safely managed by obstetricians and psychiatrists.
It is essential that women with ADHD continue to adhere to their treatment plans and collaborate closely with their healthcare providers throughout their pregnancy. This will help to ensure that symptoms are treated properly, allowing women to make the most of their pregnancy. There are alternatives to pharmaceuticals for those who are unable or don't want to stop taking their medication. These interventions can aid in reducing symptoms and increase overall well-being. These include: