ADHD Medication and Pregnancy
GPs may prescribe stimulants to treat ADHD (methylphenidate, dexamfetamine and Lisdexamfetamine) and non-stimulants like modafinil and atomoxetine. These medications can assist patients in managing their ADHD symptoms, and also attend regular appointments with an GP or a specialist.
The majority of studies on pregnancy safety of ADHD medication restrict outcomes to live births, thus underestimating the severity of teratogenic effects that can cause terminations and abortions. This study is the first to incorporate such information.
Risk/Benefit Discussion
The use of ADHD stimulants during pregnancy is a typical problem for women with the disorder. On the other hand, they function with the aid of their medication, and stopping it could result in marital conflict, difficulties at school or at work and other serious consequences. On the other hand, they do not want to expose their child to drugs whose long-term consequences aren't known.
While some doctors may advise their patients to stop taking ADHD medication prior to becoming pregnant, other doctors have come to a balance between assumed security and the needs of individual patients. The latter usually arrive at the decision after consulting with their spouse or physician and strike an equilibrium between the mother's need for her medication and the possibility of developing severe symptoms, such as depression, agitation, and trouble staying awake in the event of discontinuing the drug.
Most studies on ADHD medication and pregnancy focus on the effects of the first trimester stimulant exposure on the development of abnormalities in the fetus. The literature is inconsistent. adhd without medication is inconsistent partly because the majority of studies don't provide data on outcomes other than live births (eg. terminations, miscarriages and stillbirths) neither do they take into account confounding variables like the calendar year, characteristics of pregnancy and maternal sociodemographics.
Nevertheless, the results of a few studies suggest that there isn't a significant risk increase for the fetus with the use of the most frequently used stimulant drugs prior to, during, and after the first trimester. The signals for certain cardiac malformations are clear. This is especially true for VSD (ventricular defect). However these findings should be confirmed in larger studies that provide more specific information.
There isn't enough evidence to prove the link between methylphenidate and the use of atomoxetine by mothers, and a higher incidence of omphaloceles, gastroschisis and transverse limb impairments. Other medications may also pose the risk of developing these types of birth defects, however the risks are unclear in light of the comparatively limited information.
Avoid taking medications
Women suffering from ADHD who are expecting confront a dilemma whether to continue their ADHD medication or stop taking it? This is a significant life change that affects both the mother and the foetus. Many physicians feel that the best time to discuss this topic is when the patient informs her doctor of her desire to start a family and to provide her with the information she needs to make this decision before becoming pregnant. However, this is not always the case and women often discover that they are pregnant at a later stage in their pregnancy, and it is too late to safely stop taking medications.
Unfortunately, there is a lack of research into the dangers of stimulants during the course of breastfeeding and during pregnancy. The majority of studies are based on retrospective data analyses and do not take into account factors such as the mother's age at the time of exposure and chronic conditions, stimulant indications as well as co-treatment with pain and psychiatric medications, or other factors that could affect the risk. Although a few studies have found minor increases in preeclampsia risk and premature births associated with psychostimulants used during pregnancy, these findings should be interpreted with caution.
The use of stimulants during pregnancy has been associated with some behavioral problems in infants. Most commonly, tics (abnormal movements of the muscles) are reported by children. Other behavior issues that have been observed include increased impulsivity and irritability. The good news is that these signs generally improve when the medication is removed.
Certain ADHD medications can interact with other substances and cause dangerous side effects, especially when combined with alcohol or CNS stimulants such as methylphenidate and amphetamines salts. These medications should not comprise antidepressants, narcotics or pain relievers. They should be avoided by people who use nicotine or illegal drugs.
Some patients find that a reduction or even the discontinuation of ADHD medications during pregnancy is possible without significant impairment in function. In these situations it is crucial to educate the patient and her spouse or partner about this decision and to solicit their assistance in minimizing symptom recurrence. This could include identifying local support resources, soliciting assistance from family members or friends or requesting workplace accommodations that treat symptom-related impairments. It is also helpful to learn about cognitive-behavioral treatment and coaching for ADHD, which can be offered by trained professionals.
Considerations for Medicines
The decision to continue taking ADHD medication during pregnancy is a challenging one for patients and physicians. It is a particularly difficult choice for those who suffer from co-occurring disorders of substance use due to the fact that many of the medications that treat addiction may have the same effects as commonly used ADHD medications, including the possibility of creating high blood pressure and episodes of chest pain.
Unfortunately, these patients and their doctors do not have a lot of options. Insufficient research into how to treat a person suffering from ADHD and substance use disorder can cause some doctors to err on the side of caution, and recommend that patients discontinue their medications during pregnancy.
Ideally, the issue of whether to continue taking ADHD medication is discussed well before making plans for a family. However, a lot of women with ADHD discover they are expecting unexpectedly. This often happens in the first trimester of pregnancy, when the development of the fetus is the most vulnerable to exposure to drugs.
If the patient and doctor decide to continue taking medication during the first trimester, they should pick the lowest dose that is possible and closely monitor any symptoms. The doctor might also recommend that the woman add an immediate-release medication taken at the midpoint of the day. This can help decrease the ups and downs that are caused by the fluctuating levels of medication in the bloodstream.
In the future there is a lot of research to be done on how best to manage ADHD and substance abuse disorders in nursing or pregnant women. In the meantime, people who are pregnant or attempting to become pregnant should be encouraged to talk with their doctor and psychiatrist about the options that may be available such as psychotherapy geared towards ADHD symptoms and how these might differ from a treatment-only approach. If they choose not to take medication for ADHD, it is likely that they will experience more difficulty at work, school and even maintaining relationships. This will also have a significant impact on their children.
Medicines to Incorporate
Women suffering from ADHD frequently rely on medications as part of their treatment plan to help deal with symptoms like hyperactivity, inattention and impulsivity. Recent studies have shown that these medications do not negatively impact the fetus, and can be used during pregnancy.
This is a good thing for women who wish to become mothers and rely on their ADHD medication. However many women are concerned about the safety of sustaining their prescriptions during pregnancy, especially those who are taking stimulant drugs such as methylphenidate or amphetamines. The women and their medical professionals should discuss the potential risks and benefits of drug use based on the most current research and recommendations.
Methylphenidate is one of the most commonly used ADHD medications prescribed to pregnant women, has been proven safe when administered under the supervision of a healthcare professional. Other commonly prescribed stimulant medications like atomoxetine or amphetamine are also considered safe for women who are pregnant. However, it is important to note that both non-stimulant and stimulant medications must be monitored closely during pregnancy.
A recent study of data from Danish national registers showed that children born to mothers who were taking ADHD medication during their pregnancy did not have any adverse effects on the child's growth or development. These findings are significant because they include a much larger patient population than previous research and take into account numerous potential confounding factors.
The results also show that taking ADHD medication during pregnancy does not increase the risk of developing maternal complications, such as iron deficiency, anemia or hyperemesis. These findings are a significant advance in our understanding of how obstetricians can safely manage the use of ADHD medication during pregnancy.
Women with ADHD must adhere to their treatment plan and work closely with their healthcare professional throughout their pregnancy. This will ensure that symptoms are controlled effectively, allowing women to make the most of their pregnancy. If you are unable or do not want to stop taking medication, there are various non-pharmacological treatments that can improve symptoms and promote overall well-being during pregnancy. These include: