ADHD Medication and Pregnancy
GPs can prescribe stimulants (methylphenidate dexamfetamine Lisdexamfetamine) as well as nonstimulants such as atomoxetine or modafinil to treat ADHD. These medications can assist patients in managing their ADHD symptoms and make regular appointments with the doctor or a specialist.
The majority of studies on the safety of ADHD medication during pregnancy limit outcomes to live births. This undervalues the severe adverse teratogenic effects that can lead to abortions and terminations. This is the first study to include such information.
Risk/Benefit Discussion
The use of ADHD stimulants during pregnancy is a typical treatment dilemma for many women suffering from the disorder. On one side, a lot of women with ADHD perform well when they are taking their medication. Removing it can lead to marital conflict, problems at school or work and other negative consequences. On the contrary, they don't want to expose their baby to substances about which little is known about long-term effects.
While some doctors counsel their patients to stop using ADHD medication prior to becoming pregnant, other doctors have found a way to strike a balance between the presumed safety and the requirements of the individual patient. Patients often consult their doctors, spouses or partners before making a decision. They strike a balance between the mother's need to take her medication as well as the potential for serious symptoms, such as depression and agitation when she stops taking the medication.
The majority of studies on ADHD medication and pregnancy focus on the effects of first-trimester stimulant exposure on the development of abnormalities in the fetus. The literature is not consistent. This is mainly due to the fact that the majority of the available studies do not provide data on outcomes other than live births (eg, terminations, miscarriages, and stillbirths), and since they do not consider a range of confounding factors including calendar year, pregnancy characteristics, sociodemographics of the mother as well as indications for the drugs, maternal mental and physical health status and proxies for various mental and medical ailments.
However, the results of a handful of studies suggest that there is no significant increase in risk for the fetus with the use of the most frequently used stimulant drugs prior to or during the first trimester. While the signs for certain cardiac malformations, especially VSD (ventricular septal defect) are clear but these findings require confirmation in larger studies that have more precise and specific information.
There isn't enough evidence to establish a connection between the use of methylphenidate (MPH) and atomoxetine (ATO) and a higher incidence of gastroschisis, omphalocele and transverse limb deficiencies. Other medications may also pose the risk of developing these kinds of birth defects, but the risks are not clear from the limited data.
Avoid Medications
Women with ADHD who are pregnant often confront a dilemma: Should they continue their ADHD medication or stop it? This is a major life change that will affect both the mother and the baby. Many physicians feel that the best time to talk about this is when the patient informs her doctor of her plans to have a child and to provide her with the information she needs to make the right decision prior to becoming pregnant. This isn't always the case and women might discover that they are pregnant after the time of their the pregnancy process, after it is too late to safely stop taking medications.
Unfortunately, there are few studies on the safety of stimulants during pregnancy and breastfeeding. Most studies are based on retrospective data analysis and don't take into consideration factors such as the age of the mother at first exposure and chronic conditions, stimulant indications or co-treatment with pain medications and psychiatric medications, as well as other factors that can affect risk. A number of studies have revealed that there is a slight increase in 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 associated with some behavior problems in infants. Most often, tics (abnormal muscle movements) are observed in children. Other behavioral issues that have been reported include increased anger, irritability, and defiance. The good thing is that these symptoms tend to improve after the medication is removed.
Some medications that are prescribed for ADHD interact with other drugs and may cause dangerous side effects when mixed especially with alcohol or other CNS stimulants (methylphenidate, amphetamine salts). These medications should not be taken with antidepressants or narcotics, including pain relievers. They should be avoided by those who use illegal drugs or nicotine products.
Some patients discover that a reduction or discontinuation of ADHD medication during pregnancy is feasible without significant functional impairment. In these instances it is crucial to inform the patient and her spouse or partner about this decision and to ask them for help in minimizing symptom recurrence. This might 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 know about cognitive-behavioral therapy and coaching for ADHD which can be offered by trained professionals.
Considerations for Medications
The decision to stay on ADHD medication during pregnancy can be a difficult one for both doctors and patients. It is a particularly difficult choice for women 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 common ADHD medications, including the possibility of creating high blood pressure and attacks of chest pain.
Unfortunately, these people and their physicians do not have a lot of options. The lack of research on how to manage safely a person with both ADHD and a substance use disorder can lead certain doctors to err on the side of caution and suggest that their patients stop taking their medication during pregnancy.
Ideally, the question of whether to continue taking ADHD medication is discussed well before making plans for the birth of a child. Many women with ADHD are shocked to discover they are pregnant. This often happens in the first trimester, when the development of the fetus is vulnerable to exposure to medications.
If the patient and doctor decide to continue with medication during the first trimester, they should choose the lowest dose possible and closely monitor the symptoms. The doctor may suggest that the woman take an immediate-release medicine in the middle of the day in order to decrease the fluctuations in medication levels in the bloodstream.
In the future we hope that more research will be conducted on the best ways to manage both ADHD and substance use disorders in people who are breastfeeding or pregnant. In the meantime, people who are pregnant or attempting to become pregnant should be encouraged to talk with their GP or psychiatrist about what options may be available to them, including psychotherapy targeted at ADHD symptoms and how they could differ from a treatment-only approach. If they do not take medication and are not taking medication, they will have more difficulties at work, school, and even in maintaining a relationship. This will likely affect their children, too.
Incorporate the use of Medications
Women who suffer from ADHD may take medication to manage symptoms such as inattention hyperactivity and an impulsiveness. While research on the effects of these medications on pregnancy has been scarce Recent studies have demonstrated that they are not likely to negatively affect the fetus and are safe for use during pregnancy.
This is great news for the growing number of women who rely on their ADHD medication and want to become mothers. However many women are concerned about the safety of continuing their medications during pregnancy, especially those who are taking stimulant drugs such as methylphenidate or amphetamines. The women and their healthcare providers should discuss the potential risks and benefits of drug use in accordance with the most recent research and recommendations.
Methylphenidate is one of the most commonly used ADHD medications prescribed to pregnant women, has been found to be to be safe when used under the supervision of a healthcare professional. Other commonly prescribed stimulant medications such as amphetamine and atomoxetine are also considered safe for women who are pregnant. It is important to remember that both stimulant and other medications should be closely monitored in pregnancy.
medication for inattentive adhd of data collected 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 neurological development or long-term growth. These findings are significant because they cover a larger patient population than previous research and consider numerous potential confounding factors.
Additionally, the results show that the use of ADHD medication during pregnancy is not associated with any increased risk for maternal complications like anemia, hyperemesis gravidarum, iron deficiency or TORCH infections. These findings are a significant improvement in our understanding of how obstetricians can safely manage the use of ADHD medication during pregnancy.
Women with ADHD must continue to follow their treatment plan and work closely with their healthcare provider throughout their pregnancy. This will ensure that their symptoms are well managed, allowing them get the most out of their pregnancies. There are a variety of non-pharmacological options available to those who don't want or want to quit taking their medication. These interventions can improve symptoms and promote overall health. These include: