ADHD Medication and Pregnancy
GPs might prescribe stimulants to treat ADHD (methylphenidate, dexamfetamine and Lisdexamfetamine), as well as non-stimulants, such as modafinil or atomoxetine. These medications can improve a patient's ability to manage their ADHD symptoms and keep regular appointments with their GP and specialist.
The majority of studies on pregnancy safety of ADHD medication limit the outcomes to live births, thereby underestimating the serious teratogenic effects which result in abortions and terminations. This is the first study to include such data.
Risk/Benefit Discussion
Many women with ADHD have a problem when they are taking stimulants during pregnancy. On one hand, they function using their medication, and stopping it could result in marital conflict and difficulties at school or at work and other serious consequences. On the contrary, they don't want to expose their unborn child to substances about which little is known in terms of long-term effects.
Some doctors counsel their patients to quit taking ADHD medications prior to becoming pregnant, while others have found a way to balance the assumed safety and individual patient needs. These patients usually consult their doctors, spouses or partners before making an informed decision. They find an equilibrium between the mother's need to take her medication and the potential for severe symptoms, like depression and agitation when she stops taking the medication.
The majority of studies on ADHD medication and pregnancy focus on the impact of the first trimester's exposure to stimulant medications on the growth of malformations in the fetus (eg malformations of the heart). The literature is inconsistent. The literature is inconsistent partly because the majority of studies do not provide data on outcomes other than live births (eg. terminations, miscarriages and stillbirths), nor do they take into account confounding variables such as calendar year, characteristics of pregnancy and maternal sociodemographics.
However, the findings of a handful of studies suggest that there isn't a significant increase in risk for the fetus with the use of the most commonly used stimulant medications before and during the first trimester. The signals for certain cardiac malformations are clear. This is particularly relevant for VSD (ventricular defect). However these findings should be confirmed by larger studies that provide more exact information.
There is also insufficient evidence to suggest a link between maternal use of methylphenidate (MPH) and atomoxetine (ATO) and a greater rate of gastroschisis, omphalocele and transverse limb deficiencies. Other medications could also put you at the risk of developing these types of birth defects, but the risks are not clear based on the limited available data.
Medicines to Beware of
Women with ADHD who are expecting have to make a difficult decision to make: Should they continue taking their ADHD medication or stop it? This is a major change that affects both the mother and the fetus. Many doctors believe that the ideal time to bring up this topic is when a woman informs her doctor that she wants to start a new family. This will provide her with the information she needs to make a decision prior to when she is pregnant. It is not always feasible and women might discover that they are pregnant later on in their pregnancy, when it is too late to stop taking medications.
There are a few studies that examine the safety of stimulants during pregnancy and breastfeeding. Most studies are based on retrospective analyses of data that do not adequately control for factors such as maternal age at the time of first exposure to the drug, chronic conditions, indications for stimulants, cotreatment with psychiatric and pain medications and other factors that influence the risk. Several studies have shown a small increase in the chance of preeclampsia or premature birth when psychostimulants are used during pregnancy. However these findings must be interpreted cautiously.
A few behavioral problems in infants have been caused by the use of stimulants during pregnant women. Most often, tics (abnormal muscle movements) are reported in children. Other behavior issues that have been observed include an increase in irritability and impulsivity. The good news is that these symptoms tend to improve after the medication is removed.
Certain ADHD medications can interact with other drugs and cause dangerous side effects, particularly when combined with alcohol or CNS stimulants like methylphenidate or amphetamines salts. These medications should not be combined with antidepressants or narcotics, including pain relievers, and should be avoided by people who are using illicit drugs or nicotine products.
Some patients are able to reduce or eliminate ADHD medications during pregnancy without any significant impairment to their functional abilities. In these instances, it is important to inform the patient and her spouse or partner about the decision and ask them for help in minimizing symptom recurrence. This might include identifying local support resources, enlisting assistance from friends or family members, or seeking workplace accommodations that help with impairments related to symptoms. It is also beneficial to learn about cognitive-behavioral treatment and coaching for ADHD which can be offered by professionals who are trained.
Considerations for Medicines
Both doctors and patients find it difficult to decide whether or not to continue taking ADHD medication during pregnancy. It's a difficult choice for those with co-occurring substance use disorders since many of the drugs used to treat addictions can have similar effects to commonly used ADHD medicines, including the possibility of causing high blood pressure and attacks of chest pain.
Unfortunately, these individuals and their doctors don't have many choices. Insufficient research on how to treat a person with ADHD and substance use disorder could lead some doctors to err on the side of caution, and recommend that patients discontinue their medication during pregnancy.
It is best to discuss the question of whether or not to continue taking ADHD medications well before planning a family. However, many women who have ADHD discover that they are pregnant unexpectedly. This usually occurs during the first trimester, when growing fetus is the most vulnerable to exposure to drugs.
If the patient and doctor decide to take medication in the first trimester, it is recommended that they choose the lowest effective dose and closely monitor for any symptoms. The doctor could suggest that the patient add an immediate-release drug taken during the middle of the day. This can help decrease the ups and downs that are caused by fluctuating levels of medication in the bloodstream.
In the future, more research is hoped to be conducted on the best to manage ADHD and other addiction disorders in pregnant or nursing women. 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 to them, including psychotherapy targeted at ADHD symptoms and how they could differ from a medication-only strategy. It is important to inform them that if they do not choose to take medication, they will likely have more difficulty at work and school and may struggle to keep relationships. This will likely be a major influence on their children as well.
The use of Medications in conjunction with
Women with ADHD frequently rely on medications as part of their treatment plan to help combat symptoms such as inattention, hyperactivity and impulsivity. Recent research has shown that these medications don't harm the fetus and can be used throughout pregnancy.
for beginners is a great development for the growing number of women who depend on their ADHD medication and wish to become mothers. However, many women are concerned about the safety of sustaining their medication during pregnancy, especially those who are taking stimulant drugs such as amphetamines and methylphenidate. Women should discuss with their healthcare providers the potential risks and benefits associated with medication use, based on current research and recommendations.
Methylphenidate is one of the most frequently used ADHD medications prescribed to pregnant women, has been found to be safe when administered under the supervision of a medical professional. Other stimulant medications commonly prescribed like atomoxetine or amphetamine are also considered safe for pregnant women. It is crucial to remember that both stimulant and other medications should be closely monitored in pregnancy.
A recent study of data collected from the Danish national registers showed that children born to mothers taking ADHD medication during pregnancy did not experience adverse effects on their child's neurological development or long-term growth. These findings are significant as they cover a larger population of patients than previous studies and take into account numerous confounding factors.
The results also demonstrate that the use ADHD medication during pregnancy does not increase the risk of developing maternal complications, like anemia, iron deficiency or hyperemesis. These findings are a significant improvement in our understanding of how ADHD medications during pregnancy can be safely controlled by psychiatrists and obstetricians.
Women with ADHD must adhere to their treatment plan and work closely with their healthcare professional throughout their pregnancy. This will help ensure that their symptoms are well controlled, allowing them to benefit the most from their pregnancy. There are non-pharmacological options for those who don't want or wish to stop taking their medication. These treatments can enhance symptoms and improve overall health. These include: