ADHD Medication and Pregnancy
GPs may prescribe stimulants to treat ADHD (methylphenidate dexamfetamine, dexamfetamine and Lisdexamfetamine), as well as non-stimulants like modafinil and Atomoxetine. These medications can aid patients in managing their ADHD symptoms and make regular appointments with the doctor or a specialist.
The majority of studies on the pregnancy safety of ADHD medication limit the outcomes to live births, thereby underestimating the severity of teratogenic effects that can cause terminations and abortions. This study is the first to include such information.
Risk/Benefit Discussion
Many women with ADHD have a problem when they are taking stimulants during pregnancy. On one hand, they function well with the aid of their medication but stopping it can result in marital strife and difficulties at school or at work and other serious consequences. However, they don't wish to expose their unborn baby to drugs whose long-term effects are not known.
Some doctors suggest to their patients to stop taking ADHD medications before becoming pregnant, while others have found a way to balance the assumption of safety and individual patient needs. These patients usually consult their physicians and/or spouses before making a decision. They find the right balance between a mother's need to take her medication and the potential for severe symptoms, like depression and agitation, if she discontinues the medication.
The majority of studies on ADHD medication and pregnancy are focused on the effects of the first trimester stimulant exposure on the growth of malformations of the fetus. The literature is not consistent. This is due to the fact that most of the studies that are available don't include information on outcomes other than live births (eg terminations, miscarriages, terminations and stillbirths) and since they do not take into account a range of confounding factors including calendar year and pregnancy characteristics, maternal sociodemographics and indications for the medication as well as physical and mental health status, and proxies for other mental and medical ailments.
However, the results of a few studies indicate that there isn't any significant increase in risk for the fetus from the use of the most frequently prescribed stimulant medications prior to, during, and after the first trimester. Although the signals for some cardiac malformations, especially VSD (ventricular septal defect), are strong however, these findings require confirmation in larger studies with more precise and 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 gastroschisis, omphaloceles, and transverse limb deficiencies. Other medications may also pose a higher risk for these types of birth defects, however the risks are not clear in light of the comparatively limited data.
Medications to Beware of
Women with ADHD who become pregnant are often confronted with a difficult decision: Should they continue or stop taking their ADHD medication? This is a major shift in life that affects both the mother and the fetus. Many doctors believe that the best time to talk about this is when the patient informs her doctor of her plans to start a family in order to have the necessary information to make this decision before becoming pregnant. This is not always possible and women might discover they are pregnant after the time of their the pregnancy process, after it is too late to stop taking medications.
There are a few studies on the safety of stimulants in pregnancy and breastfeeding. Most studies are conducted using retrospective analysis of data, and don't properly control for factors like maternal age at first exposure to the drug or chronic conditions, indications for stimulants, cotreatment with psychiatric and pain medications and other factors that impact the risk. While a few studies have found small increased risks of preeclampsia and premature birth due to psychostimulants used during pregnancy, these findings must be taken with a pinch of salt.
The use of stimulants during pregnancy has been linked with a number of behavioral problems in infants. The most frequent tics (abnormal movements of muscles) are reported by children. Other behavioral issues that have been identified include increased impulsivity and irritability. The good news is that these symptoms generally improve when the medication is taken off.
Some medications that are prescribed for ADHD interact with other drugs and can trigger dangerous side effects when combined particularly with alcohol or other CNS stimulants (methylphenidate, amphetamine salts). These medications should not comprise the following: antidepressants, narcotics and pain alleviators. They should also be avoided by those who take nicotine or illegal drugs.
Some patients find that a reduction or discontinuation of ADHD medications during pregnancy is possible without significant impairment in function. In medication for adhd is important to inform the patient and her partner about this decision. Ask them for assistance in reducing symptoms recurrence. This could include locating local resources, seeking assistance from family or friends or seeking accommodations at work which address impairments resulting from symptoms. It is also helpful to learn more about effective cognitive-behavioral treatment and coaching for ADHD that can be provided by certified professionals.
Medications to Consider
The decision to continue taking ADHD medication during pregnancy is a difficult one for both doctors and patients. It's a particularly difficult choice for women who suffer from co-occurring disorders of substance use because many medications used to treat addictions may have the same effects as commonly used ADHD medicines, including the possibility of causing high blood pressure and attacks of chest pain.
Unfortunately, these patients and their physicians aren't given a lot of alternatives. Insufficient research on how to safely treat a person suffering from ADHD and addiction disorders can lead some doctors to err to the side of caution and recommend that patients discontinue their medications during pregnancy.
Ideally, the decision of whether to continue taking ADHD medication is discussed well in advance of making plans for a family. Many women with ADHD are shocked to learn that they are pregnant. This usually happens during the first trimester, which is when fetal development is most susceptible to exposure to drugs.
If the doctor and patient decide to keep taking the medication during the first trimester, they should choose the lowest dose possible and closely monitor the symptoms. The doctor might suggest that the woman take immediate-release medicine in the middle of the day to help reduce the fluctuations in the levels of medications in the bloodstream.
In the near future, more research is hoped to be conducted on the best to manage ADHD and other substance abuse disorders in nursing or pregnant women. In the meantime, people who are pregnant or trying to be 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 they could differ from a treatment-only approach. If they do not take medication and are not taking medication, they will face more challenges at school, work as well as in maintaining the relationship. This could affect their children, too.
The use of Medications in conjunction with
Women with ADHD typically rely on medication as part of their treatment plan to deal with symptoms like inattention, hyperactivity and the tendency to be impulsive. Recent studies have shown that these medications don't negatively impact the fetus, and can be used during pregnancy.
This is good news for women who want to become mothers and depend on their ADHD medication. However many women are worried about the safety of continuing their medication during pregnancy, particularly those who take stimulant medications such as amphetamines and methylphenidate. These women should discuss with their healthcare providers the potential risks and benefits associated with medication use in light of current research and recommendations.
Methylphenidate is one of the most commonly prescribed ADHD medications. It has been proven to be safe for women who are pregnant when under the supervision of a medical professional. Amphetamine and atomoxetine as well as other stimulant medications are safe for women who are pregnant. However it is crucial to remember that both stimulant and non-stimulant drugs must be monitored closely during pregnancy.
A recent study of data from Danish nationwide registers found that children born to mothers who were taking ADHD medication during pregnancy had no adverse effects on the child's growth or neurodevelopment. These findings are significant since they include a much greater number of patients than previous research and consider several possible confounding factors.
Furthermore, the results indicate that the use of ADHD medication during pregnancy does not result in an increased risk for maternal complications like anemia, hyperemesis gravidarum, iron deficiency, or TORCH infections. These findings are a major advancement in our understanding of how the use of ADHD medications during pregnancy can be effectively controlled by psychiatrists and obstetricians.
It is vital that women suffering from ADHD continue to follow their treatment plans and work closely with their healthcare professionals throughout their pregnancy. This will ensure that their symptoms are well controlled, allowing them to get the most out of their pregnancies. For those who cannot or choose not to discontinue medications, there is a variety of non-pharmacological interventions that can ease symptoms and support overall well-being during pregnancy. These include: