ADHD Medication and Pregnancy
GPs may prescribe stimulants to treat ADHD (methylphenidate dexamfetamine, dexamfetamine and lisdexamfetamine) along with non-stimulants, such as modafinil or Atomoxetine. These medications can assist patients in managing their ADHD symptoms, and also attend regular appointments with a GP or specialist.
The majority of studies on the pregnancy safety of ADHD medication limit outcomes to live births, which means underestimating the serious teratogenic effects which can cause terminations and abortions. This is the first study that includes these data.
Risk/Benefit Discussion
Many women with ADHD face a dilemma when they are taking stimulants during pregnancy. On the other hand, they function with the aid of their medication but stopping it can result in marital strife as well as problems at work or school and a host of other negative consequences. On the other hand, they don't want to expose their baby to drugs for which little is known about long-term effects.
While some doctors advise their patients to stop using ADHD medication prior to becoming pregnant, others have come to a balance between the presumed safety and the needs of each patient. These patients often consult their spouses and/or physicians before making the decision. They 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.
The majority of studies on ADHD medication and pregnancy are focused on the effects of the first trimester stimulant exposure on the development of malformations of the fetus. The literature is inconsistant. The literature is inconsistent due to the fact that most studies do not provide data on outcomes other that live births (eg. terminations or stillbirths, miscarriages, and terminations) and also do not take into account factors that can cause confusion, such as the calendar year, pregnancy characteristics and sociodemographics of the mother.
The results of a few studies show that there is no risk to the fetus through the use of stimulant medications prior to, during, and after the 1st trimester. The warning signs for certain cardiac malformations are clear. This is particularly true for VSD (ventricular defect). However these findings should be confirmed by larger studies that provide more precise information.
There isn't enough evidence to prove the connection between methylphenidate and the use of atomoxetine by mothers and an increase in the incidence of omphaloceles, gastroschisis and transverse limb deficiency. Other medications could also put you at a higher risk for these kinds of birth defects, but the risks are unclear based on the limited available information.
Treatments to avoid
Women suffering from ADHD who are expecting face a difficult choice whether to continue their ADHD medication or stop taking it? This is a major shift in life that will affect both the mother and fetus. Many doctors believe that the ideal time to discuss this topic is when a woman tells her doctor that she would like to start a new family. This will provide her with the necessary information to make a decision before she becomes 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 stop taking medication.
Unfortunately, there are only a few studies on the safety of stimulants in the course of pregnancy and nursing. Most studies are built on retrospective analyses of data that do not adequately consider factors like maternal age at first exposure to the drug, chronic conditions, indications for stimulants, cotreatment with pain and psychiatric medications and other factors that affect the risk. While certain studies have shown minor increases in preeclampsia risk and premature birth with psychostimulants used during pregnancy, these findings must be taken with caution.
Some behavioral problems in infants have also been caused by the use of stimulants in pregnancy. Most often, tics (abnormal movements of the muscles) are reported in children. Other behavior issues that have been identified include increased impulsivity and irritability. The good news is that these symptoms generally improve after the medication is removed.
Certain medications prescribed for ADHD interact with other drugs and can trigger dangerous side effects when they are combined particularly with alcohol or other CNS stimulants (methylphenidate amphetamine salts). These medications should not include antidepressants, narcotics or pain relievers. They should be avoided by those who take nicotine or illegal drugs.
Some patients discover that a reduction or a cessation of ADHD medications during pregnancy is feasible without significant functional impairment. In these instances, it's important to inform the patient and her partner about the decision. Ask them for help in minimizing symptoms recurrence. This might include identifying local resources, requesting assistance from family members or friends, or seeking accommodations in the workplace that can address symptoms-related impairments. It is also beneficial to know more about effective cognitive-behavioral treatment and coaching for ADHD that can be provided by trained professionals.
Considerations for Medications
Both patients and doctors are unable to decide whether or not to continue taking ADHD medication during pregnancy. It's a particularly difficult choice for women who have co-occurring addiction disorders due to the fact that many of the medications that treat addiction may have the same effects as commonly used ADHD medicines, including the possibility of creating high blood pressure and a recurrence of chest pain.
Unfortunately, these patients and their physicians do not have a lot of choices. The lack of research into how to manage safely those who suffer from both ADHD and an addiction disorder allows certain doctors to erron on the safe side and advise their patients to discontinue their medication during pregnancy.
It is recommended to discuss the question of whether or not to continue taking ADHD medications before deciding to start making plans for a baby. However, many women who have ADHD discover that they are expecting unexpectedly. This is usually in the first trimester, when fetal development is most vulnerable to exposure to medications.
If the patient and doctor decide to continue taking medication during the initial trimester, they should choose the lowest dosage possible and closely monitor the symptoms. The doctor may suggest that the woman take an immediate-release medication in the middle hours of the day to reduce the fluctuations in medication levels in the bloodstream.
In the near future we hope that more research will be done on how 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 be pregnant should be encouraged to speak with their GP and psychiatrist about the options that may be available such as psychotherapy geared towards ADHD symptoms and how they could differ from a medication-only strategy. If they choose not to take medication, it is likely that they will experience more difficulty at school, work, and even in maintaining a relationship. This will likely be a major influence on their children, too.
Incorporate the use of Medications
Women with ADHD often rely on medication as part of their treatment plan to deal with symptoms like hyperactivity, inattention and impulsivity. While adhd anxiety medication on how these medications can affect pregnancy has been scarce, recent studies have shown that they are not likely to affect the fetus in any way and are safe for use during pregnancy.
This is fantastic news for the growing number of women who depend on their ADHD medication and desire to become mothers. However, many women are concerned about the safety of continuing their prescriptions during pregnancy, particularly those who take stimulant medications such as amphetamines and methylphenidate. The women and their healthcare providers should discuss the potential risks and benefits of drug usage according to the most recent research and guidelines.
Methylphenidate is one of the most commonly used ADHD medications prescribed to pregnant women, has been found to be safe when administered under the supervision of a medical professional. Amphetamine and atomoxetine as well as other stimulant medicines are safe for pregnant women. It is important to keep in mind that both stimulants and other medications must be monitored closely during pregnancy.
A recent study of data from Danish national registers revealed that children born to mothers who were taking ADHD medication during pregnancy had no adverse effect on the child's long-term growth or development. These findings are significant because they cover a wider range of patients than previous research and take into account numerous confounding factors.
Additionally, the results show that the use of ADHD medication during pregnancy does not result in an higher risk of maternal complications such as anemia and iron deficiency, hyperemesis gravidarum, or TORCH infections. These findings represent a major advance in our understanding of how obstetricians effectively manage the use of ADHD medication during pregnancy.
It is vital that women with ADHD continue to adhere to their treatment plans and work closely with their healthcare professionals throughout their pregnancy. This will help to ensure that symptoms are controlled effectively, allowing women to make the most of their pregnancy. There are non-pharmacological options for those who are unable or don't want to quit taking their medication. These interventions can aid in reducing symptoms and increase overall well-being. These include: