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 improve the ability of patients to manage their ADHD symptoms and keep regular appointments with a GP and a specialist.
Most studies on the safety of ADHD medication during pregnancy limit outcomes to live births. This undervalues the severe Teratogenic side effects that can result in terminations and abortions. This is the first study to incorporate such data.
Risk/Benefit Discussion
Many women suffering from ADHD face a dilemma when they are taking stimulants during pregnancy. On the other hand, many women with ADHD are able to function normally when they are taking their medication. If they stop, it could result in conflicts in the marriage, issues at work or school and other negative consequences. On the contrary, they don't want to expose their child to drugs for which little is known about long-term effects.
Some doctors advise their patients to quit taking ADHD medications prior to having a baby, but others have found a balance between the assumption of safety and individual patient needs. Patients often consult their spouses and/or physicians before making a decision. They strike a balance between a mother's need to take her medication as well as the potential for severe symptoms, such as depression and agitation, in the event that she stops taking the medication.
Most studies of ADHD medication and pregnancy focus on the effects of first-trimester exposure to stimulant medications on the growth of fetal malformations (eg cardiac malformations). However, the research available is not well-defined. The literature is inconsistent due to the fact that most studies do not provide information on outcomes other that live births (eg. terminations, miscarriages and stillbirths) and also do not consider confounding variables such as calendar year, pregnancy characteristics and maternal sociodemographics.
However, the findings of a few studies indicate that there isn't any significant risk increase for the fetus with the use of the most commonly used stimulant medications before and during the first trimester. The signals for certain cardiac abnormalities are strong. This is particularly relevant for VSD (ventricular defect). However these findings should be confirmed in larger studies that provide more precise information.
There isn't enough evidence to prove the connection between methylphenidate the use of atomoxetine by mothers and an increased prevalence of omphaloceles, gastroschisis and transverse limb impairments. Other medications may also pose the risk of developing these types of birth defects, but the risks are not clear in light of the comparatively limited evidence.
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Women suffering from ADHD who become pregnant are often confronted with a difficult decision which option to take: Continue or take a break from their ADHD medication? This is a major change in the life of both the mother and the fetus. Many physicians feel that the ideal time to talk about this is when patients inform their doctor of her plans to start a family, so that she has the information she needs to make the right decision prior to becoming pregnant. However, this isn't always possible and women often discover that they are pregnant at a later stage during the pregnancy, when it is too late to safely stop medications.
There is a lack of research on the safety of stimulants during pregnancy and breastfeeding. Currently, most studies are built on retrospective analyses of data that do not properly control for factors like the age of the mother at the time of first exposure to the drug, chronic conditions, indications for stimulants, cotreatment with psychiatric and pain medications as well as other factors that affect the risk. While some studies have revealed minor increases in preeclampsia risk and premature birth with psychostimulant use during pregnancy, these findings should be taken with a pinch of salt.
The use of stimulants during pregnancy has been linked to a variety of behavior problems in infants. Most often, tics (abnormal muscle movements) are reported by children. Other behavioral problems that have been reported include a rise in aggression, irritability and resentment. The good news is that these signs generally improve once the medication is taken off.
Some ADHD medications may interact with other medications which can cause dangerous side effects, particularly when combined with alcohol or CNS stimulants such as methylphenidate and amphetamines salts. These drugs should not be used with antidepressants or narcotics, including pain relievers. They should be avoided by people who use illegal drugs or nicotine products.
Some patients find it possible to reduce or eliminate ADHD medications during pregnancy without significant functional impairment. In these instances, it's important to inform the patient and her partner about the decision. Request their assistance in reducing the frequency of recurrence of symptoms. This could include identifying local resources, asking for assistance from family or friends or seeking workplace accommodations that can address symptoms-related impairments. It is also beneficial to know about cognitive-behavioral therapy and coaching for ADHD, which can be provided by trained professionals.
Medicines to Beware of
Both doctors and patients are unable to decide whether or not to continue taking ADHD medication during pregnancy. It is a particularly difficult choice for women who have co-occurring addiction disorders because many medications used to treat addictions can have similar effects as common ADHD medications, including the possibility of increasing blood pressure and a recurrence of chest pain.
Unfortunately, there aren't a lot of options for those with these conditions and their physicians. Lack of research on how to treat someone suffering from ADHD and addiction disorders could lead some doctors to err to the side of caution and recommend that patients discontinue their medication during pregnancy.
Ideally, the issue of whether to continue taking ADHD medication is discussed well in advance of planning the birth of a child. However, many women with ADHD discover that they are expecting unexpectedly. This often happens in the first trimester of pregnancy, when the development of the fetus is the most susceptible to exposure to drugs.
If the doctor and patient decide to continue taking medication during the initial trimester, they should select the lowest dosage possible and closely monitor any symptoms. The doctor could also recommend that the woman take a supplement with an immediate-release medication taken during the middle of the day, which will help to reduce the fluctuations and downs that are caused by the fluctuating levels of medications in the bloodstream.
In the near future there is a lot of research to be done on how best to manage ADHD and other substance abuse disorders in pregnant or nursing women. In the meantime, women who are expecting or trying to become pregnant should be encouraged to speak with their GP or psychiatrist about what options may be available, including psychotherapy targeted at ADHD symptoms and how they could differ from a treatment-only approach. If they decide not to take medication and are not taking medication, they will experience more difficulty at work, school as well as in maintaining relationships. This could affect their children, too.
The use of Medications in conjunction with
Women suffering from ADHD may take medication to manage symptoms such as inattention hyperactivity and impulsivity. While research into how these medications may impact pregnancy has been minimal Recent studies have revealed that they are not likely to affect the fetus in any way and are safe for continued use during pregnancy.
This is great news for the growing number of women who depend on their ADHD medication and desire to become mothers. However many women are worried about the safety of continuing their medication during pregnancy, particularly those taking stimulant medications such as amphetamines and methylphenidate. The women and their medical professionals should discuss the dangers and benefits of medication use in accordance with the most recent research and guidelines.
Methylphenidate is one of the most commonly prescribed ADHD medications and has been shown to be safe for pregnant women when administered under the supervision of a healthcare provider. Amphetamine and atomoxetine as well as other stimulant medications are safe for pregnant women. However, it is important to keep in mind that both non-stimulant and stimulant medications should be closely monitored during pregnancy.
A recent study of data from Danish national registers showed that children born to mothers who took ADHD medication during their pregnancy had no adverse effects on their neurodevelopment or growth. These findings are significant because they encompass a significantly larger number of patients than prior research and take into account many potential confounding factors.
The results also show that the use ADHD medication during pregnancy does not increase the risk of developing maternal complications, such as iron deficiency, anemia or hyperemesis. These findings represent a major improvement in our understanding of how obstetricians effectively manage the use of ADHD medication during pregnancy.
It is essential that women suffering from ADHD continue to adhere to their treatment plans and collaborate closely with their healthcare providers throughout their pregnancy. This will help ensure that their symptoms are well managed, allowing them to get the most out of their pregnancies. If you are unable or do not want to stop taking medication, there are various non-pharmacological treatments which can help ease symptoms and support overall well-being during pregnancy. These include: