ADHD Medication and Pregnancy
GPs can prescribe stimulants (methylphenidate dexamfetamine lisdexamfetamine) as well as nonstimulants like atomoxetine and modafinil to treat ADHD. These medications can improve the ability of a patient to manage their ADHD symptoms and keep regular appointments with a doctor and a specialist.
The majority of studies on the pregnancy safety of ADHD medication limit their the outcomes to live births, which means underestimating the serious teratogenic effects which can cause terminations and abortions. This is the first study that includes such data.
Risk/Benefit Discussion
The use of ADHD stimulants during pregnancy is a typical problem for women with the disorder. On the one hand, many women with ADHD perform well when they are taking their medication. Removing it can cause marital conflict, problems at work or school and other negative consequences. On the other hand, they aren't keen to expose their unborn baby to medications whose long-term effects are not known.
While add adhd medications counsel their patients to quit using ADHD medication prior to becoming pregnant, other doctors have found a way to strike a balance between the assumed safety and the requirements of the individual patient. These patients usually consult their physicians and/or spouses before making an informed decision. They seek to strike a balance 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 regarding ADHD medication and pregnancy focus on the effects of 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 available studies do not include data on outcomes other than live births (eg terminations, miscarriages, terminations and stillbirths), and since they do not consider a range of confounding factors including calendar year pregnant characteristics, sociodemographics of mothers as well as indications for the drugs for maternal physical and mental health status and proxies for various mental and medical illnesses.
However, the findings of some of the available studies suggest that there isn't a significant increase in risk for the fetus from the use of the most commonly used stimulant drugs prior to and during the first trimester. The signals for certain cardiac malformations are strong. This is especially relevant for VSD (ventricular defect). However, these findings must be confirmed by larger studies that provide more exact information.
There is also insufficient evidence to support a link between maternal use of methylphenidate (MPH) and Atomoxetine (ATO) and a greater incidence of gastroschisis, omphalocele, and transverse limb deficiency. Other medications could also be a cause of an increased risk of these kinds of birth defects, however the risks are unclear based on the limited available evidence.
Medicines to avoid
Women suffering from ADHD who are pregnant are often confronted with a tough decision: Should they continue or stop taking their ADHD medication? This is a major change that will impact both the mother and the fetus. Many doctors believe that the best time to talk about this is when patients inform their doctor of her desire to start a family, so that she has the information she requires to make the right decision prior to becoming pregnant. This is not always possible, and women may discover that they are pregnant later in pregnancy, when it is too late to stop taking medications.
Unfortunately, there is a lack of studies on the safety of stimulants during the course of breastfeeding and during pregnancy. The majority of studies are based upon retrospective data analyses and do not take into account factors such as the age of the mother at the time of exposure, chronic conditions, stimulant indications or co-treatment with pain medications and psychiatric medication, or other factors that can affect risk. A number of studies have revealed an increase in the chance of preeclampsia or premature birth if psychostimulants are used during pregnancy. However, these findings should be taken with caution.
The use of stimulants during pregnancy has been linked to a variety of issues with infants' behavior. The most commonly reported is the development of tics (abnormal muscle movements) in some children. Other behavioral issues that have been identified include increased anger, irritability, and resentment. The good part is that these symptoms generally improve once the medication is removed.
Some medications that are prescribed for ADHD are incompatible 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 be combined with antidepressants or narcotics, including pain relievers, and should be avoided by people who use illicit drugs or nicotine products.
Some patients discover that a reduction or discontinuation of ADHD medications during pregnancy is possible without significant impairment to function. In these situations it is crucial to inform the patient and her partner or spouse about this decision and to seek their help in reducing recurrence of symptoms. This might include identifying local support sources, seeking assistance from family members or friends, or seeking accommodations at work that can help with impairments related to symptoms. It is also useful to be aware of cognitive-behavioral treatments and coaching for ADHD that can be offered by professionals who are trained.
Considerations for Medications
Both patients and doctors are unable to decide whether or not to continue taking ADHD medication during pregnancy. It is a particularly difficult choice for women with co-occurring substance use disorders due to the fact that many of the medications used to treat their addictions can have similar effects to the most common ADHD medications, such as the possibility of causing high blood pressure and a recurrence of chest pain.
Unfortunately, these individuals and their physicians do not have a lot of options. The lack of research on how to safely treat a person with ADHD and addiction disorders can cause some doctors to err to the side of caution, and advise patients to stop their medication during pregnancy.
It is best to discuss whether or not to continue taking ADHD medications prior to planning a family. Many women suffering from ADHD are shocked to learn that they are pregnant. This typically happens in the first trimester, when fetal growth is most susceptible to drug exposure.
If the physician and patient decide to continue with medication in the first trimester, it is recommended to choose the lowest effective dose and monitor closely for symptoms. The doctor could suggest that the patient supplement her dose with an immediate-release medication taken during the middle of the day, which will help to reduce the fluctuations and downs caused by fluctuating levels of medication in the bloodstream.
In the near future there is a lot of research to be conducted on how best to manage ADHD and other substance abuse issues in nursing or pregnant women. In the meantime, people who are pregnant or trying to get pregnant should be encouraged to talk with their GP or psychiatrist about what options may be available such as psychotherapy geared towards ADHD symptoms and how they could differ from a medication-only approach. They should be made aware that if they don't choose to take medication, they could be more difficult at work and school and may even find it difficult to keep a relationship. This could be a major influence on their children, too.
Incorporate add adhd medications of Medications
Women suffering from ADHD frequently rely on medications as part of their treatment plan to combat symptoms such as inattention, hyperactivity, and an impulsiveness. While research on how these medications can affect pregnancy has been minimal, recent studies have shown that they do not appear to negatively affect the fetus and are safe for continued use during pregnancy.
This is a great development for the increasing number of women who depend on their ADHD medication and wish to become mothers. However many women are worried about the security of keeping their medication during pregnancy, particularly those who are taking stimulant drugs like amphetamines or methylphenidate. These women should consult with their healthcare providers about the risks and benefits associated with medication use in light of current research and guidelines.
Methylphenidate is one of the most frequently prescribed ADHD medication and has been found to be safe for pregnant women when used under the care of a medical professional. Amphetamine, atomoxetine and other stimulant medicines are safe for women who are pregnant. 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 nationwide registers found that children born to mothers who took ADHD medication during their pregnancy did not have any adverse effects on their neurodevelopment or growth. These findings are important because they cover a greater number of patients than previous studies and take into account several confounding factors.
Furthermore, the results indicate that the use of ADHD medication during pregnancy is not associated with any higher risk of maternal complications such as anemia and iron deficiency, hyperemesis gravidarum or TORCH infections. These findings are a significant improvement in our understanding of how the use of ADHD medications during pregnancy can be safely managed by obstetricians and psychiatrists.
Women with ADHD must adhere to their treatment plan and work closely with their healthcare professional throughout their pregnancy. This will help to ensure that symptoms are controlled effectively, allowing women to make the most of their pregnancy. If you are unable or do not want to stop taking medication, there are many non-pharmacological options which can help ease symptoms and promote overall well-being during pregnancy. These include: