ADHD Medication and Pregnancy
GPs might prescribe stimulants to treat ADHD (methylphenidate, dexamfetamine and lisdexamfetamine) and non-stimulants, such as modafinil or Atomoxetine. These medications can help patients manage their ADHD symptoms and make regular appointments to see the doctor or a specialist.
The majority of studies on pregnancy safety of ADHD medication restrict the outcomes to live births, which means underestimating the severity of teratogenic effects that can cause terminations and abortions. This is the first study to incorporate these data.
Risk/Benefit Discussion
The use of ADHD stimulants during pregnancy is a typical treatment issue for many women with the disorder. On the one side, a lot of women with ADHD function well when they take their medication. Removing it can cause conflicts in the marriage, issues at school or work and other negative consequences. On the other hand, they do not want to expose their unborn child to drugs about which very little is known in terms of long-term effects.
While some doctors may advise their patients to quit using ADHD medications prior to becoming pregnant, other doctors have come to a balance between assumed security and the needs of individual patients. These patients often consult their physicians and/or spouses before making a decision. They strike an equilibrium between a mother's need to take her medication as well as the potential for severe symptoms, such as agitation and depression, 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 development malformations of the fetus. However, the literature is inconsistent. The literature is inconclusive, in part because most studies don't provide data on other outcomes than live births (eg. terminations, miscarriages and stillbirths), nor do they consider confounding variables like the calendar year, characteristics of pregnancy and sociodemographics of the mother.
The results of some studies show that there is no risk to the fetus from the use of stimulant drugs prior to, during, and after the first trimester. The signals for certain cardiac malformations are strong. This is particularly relevant for VSD (ventricular defect). However these findings need to be confirmed in larger studies that provide more specific information.
There is also insufficient evidence to suggest a link between maternal use of methylphenidate (MPH) and Atomoxetine (ATO) and a greater incidence of gastroschisis, omphalocele, and transverse limb deficiency. These birth defects can be caused by other medications, however the risks remain unclear due to the limited information available.
Avoid Medications
Women suffering from ADHD who are pregnant face a difficult choice: Should they continue their ADHD medication or stop it? This is a major change in life that will affect both the mother and the fetus. Many doctors believe that the ideal time to discuss this issue is when patients inform their doctor of her intention to have a baby and to provide her with the necessary information to make this decision before becoming pregnant. However, this isn't always the case, and women often find out that they are pregnant at a later time in their pregnancy, and it's too late to stop taking medications.
There isn't much studies on the dangers of stimulants during pregnancy and breastfeeding. The majority of studies have been built on retrospective analyses of data that do not properly control for factors such as maternal age at first exposure to the drug or chronic conditions, stimulants' indications, cotreatment with pain and psychiatric medications and other factors that affect the risk. Although some studies have revealed slight increases in the risk of preeclampsia and premature births associated with psychostimulant use during pregnancy, these findings should be taken with a pinch of salt.
The use of stimulants during pregnancy has been linked with a number of behavioral problems in infants. Most often, tics (abnormal movements of the muscles) are reported in children. Other behavior issues that have been observed include an increase in irritability and impulsivity. non stimulant adhd medication is that these signs generally improve after the medication is removed.
Certain medications prescribed for ADHD interact with other drugs and may cause dangerous side effects when combined especially with alcohol or other CNS stimulants (methylphenidate, amphetamine salts). These medications should not comprise the following: antidepressants, narcotics and pain relievers. They should be avoided by people who take nicotine or illegal drugs.
Some patients find that a reduction or a cessation of ADHD medications during pregnancy is possible with no significant functional impairment. In these instances, it is important to inform the patient and her partner or spouse about this decision and to solicit their assistance in reducing recurrence of symptoms. This could include locating local resources, seeking assistance from family members or friends, or seeking workplace accommodations which address impairments resulting from symptoms. It is also useful to know about cognitive-behavioral therapy and coaching for ADHD, which can be provided by trained professionals.
Medications to Consider
The decision to remain on ADHD medication during pregnancy can be a difficult one for both physicians and patients. It's a difficult choice for women who suffer from co-occurring disorders of substance use because many medications used to treat addictions can have similar effects as the most common ADHD medications, including the possibility of increasing blood pressure and a recurrence of chest pain.
There aren't many options for those with these conditions and their doctors. The lack of research on how to safely treat a person suffering from ADHD and a substance use disorder can lead some doctors to err to the side of caution, and recommend that patients discontinue their medication during pregnancy.
It is best to discuss whether or not you should continue taking ADHD medications prior to planning a family. However, a lot of women suffering from ADHD discover they are expecting unexpectedly. This often happens in the first trimester, which is when fetal development is most vulnerable to exposure to medications.
If the doctor and patient decide to keep taking the medication during the first trimester, they should pick the lowest dose possible and closely monitor symptoms. The doctor might suggest that the woman take immediate-release medication in the middle hours of the day to lower the fluctuation in the levels of medications in the bloodstream.
In the 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 expecting or planning to become pregnant, should speak to their GP about the options they have, such as psychotherapy which targets ADHD symptoms and how it might differ from a medication-only approach. If they do not take medication and are not taking medication, they will experience more difficulty at work, school as well as in maintaining the relationship. This could also have a profound impact on their children.
Medicines to Incorporate
Women with ADHD typically rely on medication as part of their treatment plan to help deal with symptoms like hyperactivity, inattention, and impulsivity. Recent studies have shown that these medications don't harm the fetus and can be used throughout pregnancy.
This is great news for the increasing number of women who rely on their ADHD medication and want to become mothers. However many women are concerned about the safety of sustaining their medication during pregnancy, particularly those taking stimulant medications such as amphetamines and methylphenidate. These women should talk to their healthcare professionals about the risks and benefits associated with medication use, based on current research and recommendations.
Methylphenidate is one of the most frequently prescribed ADHD medication and has been proven to be safe for women who are pregnant when administered under the supervision of a medical professional. Amphetamine, atomoxetine and other stimulant medications are also safe for women who are pregnant. 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 collected from the Danish national registers showed that children born to mothers who took ADHD medication during pregnancy did not have adverse effects on their child's neurodevelopment or long-term growth. These findings are significant because they encompass a significantly larger number of patients than prior research and consider several possible confounding factors.
The results also demonstrate that taking ADHD medication during pregnancy does not increase the risk of developing maternal complications, like iron deficiency, anemia or hyperemesis. These findings are a significant advance in our understanding of how obstetricians effectively manage the use of ADHD medication during pregnancy.
Women suffering from ADHD must adhere to their treatment plan and work closely with their healthcare provider throughout their pregnancy. This will ensure that symptoms are managed correctly, allowing women maximize their pregnancy. If you are unable or choose not to discontinue medication, there are many non-pharmacological options which can help ease symptoms and improve overall health during pregnancy. These include: