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 help improve the ability of a patient to manage their ADHD symptoms and keep regular appointments with a doctor and specialist.
Most studies on the safety of ADHD medication during pregnancy limit the results to live births. This is a mistake as they overlook the serious adverse teratogenic effects that can cause terminations and abortions. This is the first study to include such information.
Risk/Benefit Discussion
Many women with ADHD face a dilemma when they are taking stimulants during pregnancy. On the other side, a lot of women with ADHD are able to function normally when they take their medication. Stopping it could lead to marital conflict, problems at work or school and other negative consequences. On the contrary, 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 taking ADHD medications prior to becoming pregnant, others have found a compromise between assumed safety and the requirements of each patient. The latter often arrive at an option after consulting with their spouse or physician and strike an equilibrium between the mother's need for her medication and the possibility of experiencing severe symptoms like depression, agitation, and difficulty staying awake when stopping the medication.
Most studies on ADHD medication and pregnancy are focused on the effects of first-trimester stimulant exposure on the development malformations of the fetus. The literature is not consistent. The literature is inconclusive, in part because most studies do not provide information on other outcomes than live births (eg. terminations or stillbirths, miscarriages, and terminations), nor do they take into account confounding variables like the calendar year, pregnancy characteristics and sociodemographics of the mother.
However, the findings of a handful of studies suggest that there is no significant risk increase for the fetus due to the use of the most commonly used stimulant drugs prior to, during, and after the first trimester. While the signs for certain cardiac malformations, especially VSD (ventricular septal defect) are clear, these findings need confirmation in larger studies with more precise and specific information.
There isn't enough evidence to establish a connection between the use of methylphenidate (MPH) and atomoxetine (ATO) and a higher rate 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 not clear based on the limited available information.
Medications to avoid
Women with ADHD who become pregnant are often confronted with a dilemma which option to take: Continue or stop taking their ADHD medication? This is a major change in life that affects both the mother and the fetus. Many physicians feel that the best time to discuss this topic is when the patient informs her doctor of her plans to have a baby, so that she has the information she requires to make the right decision prior to becoming pregnant. This is not always possible and women could discover they are pregnant later on in their pregnancy, when it is too late to stop taking medication.
Unfortunately, there are only a few studies on the safety of stimulants during the course of pregnancy and nursing. Most studies are based on retrospective analyses of data and do not adequately control for factors like the age of the mother at first exposure to the drug and chronic conditions, the indications for stimulants, cotreatment with psychiatric and pain medications and other factors that affect risk. Although adhd without medication have revealed minor increases in preeclampsia risk and premature births associated with the use of psychostimulants during pregnancy, these findings must be taken with a pinch of salt.
A few behavioral problems in infants have been related to the use of stimulants during pregnancy. Most commonly, tics (abnormal movements of muscles) are reported in children. Other behavioral problems that have been identified include increased aggression, irritability and defiance. The good thing is that these symptoms usually improve once the medication is taken off.
Certain ADHD medications can interact with other substances, causing dangerous side effects, particularly when combined with alcohol or CNS stimulants such as methylphenidate and amphetamines salts. These medications should not contain antidepressants, narcotics, or pain alleviators. They should also be avoided by those who take nicotine or illegal drugs.
Some patients are able to reduce or stop taking ADHD medication during pregnancy without significant functional impairment. In these cases, it is important to inform the patient and her spouse or partner about this choice and ask them for help in limiting recurrence of symptoms. This may include locating local support sources, seeking help from family members or friends, or seeking workplace accommodations that address symptom-related impairments. It is also helpful to learn about cognitive-behavioral treatment and coaching for ADHD which can be provided by professionals who are trained.
Medicines to Take into
The decision to stay on ADHD medication during pregnancy can be a difficult one for both physicians and patients. It's a difficult decision for people who have co-occurring addiction disorders due to the fact that many of the medications used to treat addictions can have similar effects to the most common ADHD medications, such as the possibility of creating high blood pressure and episodes of chest pain.
Unfortunately, there aren't many options for these people and their physicians. The lack of research on how to safely treat someone suffering from ADHD and substance use disorder can cause some doctors to err to the side of caution, and suggest that patients stop taking their medications during pregnancy.
It is best to discuss whether or not you should continue taking ADHD medications before deciding to start making plans for a family. Many women suffering from ADHD are shocked to learn that they are pregnant. This often happens in the first trimester of pregnancy, when fetal development is most vulnerable to exposure to medications.
If the patient and doctor decide to take medication in the first trimester, it is recommended that they select the dose that is most effective and closely monitor for any symptoms. The doctor could also recommend that the woman add an immediate-release medication taken during the middle of the day, which can help decrease the ups and downs that are caused by fluctuating levels of medication in the bloodstream.
In the near future, it is hoped that more research will be done on the best way to manage both ADHD and addiction disorders in those who are nursing or pregnant. In the meantime, people who are expecting or trying to get pregnant should be encouraged to speak with their GP and psychiatrist about what options might be available, including psychotherapy targeted at ADHD symptoms and how they could differ from a medication-only strategy. If they do not take medication, it is likely that they will have more difficulties at work, school and even maintaining the relationship. This will likely be a major influence on their children, too.
Medicines to Incorporate
Women who suffer from ADHD may use medications to manage symptoms like inattention, hyperactivity and an impulsiveness. While research into the effects of these medications on pregnancy has been limited Recent studies have demonstrated that they don't appear to have negative effects on the fetus and are safe for continued use during pregnancy.
This is good news for women who are planning to become mothers and rely on their ADHD medications. However many women are worried about the security of keeping their medications during pregnancy, particularly those who take stimulant medications like amphetamines or methylphenidate. The women and their healthcare providers should discuss the dangers and benefits of medication usage based on the most current research and recommendations.
Methylphenidate, 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 health professional. Other stimulant medications that are commonly prescribed like atomoxetine and amphetamine are also considered safe for women who are pregnant. However it is important to remember that both stimulant and non-stimulant medications must be closely monitored during pregnancy.
A recent study of data from the Danish national registers has revealed that children born to mothers who took ADHD medication during pregnancy did not suffer adverse effects on their child's neurodevelopment or long-term growth. These findings are significant as they include a much greater number of patients than previous research and consider several possible confounding factors.
The results also show that taking ADHD medication during pregnancy does not increase the risk of developing maternal complications, including iron deficiency, anemia or hyperemesis. These findings represent a significant improvement in our understanding of how the use of ADHD medications during pregnancy can be safely controlled by psychiatrists and obstetricians.
Women suffering from ADHD should continue to adhere to their treatment plan and closely work with their healthcare professional throughout their pregnancy. This will help to ensure that symptoms are managed correctly, allowing women enjoy their pregnancy. For those who cannot or are unable to stop medication, there are a variety of non-pharmacological interventions that can improve symptoms and improve overall health during pregnancy. These include: