ADHD Medication and Pregnancy
GPs can prescribe stimulants (methylphenidate dexamfetamine lisdexamfetamine) in addition to non-stimulants like atomoxetine and modafinil to treat ADHD. These medications can assist patients in managing their ADHD symptoms, and attend regular appointments with an GP or 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 study is the first to include such data.
Risk/Benefit Discussion
Many women with ADHD face a dilemma when using stimulants during pregnancy. On the other side, they perform well using 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 wish to expose their unborn baby to medications whose long-term effects are unknown.
Some doctors advise their patients to stop taking ADHD medications prior to getting pregnant, while other have found a compromise between the assumed safety and individual needs of the patient. These patients often consult their spouses and/or physicians before making a decision. They find a balance between the mother's need to take her medication and the potential for serious symptoms, like depression and agitation, if she discontinues the medication.
Most studies on ADHD medication and pregnancy focus on the effects of first-trimester stimulant exposure on the growth of fetal malformations. The literature is inconsistant. This is mainly due to the fact that the majority of the studies available do not include data on outcomes other than live births (eg, terminations, miscarriages and stillbirths) and because they do not take into account a variety of confounding variables, such as the calendar year, pregnancy characteristics, sociodemographics of the mother as well as indications for the drugs as well as physical and mental health status and proxies for other mental and physical health conditions.
The results of a few studies show that there is no risk to the fetus through the use of stimulant drugs prior to, during, and after the first trimester. The signals for certain cardiac abnormalities are clear. This is particularly applicable to VSD (ventricular defect). However, these findings must be confirmed by larger studies that provide more specific information.
Insufficient evidence exists to support the connection between methylphenidate and atomoxetine use by mothers and an increase in the incidence of omphaloceles, gastroschisis and transverse limb impairments. These birth defects could also be caused by other medications, but the risks remain unclear due the lack of data available.
Treatments to Avoid
Women suffering from ADHD who are pregnant often face a difficult choice to make: Should they continue taking their ADHD medication or stop it? This is a major life change that affects both the mother and the foetus. Many physicians feel that the ideal time to discuss this topic is when patients inform their doctor of her intention to have a baby, so that she has the necessary information to make this decision before becoming pregnant. This isn't always the case and women could discover that they are pregnant after the time of their the course of pregnancy, which is too late to safely stop taking medications.
Unfortunately, there are few studies on the safety of stimulants during pregnant and breastfeeding. Currently, most studies have been conducted using retrospective analysis of data, and don't adequately consider factors like the age of the mother at the time of first exposure to the drug, chronic conditions, indications for stimulants, cotreatment with psychiatric or pain medications, and other factors that impact the risk. While a few studies have found small increased risks of preeclampsia and premature birth with psychostimulant use during pregnancy, these findings should be interpreted with caution.
The use of stimulants during pregnancy has been associated with some behavioral problems in infants. The most frequently reported issue is the development of tics (abnormal muscle movements) in a few children. Other behavioral problems that have been identified include a rise in aggression, irritability and resentment. The good thing is that these symptoms tend to improve after the medication is removed.
Some medications that are prescribed for ADHD are incompatible with other drugs and may cause dangerous side effects when they are combined, especially with alcohol or other CNS stimulants (methylphenidate amphetamine salts). These medications should not be taken with antidepressants or narcotics, including pain relievers, and should be avoided by people who are taking nicotine products or illegal drugs.
Some patients discover that a reduction or a cessation of ADHD medication during pregnancy is possible with no significant impairment in function. In these cases it is important to inform the mother and child about this decision. Ask them for their assistance in reducing the frequency of recurrence of symptoms. This may include locating local support resources, enlisting assistance from friends or family members or requesting accommodations at work that can address the underlying impairments that cause symptoms. It is also helpful to know about cognitive-behavioral therapy and coaching for ADHD that can be provided by professionals who are trained.
Medicines to Consider
The decision to remain on ADHD medication during pregnancy is a challenging one for patients and physicians. It's a difficult decision for patients with co-occurring disorders as many of the drugs they use to treat their addictions share similar effects to the common ADHD medications. These include the possibility of high blood pressure or chest pain attacks.
There aren't a lot of options for these people and their physicians. The lack of research into how to safely manage a person with both ADHD and a substance use disorder allows certain doctors to err on the side of caution and advise their patients to stop taking their medications during pregnancy.
Ideal is to discuss whether or not to continue taking ADHD medications prior to planning a family. However, many women suffering from ADHD discover they are expecting unexpectedly. This is usually in the first trimester of pregnancy, when the development of the fetus is the most vulnerable to exposure to medications.
If adhd medication ritalin and patient decide to continue with medication during the first trimester of pregnancy, it is recommended that they choose the lowest effective dose and monitor closely for signs. The doctor may recommend that the woman take immediate-release medication in the middle hours of the day to lower the fluctuation in medication levels in the bloodstream.
In the future, more research is hoped to be done on how best to manage ADHD and other addiction issues in nursing or pregnant women. In the meantime, women who are pregnant or attempting to become pregnant should be encouraged to speak with their doctor and psychiatrist about what options might be available to them such as psychotherapy geared towards ADHD symptoms and how they could differ from a medication-only approach. They should be informed that if they do not decide to take medication, they will likely be more troubled at work and school and may struggle to keep the relationship. This will also have a significant impact on their children.
Medications to Incorporate
Women with ADHD frequently rely on medications as part of their treatment plan to deal with symptoms like inattention, hyperactivity and the tendency to be impulsive. Recent studies have proven that these medications do not harm the fetus and are able to be used 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 sustaining their prescriptions during pregnancy, especially those who are taking stimulant drugs like amphetamines or methylphenidate. Women should discuss with their healthcare providers the potential risks and benefits associated with taking medication, based on current research and recommendations.
Methylphenidate is among the most frequently prescribed ADHD medications and has been proven to be safe for pregnant women when administered under the supervision of a health professional. Amphetamine and atomoxetine as well as other stimulant medicines are safe for pregnant women. However, it is important to note that both non-stimulant and stimulant medications must be monitored closely during pregnancy.
A recent study of data collected from the Danish national registers has revealed that children born to mothers taking ADHD medication during pregnancy did not have adverse effects on their child's neurological development or long-term growth. These findings are significant as they cover a wider range of patients than previous studies, and take into consideration several confounding factors.
Furthermore, the results indicate that the use of ADHD medication during pregnancy does not result in an increased risk for maternal complications like anemia, hyperemesis gravidarum, iron deficiency, or TORCH infections. These findings are a significant improvement in our understanding of how ADHD medications during pregnancy can be safely controlled by psychiatrists and obstetricians.
It is crucial that women with ADHD continue to adhere to their treatment plans and collaborate closely with their healthcare professionals throughout their pregnancy. This will help to ensure that symptoms are treated properly, allowing women to enjoy their pregnancy. For those who cannot or choose not to discontinue medications, there is a variety of non-pharmacological interventions that can improve symptoms and improve overall health during pregnancy. These include: