non prescription adhd medication uk and Pregnancy
Physicians often struggle to counsel patients on the safety of their ADHD medication during pregnancy. In the absence of further research, physicians must weigh the benefits and risks of using medications during pregnancy.
A recent study on a population-based cohort monitored 898 babies born to mothers who were who were taking ADHD medications throughout their pregnancy (stimulants such as amphetamine, methylphenidate dexamphetamine, methylphenidate; and non-stimulants such modafinil, atomoxetine, and clonidine) until they were diagnosed with a developmental disorder, or passed away or left the country.
Risk/Benefit Discussion
CAP Smart Take:
Physicians are concerned about the long-term effects of exposure to drugs during the uterus, specifically to centrally stimulating medications like those prescribed for ADHD. It is essential that women receive adequate guidance from their physicians about the risks and benefits of using medication during pregnancy and before conception. In this Smart Take on CAP, we look at the most current research in this area and how it could influence the clinical practice.
Animal studies and illicit drug research suggests that stimulant medication passes to the fetus via the placenta and can adversely affect the growth of the fetus and development. There is however, a limited amount of information on the response of the fetus to the therapeutic doses of prescription stimulant medication during pregnancy and most of this evidence is based on single-arm studies that are not sufficiently powered to detect possible significant connections.
The recent study by Cohen and co. is distinct from other studies because it is the largest and most carefully controlled. The study comprised a representative sample of 364,012 births from the Danish Medical Registry, and information on medication use was gathered through the analysis of redeemed prescriptions. The researchers specifically excluded women who had reported taking SSRI medications or clonidine as these drugs may interact with the fetal NMDA receptor and increase the risk of neurodevelopmental disorders like autism and ADHD. The authors also adjusted their analyses to control for possible confounding factors and to take into account the timing of the in utero exposure.
The data from this study, as well as the results of other studies, suggest that the majority of women who continue to use the stimulant medications prescribed for ADHD during pregnancy don't experience adverse effects on their foetuses. This means it is likely that a lot of women will continue to use their medication for ADHD during pregnancy. It is crucial for doctors to weigh the benefits and risks of these medications prior to advising their pregnant patients to stop taking these medications. Regardless of which choice they make, it is essential that pregnant women with ADHD inform their spouses or relatives, partners, and employers about the choice they have made. This is because the signs of hyperactivity, inattention, and impulsivity are likely to return when the mother stops taking their medication.
Pregnancy Tests
Preconception counseling should include a comprehensive program of management that includes both behavioural and pharmaceutical treatment and continuous monitoring throughout the perinatal period. The plan should include a discussion of the current treatment regimens, especially in the first trimester where the risks of harming the baby due to untreated ADHD are the highest. This should be a joint effort between psychiatry and primary care and obstetrics.
The discussion of risks and benefits should also include how a woman will manage her ADHD symptoms during pregnancy, the impact of this on the family's functioning, and how she feels about a decision to stop psychostimulant treatment in the early stages. This should be guided by a thorough analysis of available evidence, with consideration of the specific patient's needs and concerns.
The authors of a huge study that examined children who were exposed ADHD medications during utero concluded that "continuation psychostimulant use during the early stages of pregnancy was not associated with adverse birth outcomes and, if it was, it was associated with lower stress levels among mothers." However the conclusion they reached is not without limitations. The study did not consider the significance of the dosage of stimulant medication, nor the long it was used in addition to other factors related to sociodemographics and clinical. There is also no controlled research that examines the safety of continued use of psychostimulants by nursing mothers.
Although there is a dearth of scientifically substantiated evidence regarding the safety of ADHD medication during pregnancy, the majority of doctors have a basic understanding of what the current research suggests and apply the best practices in consultation with each patient's unique needs. It is well-known, for instance that infants born to mothers taking methylphenidate during the first trimester are more likely to suffer from cardiac malformations (Cooper, et al. 2018). However this is based on a tiny study that didn't take into account the different patient demographics and underlying psychiatric conditions.
In a recent survey of ADDitude readers, they revealed that they are more likely than ever before to quit taking their ADHD medication during early pregnancy. Women who stopped taking psychostimulants in the first trimester noticed an increase in depressive symptoms. They also reported feeling less able to enjoy their pregnancy and rated their family functioning as more difficult than those who remained on their dose of ADHD medication or increased it.
Work Functioning Test
The work function test is a vital aspect of the test, as it determines if the candidate is able to perform their duties. The test is designed to assist in testing functional limitations. It includes graded material handling exercises (lifting at various heights pulling and pushing) and tests for positional tolerance (sitting and standing while walking, balancing and walking, stooping and kneeling), as well as specialized tests. The evaluator analyzes the results to formulate an appropriate return-to-work conclusion. ROC curves are used to show the point at which there is a minimum misclassification (MIC) for both the general and physical work capability as well as the work-functioning score for a particular problem.
The MIC is calculated based on the COnsensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. This method differentiates scores for general physical work capabilities and work-functioning issues, by answering an anchor question. This will prevent a shift in metrics from biasing the average.
Driving Test
Psychostimulant medication is a standard treatment for ADHD. It reduces symptoms and improves functioning in other areas, including driving safety. Untreated severe ADHD can have significant psychosocial and financial implications.
Psychotherapeutic treatments such as cognitive behavioral therapy (CBT) and "coaching" strategies have also been proven to reduce symptoms and improve functioning. These strategies could assist women in tailoring their schedules and utilize their coping skills in ways that minimize the impact of their ADHD on work and other areas.
All of these factors can be important considerations in the decision whether to continue or stop psychostimulant therapy. The most reliable data indicate, although there is some concern regarding pregnancy outcomes with in utero exposure to stimulant medications, the risks are minimal, and the results are confounded by other medications, maternal health treatment, maternal mental and physical health, and comorbidities. Bang Madsen K, Bliddal M, Skoglund CB, Larsson H, Munk-Olsen, Hove Thomsen P, Bergink V. In utero exposure to attention deficit hyperactivity disorder medication and long-term offspring outcomes.