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ADHD Medication and Pregnancy Physicians often struggle to inform patients about the safety of their ADHD medications during pregnancy. In the absence of further research, doctors must weigh up the benefits and risks of using medications during pregnancy. A study of a population-based sample has followed 898 infants who were born to mothers who had taken ADHD medications during pregnancy (stimulants amphetamine methylphenidate ; dexamphetamine non-stimulants modafinil, atomoxetine, and clo) until they were diagnosed as having a developmental disorder, passed away, or left the country. Risk/Benefit Discussion CAP Smart Take Doctors are concerned with the long-term effects exposure to drugs during pregnancy can be a source of harm, particularly for centrally stimulating medications like those used to treat ADHD. It is important that women receive proper guidance from their physicians about the risks and benefits of using medication during pregnancy and prior to conception. In this Smart Take on CAP, we review the most recent research in this field and how it could guide the clinical practice. Animal studies and illicit drug research suggest that stimulant medications enter the fetus via the placenta and can negatively affect fetal growth and development. There aren't many data on the effects of prescription stimulant drugs during pregnancy. The majority of the evidence comes from studies conducted in case-control using a single arm which aren't strong enough to identify any significant correlations. The most recent study by Cohen and co. stands out from the others as it is the largest and most meticulously controlled. The study included 364,012 pregnancies collected from the Danish Medical Registry. Information about the use of medications was gathered by analyzing the redeemed medication. The researchers specifically excluded women who had reported taking SSRI medications or clonidine, because these medications can interact with the fetal NMDA receptor and increase the risk of neurodevelopmental disorders like autism and ADHD. The authors adjusted their analyses in order to account for timing of exposure and make sure that they control for confounding factors. The findings from this study, along with the results from other studies, suggest that the majority of women who continue to take their prescribed stimulant medication for ADHD during pregnancy do not experience adverse effects on their fetuses. As a result, it is likely that a large number of women will continue to take their medications for ADHD during pregnancy. However, it is important that physicians carefully evaluate the advantages and risks of these medications for their pregnant patients, and be aware of the unique circumstances of each patient before advising them to discontinue their medications. Whatever decision they make, it is crucial that pregnant women suffering from ADHD inform their spouses or relatives, partners and employers about the decision they have made. It is because the symptoms of inattention, hyperactivity, and impulsivity are likely to return when the mother stops taking medication. Pregnancy Tests Preconception counseling for women with ADHD who are planning to become pregnant should focus on a comprehensive plan of management that involves both pharmacologic and behavioral treatments and continuous monitoring throughout the perinatal period. The plan should include a discussion of current medication regimens, especially in the first trimester when dangers to the baby resulting from untreated ADHD are greatest. This should be a joint effort between primary care and psychiatry and the obstetrics department. The risk/benefit discussion should also consider how a woman will plan to manage her symptoms of ADHD during pregnancy, including the impact on family functioning as well as how she feels about discontinuing psychostimulant therapy during the initial stages of pregnancy. This should be based upon an exhaustive review of the available evidence and take into account the patient's individual needs and concerns. The authors of a huge study that followed children who were exposed ADHD medications during utero concluded that “continuation use of psychostimulants during early pregnancy was not associated with adverse birth outcomes and if it was, it was associated with reduced stress among mothers.” However the conclusion they reached is not without limitations. The study did take into consideration other factors, such as the duration for which stimulant medication was taken, the dose and the sociodemographics. There is also no research controlled that studies the safety of continued use of psychostimulants by nursing mothers. Although there is a lack of evidence-based research on the safety of ADHD medications during pregnancy, most physicians are aware of what the current research suggests and apply the best practices, in consultation with the individual needs of each patient. For instance, it's known that there is a higher rate of cardiac malformations in infants born to mothers who take methylphenidate within the first trimester of pregnancy (Cooper et al. (2018)), while it is important to remember that this conclusion was based on one small study that did not take into account for variations in patient demographics or underlying psychiatric co-morbidity. In a recent survey of ADDitude readers, they reported that they are more likely than ever before to stop taking their ADHD medication in the early stages of pregnancy. Women who stopped taking psychostimulants during the first trimester noticed a clinically significant rise in depression symptoms. They also reported that they were less able to enjoy their pregnancy and rated their families functioning as less than those who continued or increased dosages of ADHD medications. Work Functioning Test The test of work function is a vital component of the test as it will determine if a patient is able to carry out their duties. The test is designed to evaluate functional limitations. It will include graded material handling (lifting to different levels, pushing and pulling), positional tolerance activities (sitting or standing, balancing, walking, stooping, kneeling, crawling) as well as other relevant specialized tests (hand manipulation). The evaluator will analyze the results and formulate the return to the conclusion of the test. ROC curves can be used to determine the point of minimal classification (MIC) in the general ability to work physical work capability and the work-functioning problem score. The MIC is calculated using the COnsensus Standards for the Selection of Health Measurement Instruments Checklist (COSMIN). managing adhd without medication divides scores for general physical abilities and work-functioning issues, by answering an anchor question. This prevents any shift in metrics from biasing the average. Driving Test The most effective treatment for ADHD is psychostimulant medication. It increases safety for drivers and reduces symptoms. Insufficiency due to severe, untreated ADHD can have serious financial and psychosocial consequences. Psychotherapeutic treatments, like cognitive behavior therapy (CBT) or “coaching” methods have also been proven by research to improve symptoms and enhance function. These strategies can help women tailor their daily routines and employ their coping skills to minimize the effects of ADHD on work and other aspects. All of these aspects are important to take into account when deciding whether or not to pursue psychostimulant therapy. The most recent data available indicate that although there are some concerns about pregnancy outcomes when in utero stimulant medications are utilized, the risk-benefit ratios of this are minimal. The results are muddled by other medications, maternal healthcare utilization, maternal mental and physically health, and the 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 effects on offspring.