ADHD Medication and Pregnancy
GPs can prescribe stimulants (methylphenidate dexamfetamine lisdexamfetamine) and non-stimulants such as atomoxetine or modafinil to treat ADHD. These medications can improve the ability of a patient to manage their ADHD symptoms and keep regular appointments with their GP and a specialist.
The majority of studies regarding the safety of ADHD medication during pregnancy limit the outcomes to live births. This is a mistake as they overlook the serious teratogenic side effects that result in terminations and abortions. This is the first study to include such information.
Risk/Benefit Discussion
The use of ADHD stimulants during pregnancy is a frequent problem for women suffering from the disorder. On the one side, they perform well using their medication and stopping it may cause marital conflict, difficulties at school or at work and a host of other negative consequences. On the other hand, they do not want to expose their child to drugs for which little is known in terms of long-term effects.
While some doctors advise their patients to stop taking ADHD medications before they become pregnant, other doctors have found a way to strike a balance between the assumed safety and the needs of the individual patient. The latter often arrive at an option after consulting with their spouse and/or physician, striking a balance between the mother's need for her medication and the possibility of developing severe symptoms, such as depression, agitation, and trouble staying awake in the event of discontinuing the medication.
Most studies of ADHD medication and pregnancy concentrate on the impact of the first trimester's exposure to stimulant medication on the formation of malformations in the fetus (eg malformations of the heart). However, the literature is inconclusive. This is mainly due to the fact that the majority of the studies available do not provide data on outcomes other than live births (eg terminations, miscarriages, terminations, and stillbirths) and because they fail to consider a range of confounding variables, such as the calendar year pregnant characteristics, sociodemographics of the mother and indications for the medication, maternal mental and physical health status, and proxies for other mental and physical health conditions.
However, the findings of a handful of studies suggest that there isn't a significant increase in risk for the fetus due to the use of the most frequently used stimulant drugs prior to and during the first trimester. The signals for certain cardiac malformations are clear. This is especially relevant for VSD (ventricular defect). However, these findings must be confirmed in larger studies that provide more specific information.
There is also insufficient evidence to suggest a link between the use of methylphenidate (MPH) and atomoxetine (ATO) and a greater rate of gastroschisis, omphalocele and transverse limb deficiency. Other medications could also be a cause of a higher risk for these types of birth defects, but the risks are not clear based on the limited available evidence.
Avoid Medications
Women suffering from ADHD who are pregnant confront a dilemma whether to continue their ADHD medication or stop taking it? This is a major shift in life that affects both the mother and the fetus. Many doctors believe that the ideal time to discuss this issue is when the patient informs her doctor of her desire to have a baby and to provide her with the information she requires to make the right decision prior to becoming pregnant. However, this is not always the case, and women frequently discover they are pregnant at a later point in their pregnancy, and it may be too late to safely stop medications.
Unfortunately, there isn't much studies on the dangers of stimulants during pregnancy and breastfeeding. Most studies have been based on retrospective analyses of data and do not properly control for factors such as maternal age at the time of first exposure to drug and chronic conditions, the stimulants' effects, co-treatment with pain and psychiatric medications as well as other factors that influence risk. While best adhd medication for adults with anxiety have revealed slight increases in the risk of preeclampsia and premature birth with psychostimulants used during pregnancy, these findings must 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 issues that have been identified include a rise in anger, irritability, and resentment. The good news is that these signs generally improve when the medication is taken off.
Certain ADHD medications may interact with other medications and cause dangerous side effects, especially when used in conjunction with alcohol or CNS stimulants like methylphenidate and amphetamines salts. These medications should not comprise antidepressants, narcotics or pain relievers. They should also be avoided by people who use nicotine or illegal drugs.
Some patients are able to reduce or eliminate ADHD medications during pregnancy without any significant impairment to their functional abilities. In such cases it is crucial to inform the patient and her partner about this decision. Request their assistance in reducing the frequency of recurrence of symptoms. This might include identifying local support resources, enlisting help from friends or family members, or seeking accommodations at work that address the underlying impairments that cause symptoms. It is also beneficial to learn about effective cognitive-behavioral therapies and coaching for ADHD that can be offered by trained professionals.
Considerations for the use of medications
The decision to remain on ADHD medication during pregnancy is a difficult one for both doctors and patients. It's a particularly difficult choice for women who have co-occurring addiction disorders due to the fact that many of the medications that treat addiction can have similar effects to the most common ADHD medications, including the possibility of causing high blood pressure and episodes of chest pain.
Unfortunately, these individuals and their medical professionals don't have many options. The lack of research into how to manage safely a person with both ADHD and a substance use disorder makes it easy for certain doctors to erron on the side of caution and recommend that their patients discontinue their medications during pregnancy.
Ideal is to discuss the question of whether or not to continue taking ADHD medications before deciding to start planning a family. Many women suffering from ADHD are surprised to learn that they are pregnant. This usually happens during the first trimester, which is when fetal development is most vulnerable to exposure to drugs.
If the patient and doctor decide to continue with medication in the first trimester, they should choose the lowest dose possible and closely monitor symptoms. The doctor might suggest that the woman take an immediate-release medication during the middle of the day to help lower the fluctuation in the levels of medication in the bloodstream.
In the near future, it is hoped that more research will be done on the best ways to manage both ADHD and addiction disorders in those who are nursing or pregnant. In the meantime, women who are pregnant or planning to become pregnant, should speak with their doctor about the options they have, such as psychotherapy which targets ADHD symptoms and how this might differ from a treatment-only approach. If they do not take medication for ADHD, it is likely that they will have more difficulties at school, at work and even maintaining a relationship. This could also have a major impact on their children.
The use of Medications in conjunction with
Women with ADHD typically rely on medication as part of their treatment plan to manage symptoms like inattention, hyperactivity and impulsivity. While studies on how these medications can affect pregnancy has been limited, recent studies have shown that they do not appear to negatively affect the fetus and are safe for use during pregnancy.
This is great news for the increasing number of women who depend on their ADHD medication and wish to become mothers. Many women are concerned about whether they should continue taking their medications during pregnancy, particularly if they take stimulant medications like amphetamines and methylphenidate. The women and their healthcare providers should discuss the risks and benefits of medication usage in accordance with the most recent research and recommendations.
Methylphenidate is one of the most frequently used ADHD medications prescribed to pregnant women, has been found to be to be safe when used under the supervision of a medical professional. Other stimulant medications that are commonly prescribed like atomoxetine and amphetamine are also considered safe for women who are pregnant. It is vital to remember that stimulants and other medications must be monitored closely during pregnancy.

A recent study of data gathered 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 neurological development or long-term growth. These findings are significant because they cover a greater number of patients than previous research and consider many potential confounding factors.
The results also show that the use of ADHD medication during pregnancy does not increase the risk of developing maternal complications, like iron deficiency, anemia or hyperemesis. These findings represent a major improvement in our understanding of how obstetricians effectively manage the use of ADHD medication during pregnancy.
Women with ADHD must continue to follow their treatment plan and closely work with their healthcare professional throughout their pregnancy. This will help to ensure that symptoms are treated properly, allowing women to maximize their pregnancy. There are a variety of non-pharmacological options available to those who don't want or wish to stop taking their medication. These treatments can improve symptoms and promote overall well-being. These include: