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ADHD Medication and Pregnancy Physicians often struggle to counsel patients about the security of their ADHD medication during pregnancy. In the absence of further research, physicians must weigh the advantages and risks of using medication during pregnancy. A recent study on a population-based cohort followed 898 babies born to mothers who were taking ADHD medications throughout their pregnancy (stimulants such as amphetamine, methylphenidate dexamphetamine, methylphenidate; and non-stimulants such modafinil, atomoxetine, clonidine) until they were diagnosed with a developmental disorder, or died or left the country. Risk/Benefit Discussion CAP Smart Take Physicians are concerned about the long-term consequences of exposure to drugs in utero, particularly to centrally stimulating medications such as those used for ADHD. It is essential that women receive proper medical advice from their doctors regarding the risks and benefits of taking medication prior to conception and during pregnancy. In this CAP Smart Take, we look at the most current research in this area and how it could inform clinical practice. Animal studies and illicit drug research have suggested that stimulant medications enter the fetus through the placenta, and may negatively affect fetal growth and development. There aren't many data on the effects of prescription stimulant medications during pregnancy. adhd anxiety medication of the evidence comes from studies conducted in case-control with a single arm, which isn't powerful enough to reveal any significant correlations. The study conducted by Cohen and colleagues4 is distinctive because it is the most comprehensive and well-controlled. The study comprised a sample of 364,012 pregnancies from the Danish Medical Registry, and data on the use of medication was obtained by analyzing redeemed prescriptions. The researchers specifically excluded women who reported taking SSRI drugs or clonidine as these drugs may interfere with the fetal NMDA receptor and increase the risk of neurodevelopmental disorders such as autism and ADHD. The authors also modified their analyses to control for potential confounding factors as well as to account for the timing of the in utero exposure. The results of this study and other studies show that the majority of women who continue to take their stimulant medication prescribed for ADHD during pregnancy are not experiencing adverse effects on their foetuses. Therefore, it is likely that many women who are pregnant will continue to use their ADHD medication. However, it is crucial that doctors carefully evaluate the advantages and risks of these medications for pregnant patients, and take into consideration the individual circumstances of each patient before suggesting that they stop taking their medication. It is important that pregnant women suffering from ADHD inform their partners family members, extended families, and employers of the decision they've taken. This is because symptoms of hyperactivity, inattention and impulsivity could be recurred when the mother stops taking her medications. Pregnancy Tests Preconception counseling should comprise a comprehensive management program that incorporates both behavioral and pharmaceutical treatment and ongoing monitoring during the perinatal stage. The plan should include a review of the current treatment regimens, particularly in the first trimester when the risks of harm to the baby from untreated ADHD are greatest. This should be a coordinated effort with obstetrics, psychiatry, and primary care. The discussion of risks and benefits should also include how a woman will manage her ADHD symptoms during pregnancy, the effects of this on the family's functioning and her feelings about a decision to stop psychostimulant treatment in the beginning. This should be based upon an in-depth analysis of the evidence available and be mindful of the patient's individual needs and concerns. In a recent study that followed children exposed to ADHD medications in utero and concluded that “continuation of psychostimulant use during the early stages of pregnancy did not increase the risk of adverse birth outcomes and if anything, it was associated with less stress for mothers.” However, this conclusion is not without its limitations. The study did consider other factors such as the duration for which stimulant medications were used as well as the dose and sociodemographics. Furthermore, there is no controlled study that examines the safety of continuing use of psychostimulants in nursing mothers. Although there is a lack of clear scientific data on the safety of ADHD medications in pregnancy, most physicians have a basic understanding of what the research suggests and employ the best practices while collaborating with each patient's unique needs. For instance, it is recognized that there is a higher incidence of cardiac malformations in babies born to mothers who have taken methylphenidate within the first trimester of pregnancy (Cooper and colleagues. (2018)) It is important to remember that this result was based on one small study that did not take into consider differences in patient demographics or underlying psychiatric co-morbidity. In an earlier survey of ADDitude readers, they found that they are more likely than ever to stop taking their ADHD medication in the early stages of pregnancy. Women who stopped taking psychostimulants in the first trimester showed an increase in depressive symptoms. They also reported feeling less than able to enjoy their pregnancy and rated their families functioning as more difficult than those who continued or increased their dosages of ADHD medication. Work Functioning Test The test for work function is a vital component of the exam, as it determines if the candidate is able to perform their duties. The test is intended for evaluating functional limitations. It includes graded material handling exercises (lifting at different heights, pulling and pushing) as well as positional tolerance exercises (sitting and standing, balancing and walking, stooping and kneeling) as well as specialized tests. The examiner will analyse the results and formulate the return to a conclusion of the work. ROC curves can be used to determine the point of minimal classification (MIC) in both the general work ability physical work capability, and the work-functioning problems score. The MIC is calculated according to the COnsensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. This method separates the scores of the general and physical work ability and work-functioning difficulties based on the answer on an anchor question, to avoid changes in the measurement from affecting the overall average. Driving Test Psychostimulant medications are a gold treatment for ADHD. It helps reduce symptoms and improves performance in other areas, including driving safety. The effects of severe, untreated ADHD can have profound financial and psychosocial consequences. Psychotherapeutic interventions like cognitive behavioral therapy (CBT) and “coaching” strategies have also been shown to improve symptoms and enhance functioning. These strategies could aid women in adjusting their schedules and utilize their strategies to cope in ways that minimize the effects of their ADHD on their work and other areas. All of these factors can be significant considerations in the decision of whether to continue or discontinue psychostimulant therapy. As the most recent data available indicate, although there is some concern regarding the outcomes of pregnancy after in utero exposure to stimulant medications the relative risks are small and the results are confounded by other medications, maternal health care utilization and physical and mental health and other comorbidities. Bang Madsen K, Bliddal M, Skoglund CB, Larsson H, Munk-Olsen TL, Hove Thomsen P, Bergink V. In utero exposure to attention-deficit hyperactivity disorder medication and long-term offspring outcomes.