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ADHD Medication and Pregnancy Physicians are unable to provide accurate information about the safety of ADHD medications during pregnancy. In the absence of further research, physicians must weigh up the benefits and risks of taking medication during pregnancy. A recent study on a population-based cohort tracked 898 infants born to mothers who were taking ADHD medications throughout pregnancy (stimulants such as amphetamine, methylphenidate, dexamphetamine; non-stimulants: 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: Doctors are concerned with the long-term effects exposure to drugs in utero can be a source of harm, particularly for centrally stimulating drugs like those used to treat ADHD. It is therefore critical that women receive the appropriate medical advice from their doctors regarding the risks and benefits of taking medication before conception and during pregnancy. In this CAP smart take, we review the most recent research on this topic and how they could guide the clinical practice. Previous animal studies and research on illicit drugs indicate that stimulant medication passes to the fetus through the placenta, and could negatively affect fetal development and growth. However, there is a lack of information on how the fetus responds to therapeutic doses of prescription stimulant medications during pregnancy, and most of this evidence is based on single-arm studies that have been underpowered to identify significant correlations. The study conducted by Cohen and colleagues4 is distinctive because it is the most complete and carefully controlled. The study involved 364,012 births collected from the Danish Medical Registry. Information about the use of medications was gathered by analyzing the redeemed medication. Researchers excluded women who had taken SSRIs, clonidine or clonidine since these drugs can interact with the fetal NMDA and increase the risk for neurodevelopmental disorders like autism and ADHD. The authors modified their analysis to take into account the timing of exposure and to take into account confounding factors. The results of this study as well as other limited trials indicate that the vast number of women who continue to use their stimulant medication prescribed for ADHD during pregnancy are not experiencing adverse effects on their fetuses. As a result, it is likely that a large number of women will continue to use their medications for ADHD during pregnancy. It is essential for doctors to weigh the risks and benefits of these medications prior to giving their pregnant patients the advice to stop taking the medications. No matter what decision they make, it is vital that pregnant women with ADHD inform their spouses or relatives, partners and employers about the decision they've made. It is because the signs of hyperactivity, inattention, and impulsivity are likely to return if the mother ceases taking their medication. Pregnancy Tests Preconception counseling should comprise an extensive management plan that includes both behavioral and pharmaceutical treatments, as well as ongoing monitoring during the perinatal stage. The plan should include a discussion about current medication regimens, particularly during the first trimester when the chances of harming the baby because of untreated ADHD are highest. This should be a collaborative effort between psychiatry and primary care, as well as Obstetrics. The discussion of risks and benefits should also cover how a woman will manage her ADHD symptoms during pregnancy, the effect of this on family functioning, and how she feels about a decision to stop psychostimulant treatment in the beginning. This should be based on a thorough review of available evidence, with consideration of the individual patient's needs and concerns. The authors of a huge study that followed children who were exposed ADHD medication during pregnancy concluded that “continuation use of psychostimulants during early pregnancy was not associated with adverse birth outcomes and if it was, it was associated with less stress among mothers.” However their conclusion isn't without limitations. The study did not consider the significance of the dosage of stimulant medication, nor the long it was used for, along with other sociodemographic and clinical factors. Moreover, there is no controlled research that evaluates the safety of continuing psychostimulant use in nursing mothers. There isn't any definitive research-based evidence on the safety of ADHD medication during pregnancy. However, most doctors are aware of what research suggests and apply best practices in consultation with each patient's individual needs. It is known, for instance that babies born to mothers who are taking methylphenidate during the first trimester are more likely to suffer from cardiac malformations (Cooper, et al. 2018). However, this finding is based on a comparatively small study that didn't consider the differences in the demographics of patients and the underlying psychiatric conditions. In a recent survey ADDitude readers said that they were more likely to stop their ADHD medication during early pregnancy than in the past. Women who stopped taking psychostimulants during the first trimester showed a clinically significant rise in depressive symptoms. They also reported that they were less capable of enjoying their pregnancy and described their family functioning as less than those who continued or increased dosages of ADHD medication. Work Functioning Test The test of work function is an essential element of the test as it determines if a patient is able to perform their duties. The test is designed to determine functional limitations. It includes materials handling that is graded (lifting to various levels pushing and pulling), positional tolerance activities (sitting or standing, balancing, walking or stooping, kneeling, crawling) along with other relevant specialized tests (hand manipulation). The evaluator will analyze the results and formulate an appropriate return to work conclusion. ROC curves can be used to determine the point of minimal classification (MIC) in the general work capability and physical work ability and the work-functioning problem score. The MIC is calculated using the COnsensus Standards for the Selection of Health Measurement Instruments Checklist (COSMIN). This method separates the scores of the general and physical work ability and work-functioning problems score by answer on an anchor question, to avoid a change in measurement from affecting the overall average. Driving medication for adhd are a gold treatment for ADHD. It improves driving safety and reduces symptoms. If left untreated, severe ADHD can have significant psychosocial and financial implications. Psychotherapeutic interventions, such as cognitive behavior therapy (CBT) or “coaching” techniques have also been proven by research to reduce symptoms and improve functioning. These strategies may aid women in adjusting their schedules and utilize their strategies to cope to minimize the effects of their ADHD on their work and other areas. All of these factors can be important considerations in the decision whether to continue or end psychostimulant therapy. The most recent data available indicate that although there are concerns about pregnancy outcomes when in utero stimulant medication is used, the relative risks of this are small. Additionally, the results are complicated by other medication, the use of maternal healthcare as well as physical and mental 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.