For years, you’ve relied on your Concerta prescription to keep you calm and focused during the day. Can you continue to do so now that you’re pregnant?
Unfortunately, there is no easy answer to that question. Dr Kim Sonntag, a Cape Town-based obstetrician and gynaecologist, explains that it is extremely difficult to conduct drug testing in pregnant women; moreover, there are significant ethical considerations to such studies. “As a result, we have to rely on animal studies, although these are often sub-optimal,” Dr Sonntag says.
“Although animal studies have shown that there may be a risk to the foetus, there aren’t enough studies among pregnant women to determine the drug’s effects…”
Because of this dilemma, ADHD medication is classified as a Category C pregnancy risk. This categorisation, which was developed by the United States’ Food and Drug Administration (FDA), lays out the safety of drug use during pregnancy. For example, Category A drugs have passed various well-controlled studies among a large number of subjects, and have found to be safe for foetuses during the first trimester.
At the other end of the spectrum, drugs in Category X have demonstrated foetal abnormalities in both human and animal studies, and the risk of use during pregnancy clearly outweighs any potential benefits. Category C drugs sit somewhere between these two extremes: although animal studies have shown that there may be a risk to the foetus, there aren’t enough studies among pregnant women to determine the drug’s effects. As a result, it is impossible to rule out risk, and it is deemed safest to assume that this risk would outweigh potential benefits. “We need more research in this field, especially as the use of these medications has increased drastically over the last few years,” Dr Sonntag comments.
She adds that taking the drug (especially during the first trimester) may lead to an increased likelihood of birth defects. “We don’t know what the effects of the medication are if taken later during pregnancy.”
This leaves pregnant women suffering from ADHD in a predicament: do they continue to take the medication in spite of the risk, or struggle with their symptoms during a time that is, for some people, already uncomfortable?
Dr Sonntag says that the best course of action is to discuss your situation with the doctor who initially prescribed your medication, as well as the practitioner providing care during your pregnancy.
“She adds that taking the drug (especially during the first trimester) may lead to an increased likelihood of birth defects.”
“It’s best to follow a multi-disciplinary approach that takes all factors into consideration,” she says. “Often, this treatment is vital for daily function, so each case needs to be considered on its own merits. In some instances, the benefit may outweigh the risk, especially if the condition is severe. On the other hand, if your symptoms are mild, stopping the medication may be the better option.”
If you choose to go this route, it may be worth discussing alternatives to medication with your practitioner. Some patients find that exercise and diet help, others rely on techniques from cognitive behavioural therapy. It’s also a good idea to let those close to you (such as your family, employer, friends and colleagues) know that you have stopped taking your medication, and that you may therefore display symptoms such as inattention, hyperactivity or impulsivity. They may even be able to help you manage these symptoms; for example, by reminding you of deadlines or appointments.