Preconception counseling and proper perinatal planning are effective for managing risks associated with attention-deficit/hyperactivity disorder (ADHD) in pregnancy, according to a recent study published in the American Journal of Obstetrics & Gynecology.1
Takeaways
- Preconception counseling and proper perinatal planning are crucial for managing attention-deficit/hyperactivity disorder (ADHD) in pregnant women, helping to mitigate risks and improve outcomes.
- Approximately 75% of women with ADHD continue to experience symptoms into adulthood, which can become more challenging to manage during pregnancy.
- ADHD in pregnancy is associated with potential negative neurocognitive effects, including confusion and memory impairment, as well as an increased risk of postpartum depression.
- Effective management should involve a comprehensive plan that includes the patient, their support network, and healthcare providers across psychiatry, obstetrics, and primary care.
- Both pharmacologic and nonpharmacologic treatments should be considered, with adjustments made as necessary. Mild to moderate ADHD may be managed with psychoeducation, self-management strategies, coaching, and psychotherapies.
ADHD is characterized by trouble with concentration and impulse control and presents in 3% to 7% of children worldwide. Approximately 75% of women with ADHD experience symptoms into adulthood, with 3.2% of adult women overall impacted.
Only approximately 10% of adults with ADHD receive treatment, and ADHD often co-exists with other psychiatric illnesses. This indicates a need to manage ADHD in adults to improve quality of life. As a chronic condition, ADHD cannot be diagnosed prenatally. However, symptoms often persist into pregnancy and become more difficult to manage.1
Investigators conducted a review to highlight ADHD in pregnancy and the postpartum period. In adults, ADHD more often presents as inattentive symptoms, and diagnosis begins by having patients complete part A of the Adult ADHD Self-Report Scale. Those who screen positive for ADHD undergo additional testing.1
In adults, ADHD often leads to difficulties in home management and keeping track of children’s schedules and appointments. Data has also indicated potential negative neurocognitive effects during pregnancy, including self-reported confusion, impaired memory, disorientation, and reading difficulties.
ADHD has also been linked to an increased risk of postpartum depression (PPD).2 One study reported a 24% risk of PPD incidence among women without a history of depression who had ADHD vs those without ADHD. Rates of PPD diagnoses were 6.4% vs 5.2%, respectively.
Pregnancy involves multiple appointments that must be coordinated and preparing the home environment for the baby.1 Certain diets and regimens may also be necessary in women with complications such as gestational diabetes, which are more common in patients with ADHD.
Parents with ADHD may be overwhelmed, with further difficulties among parents lacking organizational skills to manage their symptoms. This has led to increased parental distress among patients with ADHD in the first year postpartum vs those without ADHD. This indicates a need to provide special attention to pregnant patients with ADHD.
Investigators recommended ADHD during pregnancy be managed using preconception counseling and proper perinatal planning, management, and support. This includes discussing risks of untreated ADHD with patients as well as methods for symptom reduction.1
Pharmacologic and nonpharmacologic treatments should be considered to manage ADHD in pregnant women, and regimens may need to be changed prior to pregnancy. Doctors should also reinforce that patients should seek help if symptoms worsen during pregnancy.
Planning may be accomplished by asking all pregnant patients about their personal ADHD history. Management plans should include the pregnant patient, their family or support network, psychiatry, obstetrics, and primary care.1
Ongoing monitoring and any necessary adjustments to medications should be considered. Stress, sleep deprivation, and inadequate nutrition all may adversely impact perinatal functioning and should also be addressed.
A combination of behavioral therapy and medications is often used to treat ADHD. Instigators recommended mild to moderate ADHD be managed using psychoeducation, self-management strategies, coaching, and psychotherapies. The presence of ADHD should be considered alongside other psychiatric illnesses.1
While data has indicated a potential link between ADHD medication use in pregnancy and pregnancy complications, this data is mostly from small studies evaluating illicit medication use. These increased risks also may be associated with the presence of ADHD rather than medication use.
This review highlighted the importance of preconception counseling and proper perinatal planning among pregnant patients with ADHD. Investigators recommended encouraging pregnancy planning among patients diagnosed with ADHD.1
References
- Scoten O, Tabi K, Paquette V, et al. Attention-deficit/hyperactivity disorder in pregnancy and the postpartum period. American Journal of Obstetrics & Gynecology. 2024;231(1):19-35. doi:10.1016/j.ajog.2024.02.297
- Krewson C. Maternal ADHD and postpartum depression risk. June 27, 2024. July 8, 2024. https://www.contemporaryobgyn.net/view/maternal-adhd-and-postpartum-depression-risk
