Pregnancy & mental illness
Pregnancy can be one of the most exciting times for all parents-to-be, but for people with mental illness it can also bring added concerns. As the body changes through pregnancy, mental health can be affected in different ways and day to day management of symptoms through medication may no longer be possible or advisable.
This is because some types of medication used to treat mental illness can present a risk to an unborn baby. But you can take steps to minimize the risk to yourself and to your baby by understanding the complexities of pregnancy and mental illness.
Medication & pregnancy
Several psychotropic drugs carry a small risk of birth defects if taken during pregnancy. But medication accounts for only a small proportion of the total number of birth abnormalities; it has been shown that people with schizophrenia are more likely to have minor physical anomalies than the general population, some apparent from birth, others not till later on in life.
If you are taking medication for mental illness and wish to become pregnant you should discuss your plans with your doctor.
If you are on medication and you find out that you are pregnant, you should contact your doctor immediately. In general, it is desirable to minimise or avoid the use of medication during pregnancy and a plan should be drawn up for you and your doctor to monitor your mental health throughout the pregnancy.
The Maudsley Prescribing Guidelines (2009) outline some general principles about prescribing and taking medication for mental illness during pregnancy -
- prospective parents should be fully involved in all discussions regarding the pregnancy
- the lowest effective dose should be used
- the drug with the lowest risk to the mother and foetus should be used
- as few drugs as possible should be prescribed at the same time
- parents-to-be should try receive adequate screening procedures during the pregnancy
- the baby should be monitored after birth in order to check for any signs of withdrawal effects
- all decisions should be accurately documented by the medical team
Antipsychotics
The older antipsychotics (typicals) are generally thought to have a minimal risk of causing malformations in the unborn baby. Evidence from research into the more modern atypicals is still growing, with most information on olanzapine. Olanzapine seems to be relatively safe in terms of malformations in the unborn baby, although it has been associated with other problems such as lower birth weight. Limited information says suggests that risperidone and quetiapine do not have a high risk of producing malformations in the unborn child. There is little information on any other atypical antipsychotics.
Antidepressants
The older ‘tricyclic’ antidepressants have been widely used for many years without any apparent negative effects on the unborn baby, although some babies of mothers who have used these drugs in the last three months can show signs of withdrawal effects after birth.
The more modern SSRIs also appear not to be linked with causing abnormalities when used during pregnancy.
But MAOIs should be avoided in pregnancy because of a suspected increase in the risk of congenital malformations, and the risk of increasing blood pressure to dangerously high levels.
Mood stabilizers
The risk to women with bipolar disorder of relapsing before or after birth is high if drug based treatment is stopped.
No mood stabilizer is completely safe – lithium should be avoided in pregnancy if possible. This would preferably be by discontinuing it slowly before conceiving rather than coming off it abruptly. Valproate and carbamazepine have some known links to foetal abnormalities. They should be avoided in pregnancy if possible.
