Meds; to take or not to take when pregnant, that is the question

Pregnant woman with pills

There are risks associated with taking psychotropic (mood altering) medication in pregnancy and during breast feeding, but then ANY medication can carry risks to a pregnant woman.

It is important to note that no psychotropic medication is licensed to be used by women who are known to be pregnant.

If a woman has taken a psychotropic medication with known teratogenic (can cause congenital malformation of the embryo/fetus whilst in the womb) risk at any time during the first trimester then the following should be considered;

  • offer additional screening for fetal abnormalities and counselling regarding whether to continue with a pregnancy or not.
  • explain to mother and those supporting her that there will be a higher level of monitoring compared to an expectant mother who has not taken psychotropic medication.

At one’s booking appointment (circa. 10 weeks gestation in the UK) where one’s pregnancy is confirmed by a midwife and the mother’s medical history is discussed, it is absolutely vital that the mother discloses any mental health issues, past and/or present. If the mother’s condition falls into the severe mental illness category (bipolar,schizophrenia etc.) then I would strongly recommend that you make an appointment with your GP as soon as you get a positive pregnancy test. This way, the mother can be referred to a Perinatal Psychiatrist (a psychiatrist who specialises in the treatment of women both antenatal and postnatal) straight away.

As previously mentioned in my last bloglithium is the most commonly prescribed medication for bipolar. When taking lithium in pregnancy it is important to note the following;

  • there is a risk of fetal heart malformation
  • lithium levels may be high in breast milk with risk of toxicity of baby
  • lithium levels will be monitored more frequently during pregnancy

If a woman is pregnant and currently suffering from the effects of bipolar whilst taking lithium, the medical team should consider one or more of the following;

  1. Switch gradually to another psychotropic medication.
  2. Stop taking lithium during the first trimester and then reintroduce again in the second trimester.
  3. Continue taking lithium for the mother’s safety and closely monitor her.

As for the effects of other medication prescribed for bipolar previously mentioned in last week’s blog, see below table. Information has been taken from British National Formulary, a pharmacology hand book used by the medical professions in the UK.

bipolar meds in pregnancy 2

The above may seem a little daunting, but as long as you have a good support network (family, friends and professionals) you will be able to minimalise risks. We must also remember that drug companies are terrified of being sued, and therefore they will always cover themselves by telling us the worst, even if statistically it may be very unlikely.

Do not cease taking any medication without the support of your GP and/or Psychiatrist.

It may also be a good idea to speak to you GP or Psychiatrist before trying for a baby and have an action plan of how you and your support team are going to handle each hurdle as it comes along. As mentioned in previous blog, I was supported by a Perinatal Psychiatrist throughout my pregnancy and I am still under her supervision now as my baby is 18 weeks today and she will support me until Lola is 1 year old.

Helpful links

PANDAS (Pre and Postnatal Depression Advice and Support)

Mind – Antidepressants in Pregnancy

NICE (National Institute for Health and Care Excellence) – Antenatal and postnatal mental health

 

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