British Association for Psychopharmacology consensus guidance on the use of psychotropic medication preconception, in pregnancy and postpartum 2017

Abstract

Decisions about the use of psychotropic medication in pregnancy are an ongoing challenge for clinicians and women with mental health problems, due to the uncertainties around risks of the illness itself to mother and fetus/infant, effectiveness of medications in pregnancy and risks to the fetus/infant from in utero exposure or via breast milk. These consensus guidelines aim to provide pragmatic advice regarding these issues. They are divided into sections on risks of untreated illness in pregnancy; general principles of using drugs in the perinatal period; benefits and harms associated with individual drugs; and recommendations for the management of specific disorders.

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“…The decision to use any pharmacological intervention during pregnancy is challenging for the mother in addition to the prescriber and requires clear knowledge of potential harmful effects on the developing fetus and risks such as the development of gestational diabetes. However, the choice to continue treatment or not can be overshadowed by the clinical need for therapy during gestation, and the potential consequences of withdrawing treatment …”

“…This is particularly important given that recent reports in the UK have suggested that one in 25 women (aged 20–35 years), who die by suicide, do so during the perinatal periods (conception–pregnancy and postnatal) . And further, that poor mental health during gestation is highly correlated with poor mental health postnatally …”

“…Clinicians are likely to be faced with the possibility of treatment (or not) within the perinatal setting. However, clinical studies have demonstrated that pregnancy should be considered as a ‘high‐risk’ period for relapse in the context of a discontinuation of any maintenance treatment options . This is particularly important given that recent reports in the UK have suggested that one in 25 women (aged 20–35 years), who die by suicide, do so during the perinatal periods (conception–pregnancy and postnatal) .…”

Increased attention should be paid to perinatal mental health and to the need of dedicated services

“…A decision to use antidepressants during pregnancy should be based on the balance between risks and benefits, taking into account the severity of illness and psychiatric history. Recently, consensus guidelines have proven very useful to help healthcare professionals in clinical decision-making 15. It therefore appears appropriate that the different professionals involved (psychiatrists, general practitioner, gynaecologists, obstetrics) identify the depressive and/or anxious symptoms at an early stage or identify as soon as possible women who are at increased risk for perinatal depression and anxiety.…”

17th Latest Advances in Psychiatry Symposium 2018

“…1 For other anti-epileptic and anti-epileptic mood stabilsers, carbamazepine can increase the risk of congenital malformations, but as lamotrigine is no longer strongly associated with cleft-palate or cleft-lip "it is the one of these three that we would feel more relaxed about prescribing during pregnancy", said Prof. McAlister-Williams.…”