Psychotropic medication in pregnancy

Wallace, J. The Mental Elf Blog. Published online 17 May 2016

Postpartum psychosis is more common in women with bipolar disorder and even more so in those who were medication free during pregnancy (Wesseloo et al, 2016). Patients who suffer from schizophrenia also report worsening mental health following pregnancy (Jones et al, 2014).

There is a severe lack of evidence on the risks and benefits of psychotropic medication in pregnancy. No randomised controlled trials have been conducted that establish whether the benefits of taking antipsychotic drugs outweigh the risks for pregnant or postpartum women (Webb et al 2004, 2009). Some psychotropic medications are known to have teratogenic and adverse neurodevelopmental effects (Epstein et al, 2015; Tomson et al 2012) and currently no psychotropic medication is licensed for use in pregnancy. This creates a dilemma for healthcare professionals and patients; protect the woman’s mental health or protect the unborn child from the potentially damaging effects of psychotropic medication?

Image source: Tatiana Vdb // CC BY 2.0

The National Institute for Health Research has commissioned research to address the question: What are the risks and benefits of psychotropic drugs in women treated for psychosis who become pregnant? (Peterson et al, 2016). The results show that the majority of women discontinue psychotropic medication either before or early in pregnancy. In this cohort, women prescribed anticonvulsant mood stabilisers, in particular valproate, were at increased risk of giving birth to a child with major congenital malformation, neurodevelopmental and behavioural disorders.

This is in contrast to those prescribed antipsychotics where, after controlling for confounding factors such as obesity, alcohol problems, smoking, concomitant medications and illegal drug use, there was no increased risk of major congenital malformations, confirming previous research (Tomson et al 2012; Coughlin et al, 2015; Wide et al, 2004) and Guidelines (NICE, 2014).

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