The use of medications during pregnancy and childbirth
While having a baby can be one of the most exciting and important things to happen in a woman’s life, it can be a time of great anxiety, especially if the woman has mental health problems.
While pregnancy is often portrait in the media as a time when women are seen with big beaming smiles on their faces, in fact pregnancy does not protect against mental illnesses such as depression and anxiety. Even worse, immediately after giving birth is the time of greatest risk of mental illness for all women. Some women are particular at risk, including those who suffer from a bipolar disorder or who have had a previous ‘post partum’ (after birth) illness.
We know that in general, medication can help many people who suffer from mental illnesses such as depression, bipolar disorder and schizophrenia stay well. However, some of the medications used can affect the chances of a woman becoming pregnant. In addition, some medications if taken during pregnancy may lead to harm to the unborn child.
This means that decisions about medication before, during and after pregnancy can be very difficult. Concerns of risk to the baby from the medication have to be balanced against findings that untreated mental illness during and after pregnancy can also have a negative effect on the child.
The British Association of Psychopharmacology (BAP) is an independent academic association of researchers and clinicians. It has twin aims of advancing research into the use of medications used for mental illness and improving the education of doctors who use these medications. In addition, to help guide doctors, the BAP also produces guidelines that are widely used in the U.K., especially by psychiatrists.
The head of the Northern Centre for Mood Disorders (NCMD), Dr Hamish McAllister-Williams, recently led a group of experts from across the U.K. in developing BAP guidelines for the use of medication for mental illness before, during and after pregnancy (see https://www.bap.org.uk/pdfs/BAP_Guidelines-Perinatal.pdf). These guidelines are primarily for doctors and so are very technical in the way they have been written. However, women who are planning a pregnancy, or who are pregnant, or their partners or family, may find the guidelines of value. In particular, it may be helpful to discuss the recommendations in the guidelines with the woman’s own doctor or psychiatrist.