A handy fact sheet on mental health medicines and pregnancy General advice About these leaflets This leaflet is written for: women who are taking a medicine and want to become pregnant women who are taking a medicine and find they are pregnant women with mental health problems during pregnancy needing a medicine pregnant women who have had mental health problems in the past their partners, family or friends. The leaflet will help you learn about: how to decide whether or not to take a medicine for mental health problems in pregnancy how to stay well during pregnancy and after the birth of the baby what help and support there is during pregnancy for women with mental health problems. This information must be used along with information from, and discussions with, a healthcare professional about the options available. There are no right or wrong answers. Any decision should be made thinking about what is best for mother and baby. Medicines and pregnancy It is important to talk about any medication taken in pregnancy with a healthcare professional. They will give you the information you need to help you decide what is best for mother and baby. Medication can be continued, changed or stopped. If possible, talk to a doctor before becoming pregnant. If the pregnancy is unplanned see a doctor as soon as you know. Do not stop your medication suddenly, unless told to by a doctor. Stopping medicines suddenly can be more dangerous than carrying on. Decisions It is important to know that no decision is completely free of all risks:
There will be a risk to mother and baby from taking a medicine during pregnancy There will also be risk from stopping a medicine e.g. getting ill again About 2-4% (up to 1 in 25) babies are born with a major problem, even if no medicines have been taken The main possible problems are: 1. First trimester (months 1 to 3) – a baby completes its main development between days 17 and 60 of the pregnancy and so the first 2-16 weeks of pregnancy are very important. 2. Second and third trimesters (months 4 to 9) – there could be problems with slower growth. 3. Birth –medicines might interact with other medicines e.g. painkillers and there could be withdrawal symptoms in the baby. 4. Breast-feeding – medicines getting through to the baby in the milk. 5. After the birth - development of the child’s brain.
No one can make the decision for mother and baby. The best we can do is to help you understand some of the issues, so you can make an informed decision.
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The risks of untreated symptoms A healthcare professional can help you to think carefully about the advantages and disadvantages of taking medication. To help you weigh up the pros and cons of taking medication. Have a look at the scales below. Tick the box if the answer to a question is “Yes”. Ticks on the right hand side are good - they increase the chances of doing well. Ticks on the left hand side are not good - they increase the chances of not doing well. □ □ □ □ □ □ □
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Has mum been unwell several times? Has mum had any recent stresses or life events? Does mum become very unwell? Does mum become unwell quickly? Does it take several medicines to get mum well again? Was mum unwell for several months? When mum has been ill has this had a big effect on your family, friends, job, money? If mum has stopped medicines in the past did she become unwell in a few weeks or months?
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Does mum notice if she’s getting unwell and get help? Do other people say if mum is getting unwell? If medicines are restarted does mum get better quickly e.g. in a few weeks? Does mum have good family or carer support? Is mum happy about being pregnant? Has mum’s mental health been stable for the last year or so? Did the medicines help mum get better?
If the mum becomes ill again, more medicines may be needed If there are problems with mental health during pregnancy, this may lead to several problems, such as:
You may not take good care of yourself. You might not attend appointments with your midwife. This means you may not get the care you need. You may use more drugs and alcohol when unwell. This can be harmful for your unborn baby. You may need higher doses of the medication if you become ill. Sometimes you may need more medication to treat a relapse. This might be more risky for the unborn baby than a regular lower dose throughout pregnancy. You may need in-patient treatment You may still be unwell when your baby is born. You may then find it more difficult to care for your baby. This may also affect your relationship with your baby. Babies do better with well mothers. If your symptoms are not treated, this may be more harmful for your baby than the effect of medication. For example, many research studies have found babies are more likely to have a low birth weight if their mother has depression in pregnancy. Untreated mental illness can also affect a baby’s development later on e.g. bonding.
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What else you can do to maintain mental well-being during pregnancy
Eat a healthy, balanced diet Reduce alcohol intake and stop drinking if possible Stop smoking (ask a healthcare professional about ‘smoking cessation’ services) Find some time each week to do something enjoyable and relaxing Let family and friends help you with housework, shopping etc. Exercise (ask your healthcare professional about exercise in pregnancy and local exercise classes) Discuss any worries you may have with your family, your midwife or GP Get regular sleep. Know what relapse symptoms to look out for and know who to contact
How to help others to help you A number of services and professionals offer help and support during pregnancy. Maternity services – make sure the midwife knows about any mental health problems and attend all your antenatal appointments during pregnancy. In some areas midwives can do home visits. GP – talk to the GP if you are worried about mental health problems in pregnancy. They will give you information, advice and treatment and refer you to specialist services if needed. Community Mental Health Teams (CMHTs) and Specialist Perinatal Mental Health Services If a CMHT is involved, make sure they know about the pregnancy. They will know what treatment and support is available for pregnant women, and new mothers, in your area. In some areas there are specialist mental health services for pregnant and postnatal women called Perinatal Mental health Services. GPs and midwives can tell you if this type of service is available in your area. Children and Families Social Services – you may be referred to Children and Families Social Services. They focus on the child’s wellbeing and provide care and support for children and families. Health visitors – they see all women with new babies and offer advice and help about the baby’s health, feeding, sleep and other issues. Health visitors may visit even before the baby is born. Where you can I get further information, help and support
National Childbirth Trust (www.nct.org.uk), Pregnancy and birthline: 0300-3300772 for advice, support and counselling on all aspects of childbirth and early parenthood. Meet-A-Mum-Association (MAMA) (www.mama.co.uk), Helpline: 0845-120-3746 (7-10pm weekdays). Support for Mums, and Mums-to-be, suffering from isolation, loneliness and depression in pregnancy and childbirth, as well as their families. Local groups and on-line support. Netmums (www.netmums.com) - a website offering support and information on pregnancy and parenting. There is a section of the website offering support and local resources and support groups. The Association for Postnatal Illness (APNI) (apni.org), tel: 020-7386-0868, helpline and information leaflets for women with postnatal mental illness. Also a network of volunteers (telephone and postal), who have themselves experienced postnatal mental illness. Family Action (www.family-action.org.uk), tel: 020-7254-6251, Support and practical help for families affected by mental illness. Includes 'Newpin' services - offering support to parents of children under 5 whose mental health is affecting their ability to provide safe parenting. Royal College of Psychiatrists have leaflets on postnatal psychosis and depression (www.rcpsych.ac.uk) See the fact sheets for information on different medicines
The small print: This leaflet is to help you understand about medicines and pregnancy. Go to our website for fuller answers to these and many other questions. V01.06 [5-2016] ©2016 MisturaTM Enterprise Ltd (www.choiceandmedication.org). Choice and MedicationTM indemnity applies only to licensed subscribing organisations
https://www.choiceandmedication.org/ireland/