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It is important to offer advice to women on healthy behaviours including maintaining a healthy diet, regular physical activity, promoting emotional wellbeing, use of folic acid supplement’s, sexual health checks and ensuring that immunisations are up to date.
Identify risk factors that could affect maternal and foetal outcomes such as smoking, alcohol, substance abuse, obesity, long-term physical and mental health conditions, previous pregnancy complications, genetic risks, maternal age, adverse childhood experiences, domestic abuse and migrant health factors.
Consider referring a woman to a secondary mental health service (preferably a specialist perinatal mental health service) for preconception counselling if she has a current or past severe mental health problem and is planning a pregnancy.
When prescribing psychotropic medication for women of childbearing potential, take account of the latest data on the risks to the foetus and baby.
Valproate (Epilim, Depakote and other generic brands) is associated with a significant risk of birth defects and developmental disorders in children born to women who take valproate during pregnancy. If valproate is taken during pregnancy, up to 4 in 10 babies are at risk of developmental disorders, and approximately 1 in 10 are at risk of birth defects.
Medicines and Healthcare products Regulatory Agency (MHRA) states that Valproate must no longer be used in any women of childbearing age unless they have a pregnancy prevention programme in place. This is designed to make sure patients are fully aware of the risks and the need to avoid becoming pregnant. No women or girls should stop taking valproate without first discussing it with their doctor.
Guidance on Valproate use in women and girls is available here:
gov.uk
Below is a guide for healthcare professionals involved in the care of women with serious mental illness (SMI) in primary and secondary care, developed by KCL in partnership with PHE, NHSE and Tommy’s:
Delivering preconception care to women of childbearing age with serious mental illness leaflet
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