Top tips for GPs in prescribing in perinatal period
Perinatal mental illness affects 1 in 5 women and the vast majority of them are seen within primary care. GPs often encounter scenarios where women are taking psychotropic medication and they want their GPs to advise them whether these medications should be continued in pregnancy.
Here are a few helpful tips to enable GPs to approach these scenarios:
Stopping treatment abruptly may carry a high risk of relapse. Discuss with the woman about potential risks and benefits of psychotropic treatment. Relapse may ultimately be more harmful to mother and the child than continued effective drug therapy.
Consider remaining with current (effective) medication, rather than switching, to minimise the number of drugs the foetus is exposed to.
Consider switching to low risk drug (those with latest up-to-date evidence of safety for the mother or foetus), if necessary.
If you need further advice, contact your local perinatal mental health team.
If starting treatment during in the perinatal period.
Choose the drug with the lowest risk profile for the woman, foetus and baby, taking into account a woman’s previous response to medication.
Use the lowest effective dose.
Use a single drug, if possible, in preference to polypharmacy.
take into account that dosages may need to be adjusted in pregnancy.
Avoid drugs contraindicated during pregnancy in women of childbearing age group (especially Valproate and Carbamazepine).
The woman (and her family, if appropriate) need to be involved in making an informed decision.
More information is available at the following websites:
RCGP Perinatal Mental Health Tookit
This Perinatal Mental Health toolkit is a set of relevant tools to assist members of the primary care team to deliver the highest quality care to women with mental health problems in the perinatal period.