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Planning a pregnancy with a mental health condition
This information is for you if you have or had a mental health problem in the past, and you’re planning to have a baby.
Most pregnant people with mental health problems have healthy babies with the right treatment and care, but it is important to talk to your doctor or specialist early on.
Some medicines can make it harder to get pregnant or may not be suitable to take during pregnancy.
It’s natural to worry about the effects of medicine on a baby, but if you’re taking medication, it’s important not to stop taking it without speaking to your doctor first. Stopping taking medicine could make your symptoms come back or get worse.
Your doctor will discuss:
Whether your medicine might affect your fertility.
How pregnancy and birth might affect you.
How your treatment can be made as safe as it can be during pregnancy.
Finding out how pregnancy may affect your mental health can help you feel more prepared and in control. This includes knowing how the medicines used to treat mental health problems may affect you and your baby.
Pregnancy, giving birth and caring for a baby can affect people with mental health problems in different ways. Your symptoms could come back or get worse during pregnancy or in the weeks after birth.
This can sometimes happen soon after childbirth and can quickly become more serious. But with the right support and treatment before you get pregnant, as well as during pregnancy, the risk of this will be much less.
Do not stop taking medicine for mental health problems before talking to a doctor. This can lead to withdrawal, particularly if stopped abruptly, or it could make your symptoms come back or get worse.
Your fertility may return to normal a few days after you stop using most types of contraception. The only one this doesn’t apply to is the contraceptive injection, where it can take up to a year.
Because you cannot know how quickly you will become pregnant, the best thing to do is keep using contraception until you’ve spoken to your doctor about your treatment.
Most couples will get pregnant within a year if they have unprotected sex (without contraception) every 2-3 days. For some, it can happen much more quickly than that, while others may take longer.
Talk to your GP – and any mental health specialists you may be seeing – about your plans for pregnancy and your past, or current, mental health problems.
They are there to help you, not judge you in any way. You could try asking these questions:
How might pregnancy and childbirth affect me?
What is the risk of my mental health condition coming back or getting worse?
How might my condition and its treatment affect me and my pregnancy and after the birth?
How might my condition and its treatment affect how well I can parent?
Are there any risks of not treating my condition?
If I’m not taking medication, how will my symptoms be controlled?
What should I do if I feel my mental health is getting worse?
What mental health services are there for pregnant people local to me?
What kind of support can I access after my baby is born?
Will I get specialist support?
You may be referred to a specialist perinatal mental health service if there is one near you. These are community-based teams of mental health professionals who care for pregnant women and women after childbirth with mental health problems, as well as their families.
They may offer you pre-conception counselling, which is a chance to ask questions about how your mental illness may affect a future pregnancy and your chances of getting pregnant. They will help you make informed choices about your planned pregnancy.
If you are referred for specialist support before pregnancy, you should keep using contraception and any other medicine until you have had an assessment.
Your healthcare team will talk to you about any prescribed medications you are taking and your options. These may include:
taking prescribed medications if you are not already taking any
carrying on with your current medication
changing your medication to something with a lower risk of side effects for you and baby
stopping your medication slowly
using other treatments instead, e.g. talking therapy
To help you decide the best course of action, your healthcare professional will talk to you about:
how unwell you have been in the past
how quickly you have become unwell if you have stopped taking medication
what medications have helped you the most
whether any medications have caused side effects.
The treatment you have will be your decision. Your doctor can help you by discussing what your preferences are with you and explaining the risks and benefits of all options.
The treatment you have will be up to you. Your doctor can help you by talking to you about the risks and benefits of all the options.
Talking treatments
Your doctor may also suggest talking treatments. These are also known as psychological therapies. This may include visits from a health visitor, cognitive behavioural therapy (CBT) or counselling.
Having support around you can help you if you have mental health issues during pregnancy or afterwards. Your support network may include a partner, family or friends.
You may find it helpful to tell people you trust about your mental health condition. They can help you by:
They can also help you make choices about any tests, treatment or care options as you plan your pregnancy.
Alcohol and drug use
Some people may use alcohol or illegal drugs as a way of coping with their mental health problems. It is important to stop, because substance abuse can make it harder to get pregnant and cause harm to both you and your baby in pregnancy.
If you struggle with alcohol or drugs, your GP, mental health specialist or any other healthcare professional can help you find the support you need.
People with mental health conditions are more likely to smoke and find it harder to give up, but getting support can make a big difference.
Not only is smoking a risk to you and your baby if you become pregnant, it also affects your metabolism. This means that you might need a higher dose of certain mental health medications if you smoke. Quitting means you could reduce the dose, which may be safer for your baby.
Breastfeeding has benefits for your baby. Health professionals will suggest you do it if you can, and if you feel you want to. They should talk to you about treatment options for use while you breastfeed.
Some medications can pass into breast milk and may affect your baby, but in many cases the benefits outweigh any risks. Health professionals will discuss the risks of starting, stopping, continuing or changing medication with you.
You may need medication that means breastfeeding isn’t safe for your baby, or there could be other reasons that breastfeeding is not for you (such as the impact of lack of sleep on your mental health). If so, you should be given support, and not made to feel guilty about. What matters most to your baby is that you stay as well as you can.
If you’re breastfeeding and are taking medication for a mental health problem, your baby should be checked for any side effects.
You can get pregnant 3 weeks after you’ve given birth, even if you’re breastfeeding and your periods haven’t started again. Unless you want to get pregnant again, plan to start contraception after your baby’s born.
If you’ve talked to your doctor and are ready to get pregnant, use our ovulation calculator to find out when you’re most fertile.
1. NICE (2020). Antenatal and postnatal mental health: clinical management and service guidance. National Institute for Health and Care Excellence. https://www.nice.org.uk/guidance/cg192
5. Campion J, Hewitt J, Shiers D, Taylor D (2017) Pharmacy guidance on smoking and mental disorder – 2017 update. Royal College of Psychiatrists, National Pharmacy Association and Royal Pharmaceutical Society. Available at: https://www.drugsandalcohol.ie/27195/
