Planning a pregnancy with a mental health condition

Pregnancy and having a baby can be an exciting and demanding time for women. If you have an existing or past mental health condition it brings extra challenges and you are at higher risk of relapse during this time than at others.

If you have or had a mental health problem in the past and you’re planning to have a baby, you should talk to your doctor before you become pregnant. Most women 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.

If you are looking for general mental wellbeing information while planning a pregnancy click here. 

Some medicines used to treat mental health conditions can also 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 it’s important not to stop taking any medication you are taking without speaking to your doctor first, because stopping taking medicine could make your symptoms come back or get worse.

The doctor will talk to you about medicine that is safest for pregnancy and your health. Talking to the doctor will also help you find out how pregnancy may affect your mental health, which may help you feel more prepared and in control. This includes knowing how the medicines used to treat mental problems may affect you and your baby.

Pregnancy, giving birth and caring for a baby can affect women with mental health problems in different ways. Even if your condition is being managed well now, your symptoms could come back or get worse during pregnancy or in the weeks after birth.

This can sometimes happen quickly after childbirth and can become more serious. However, with the right support and treatment before you get pregnant as well as during pregnancy the risk of this will be much less.

Which medications can make it harder to get pregnant?

There are some types of medication that can affect your ability to get pregnant, and some others that have serious risks for the developing baby.

The National Institute for Health and Care Excellence (NICE) lists the following in particular:

Antipsychotics: Some types can make it harder for you to become pregnant – if this is happening it can be spotted through blood tests and you may be offered a different type.

Anticonvulsants: These are used to treat bipolar disorder and some are not suitable for women who are planning a pregnancy because there are serious risks to the baby. Speak to your doctor if you are taking these medications. 

Benzodiazepines: If you are taking a benzodiazepine and you are planning to have a baby, your doctor should talk to you about possibly stopping it gradually.

Lithium: You shouldn’t be offered lithium if you’re planning to have a baby, unless you have tried antipsychotic medication and it hasn’t helped. If you are offered lithium, your doctor should tell you how it may affect your baby. They should also talk with you about how often you will need to have check-ups. You should not breastfeed if you need to take Lithium.

Should I stop taking my medication now?

Do not stop taking medicine for mental health problems before talking to a doctor. This can lead to withdrawal symptoms, particularly if stopped abruptly, or it could make your symptoms come back or get worse.

Because it’s impossible to know when you will become pregnant, the best thing to do is keep using contraception until you’ve spoken to your doctor about your treatment.

They will discuss:

  • How pregnancy and birth might affect your condition
  • How your treatment can be made as safe as possible during pregnancy.

You should tell the team who look after your mental health that you’re pregnant, and also tell the midwife or doctor looking after your pregnancy that you have a mental health condition.

If you have or had a psychotic disorder (such as bipolar disorder or schizophrenia), the health professionals will work together to make a plan for your care during pregnancy, birth and afterwards.

If you’re already under the care of a community mental health team (CMHT), you should tell your care co-ordinator that you’re pregnant. They will be able to tell you about the treatment and support that are available for pregnant women and new mums in your area. If you are not under the care of a CMHT, but have been in the past, you should talk to your GP. You may need the support of the CMHT during pregnancy and for a few months after your baby is born.  

You can read more about different types of medication and pregnancy here.

What should I ask my doctor about?

Talk to your GP about your plans for pregnancy and your experience of mental health problems.

Remember, your doctor is there to help you, not judge you in any way. You could try asking the following questions: 

  • How might pregnancy and childbirth affect me?
  • What is the risk of my mental health condition I have had before coming back or getting worse?
  • How might my condition and its treatment affect me and my pregnancy and afterwards?
  • How might my condition and its treatment affect parenting?
  • Are there any risks associated with not treating my condition?
  • If my condition isn’t treated with medication how will my symptoms be controlled?
  • What mental health services are available for pregnant women in my area?
  • What kind of support is available after my baby is born?

Will I get specialist support?

Your GP may refer you for pre-conception counselling if you have a current or past severe mental health condition such as a severe depressive disorder, bipolar disorder, or psychosis.

You may also be referred to a specialist perinatal mental health service if there is one in your area. These are community-based teams of mental health professionals who care for pregnant women and women after childbirth with mental health problems, and their families.

If you are referred for specialist support before pregnancy, you should continue using contraception and any other medicine until you have had a full psychiatric assessment.

Find out more about specific mental health conditions and how they are managed in pregnancy. 

What kind of treatment will I get?

Your healthcare team will talk to you about any prescription 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 gradually
  • using other treatments instead of medication 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 medication
  • what medications have helped you the most
  • if 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.

If you would like to stop medication when you are pregnant, but medication is the best treatment for your mental health problem, your doctor should talk to you about your reasons for wanting to stop medication and about the risks, if any, to you and your baby.

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 or counselling.

Find out more about treatment and support for mental health.

How will my mental health be monitored?

You and the healthcare professionals responsible for your care will decide:

  • what contact and support you need
  • how your symptoms will be treated
  • how your symptoms will be monitored throughout your pregnancy, 
    during the first few weeks after childbirth and afterwards
  • the role of all the healthcare professionals involved in your care.

This information will be included in a care plan.

Support from family and friends

Having a supportive partner and/or a network of supportive people 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 during the decision-making process about any investigations, 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 using alcohol or drugs can damage your ability to get pregnant and are harmful to both women and babies in pregnancy. There is support available in these circumstances.

Find out more about alcohol and drug use when planning to have a baby. 

Cigarette smoking

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.

Find out more about support to quit smoking here.

What about medication when I’m breastfeeding ?

Breastfeeding has benefits for your baby, and health professionals will encourage you to do it if you can. They should talk to you about treatments that you could take if you decide to breastfeed. Many types of medication for mental health problems can pass through your breastmilk but in most cases it is in extremely small amounts, considerably less than the amount that passes through in pregnancy. A few medications may affect your baby so health professionals will discuss the risks of starting, stopping, continuing or changing medication with you.

If you need medication that means breastfeeding isn’t safe for your baby, or there are other reasons that breastfeeding is not for you (such as the impact of sleep deprivation on your mental health, you should be supported and not made to feel guilty about this. It is important to your baby that you are not unwell.

If you are breastfeeding and are taking medication for a mental health problem, your baby should be checked for any side effects.

Find out more about antidepressant medications and their side effects (NICE guidance)

Find out more about antipsychotic medications and their side effects (NICE guidance)

What can I do to help myself?

 

Sources

1. NICE (2013) Antenatal and postnatal mental health: clinical management and service guidance National Institute for Health and Care Excellence

2. Clinical Knowledge Summaries (Aug 2017) Pre-conception advice and management https://cks.nice.org.uk/pre-conception-advice-and-management

3. National Institute for Health Research (2017) Better beginnings Improving health for pregnancy https://www.dc.nihr.ac.uk/themed-reviews/health-in-pregnancy-research.htm

4. British Medical Association (2014) Smoking and reproductive life; The impact of smoking on sexual, reproductive and child health https://www.rauchfrei-info.de/fileadmin/main/data/Dokumente/Smoking_ReproductiveLife.pdf

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Last reviewed on February 1st, 2015. Next review date February 1st, 2018.

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