Miscellaneous

Here we cover general principles: disorder-specific guidance is given in the relevant chapters.

With a few exceptions, most prescribing decisions are a balance of risks and benefits in the context of an individual patient, rather than simple instructions. ^BAP

Data on safety of psychotropic drugs in pregnancy should be considered with caution as the evidence is generally based on observational studies rather than randomised controlled trials (RCTs). There are significant risks of confounding variables (e.g. smoking and alcohol use). Efficacy is usually generalised from studies in the non-perinatal populations. ^BAP

Discuss treatment and prevention options with woman including potential benefits of treatment, consequences of no treatment, harms associated with treatment and what might happen if treatment is changed/stopped. ^NICE

Poor mental health in pregnancy predicts mental illness post-partum, but it is possible that effective treatment might ↓ this risk. ^BAP

Untreated mental illness can have a negative impact on pregnancy outcome, specifically due to higher rates of substance misuse, poor self-care and suboptimal use of antenatal care. ^BAP

Untreated antenatal depression may be associated with low birth wt, preterm delivery and emotional problems in the child. ^BAP

Antenatal stress and anxiety may be associated with behavioural and mental health problems in the child. ^BAP

Eating disorders ↓ fertility. Anorexia nervosa is associated with ↓ birth wt. Bulimia nervosa is associated with ↑ birth wt. ^BAP

General factors to consider in management: Accuracy of diagnosis, illness factors (course, severity, risk), comorbidities, relapse frequency/triggers, (F)Hx of perinatal relapses, treatment Hx, social function. ^BAP

Minimise number and dose of medications but avoid subtherapeutic doses. ^BAP

Using a drug with known efficacy in this patient may be preferable to one of unknown efficacy with a possible lower pregnancy risk. ^BAP

Explore and address substance misuse, including smoking. ^BAP