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  • Kim WD, Psych NP

I’m Pregnant! What Do I Do About My Psych Meds?

If you are reading this post about being pregnant while taking psych meds, let me assure you that 1) you aren’t the first, 2) you won’t be the last, and 3) you are not alone. The vast majority of women (and babies!) who find themselves in this same situation come through just fine. In the United States, roughly one out of five women (about 18-24%) take medication for a mental health condition. And whether a woman plans on having a child or not, many women do become pregnant each year while on psych meds. We know that because –

  • 49% of pregnancies in the US are unintended

  • 80% of teen pregnancies are unintended

  • 82% of US women have had a child by age 40

The good news is that despite information circulating to the contrary, overall there is a very low risk that the psychiatric medications you are now (or will be) taking will harm you or your developing baby. The important thing will be that you and your healthcare team work together to keep your (and your baby’s) risks as low as possible. We do this by prioritizing and working with you towards three goals.

Goal #1: Co-management of pregnancy, labor, delivery, and post-partum

It may be in your best interest to have a Psychiatric-Mental Health (PMH) provider on your team. But if you are wondering, “Do I have to give up my own Doctor or Nurse Practitioner if I see a PMH provider?” that’s easy to answer – no, you don’t. Your team of trusted healthcare professionals is expanding, not being replaced. By including someone experienced in caring for the special psychiatric and mental health needs of pregnant (and post-partum) women, everyone else’s jobs become that much easier.

As a team, your healthcare providers will share information and any concerns about assessment, screening and management of your physical and mental health. Your team will communicate with each other and with you. Together they will be able to focus on both acute and chronic issues – and your physical and mental health – to assure a healthy pregnancy, a healthy mom, and a healthy baby.

Goal #2: Prioritize maternal mental health

Each of your healthcare providers is a specialist, and each provides care within their own specialty. As a healthcare team we work we together to –

  • ensure maternal stability

  • optimize the health of your newborn

  • optimize the well-being of other family members, especially young children in the family

Psychiatric disorders can be a challenge to live with, and having a mental health issue can increase the risks of other problems. During pregnancy and the period immediately after, we concentrate on optimizing and stabilizing each mother’s mental health. If a woman is already taking psych meds, we work with her to support her mental health treatment, which is guided by her PMH provider.

During pregnancy and postpartum, it’s important to carefully weigh any decisions to start or stop medications. What we have learned over the years is that the risks associated with discontinuing psychiatric medications usually outweighs the risks of continuing them. We know that women who discontinue their psych meds –

  • are at much higher risk of mental health relapse (rates of relapse during pregnancy range between 55% to 70%)

  • are more likely to experience recurrences (85.5% vs. 37%) of mental health issues, and spend more time ill, and

  • have much higher rates of mood episodes postpartum (70%)

In every case, your PMH provider will carefully assess the risks associated with medications, and whether continuing to take a medication is safer than risking destabilization by not taking that medication.

Goal #3: Manage medication and mental health risks

There are some medications that your Psychiatric-Mental Health provider will watch more closely, and some mental health conditions that will also be monitored and assessed more frequently. But when you have access to a team of healthcare professionals who are experienced in working with women of childbearing age, you are in good hands.

Your PMH provider will be guided by your preferences and goals. You will be offered education on the risks and benefits of mental health medications to help you make informed decisions about your own mental health needs. No two women are the same, and what may be perceived as an acceptable risk by one woman may be considered unacceptable by another. Together with your PMH provider, you will engage in goal setting, discuss risks and benefits, and establish treatment preferences.

Post-partum Depression (PPD)

The baby blues. One of the primary focuses for Psychiatric-Mental Health providers has become helping women through that period known as maternal depression, or the baby blues. Whether it’s a few sleepless nights with a colicky baby, or a deeper, longer, and more overwhelming sadness, it is important that we give this condition the attention it deserves. Nationally, we estimate that 10% to 20% of new moms will have the baby blues at some point.

Why do we consider treating maternal depression to be so important? Because PPD affects everything. PPD impacts the health of the mother, the health and future of her infant, and the well-being of her entire family. We have come to understand how important it is to screen for PPD risk. Screening for PPD is important because we’ve learned that many women with PPD are ashamed of their symptoms. There is a social stigma associated with the diagnosis of PPD.

What symptoms of postpartum depression do we watch for? Common, concerning symptoms include –

  • sleep disturbances

  • anxiety

  • irritability

  • feeling overwhelmed

  • preoccupation with baby’s health or feeding

We screen for maternal depression not only because of the negative effects on the mother, but also because of the long lasting, and often permanent effects PPD can have on her child. We now know that not treating post-partum depression in the mother raises risks for all of the following in her baby –

  • insecure attachment

  • behavioral problems

  • cognitive function

  • increased risk of abuse, neglect

  • childhood psychiatric diagnoses and symptoms

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