GPs should ask women of childbearing age who have a history of mental health problems about their use of contraception and whether they plan to get pregnant, say new NICE guidelines on managing mental illness before, during and after pregnancy.
The new guidance says GPs should discuss how pregnancy and childbirth can impact on a women’s mental health, and also how mental illness and treatments may impact on the baby and parenting.
The guidelines’ ‘key priorities for implementation’ say GPs should ‘discuss with all women of childbearing potential who have a new, existing or past mental health problem: the use of contraception and any plans for a pregnancy; how pregnancy and childbirth might affect a mental health problem, including the risk of relapse; how a mental health problem and its treatment might affect the woman, the fetus and baby; and how a mental health problem and its treatment might affect parenting’.
In other key new recommendations, GPs are advised to choose treatment with TCAs, SSRIs and (S)RNIs in pregnant women carefully because of the risks of discontinuation syndrome – and to avoid paroxetine and venlafaxine in particular where possible.
The guidance states: ‘When choosing a tricyclic antidepressant (TCA), selective serotonin reuptake inhibitor (SSRI) or (serotonin) noradrenaline reuptake inhibitor ([S]NRI), take into account… the risk of discontinuation symptoms in the woman and neonatal adaptation syndrome in the baby with most TCAs, SSRIs and (S)NRIs, in particular paroxetine and venlafaxine.’
The guidelines also highlight that GPs should no longer prescribe valproate in women who may get pregnant, after the European drugs regulator’s decision earlier this year to ban its use in pregnant women because of the risks of malformations and developmental problems in children exposed to the drug in the womb.
And as part of advice aimed at improving the recognition and care of women who develop mental illness with pregnancy, GPs are now advised to screen women for anxiety as well as depression before and during pregnancy.
Professor Mark Baker, director of the NICE centre for clinical practice, said: ‘The guidance makes a number of new and updated recommendations, covering not only treatments, but also in providing women who are newly diagnosed or with a history of mental health problems with the information and support they need before they become pregnant.’