Psychotropic Medication and Childbirth

Established: April 2006; first meeting Sept 06

Convenor (Chair): Dr Hamish McAllister-Williams, Reader in Clinical Psychopharmacology, University of Newcastle. (e-mail: r.h.mcallister-williams@newcastle.ac.uk)

Members: By its very nature this work requires to be multidisciplinary involving Obstetricians, Perinatal Psychiatrists, Psychopharmacologists, Teratologists and Developmental Psychologists (plus Paediatricians and Perinatal Community Nurses who will be recruited at a later date). The group will work closely with the National Teratological Information Service (NTIS). In addition to the North East, the current membership of the group covers the South of London, North West and East Midlands Hubs of the MHRN, in addition to Wales and Scotland.

Dr R.H. McAllister-Williams (Convenor. Clinical Psychopharmacologist, University of Newcastle); Prof P. Baker (Obstetrician, University of Manchester); Ms J. Benjamin (Service user, Action on Puerperal Psychosis); Dr R. Cantwell (Perinatal Psychiatrist, University of Glasgow); Prof D. Hay (Developmental Psychologist, University of Cardiff); Dr C. Henshaw (Perinatal Psychiatrist, University of Keele); Dr I. Jones (Perinatal Psychiatrist, University of Cardiff); Dr T. Kelly (Neuropsychologist, University of Newcastle); Prof A. Le Couteur (Child Psychiatrist, University of Newcastle); Dr P. McElhatton (Teratologist, NTIS, University of Newcastle); Dr P. Moran (Obstetrician, University of Newcastle); Dr M. Oates (Perinatal Psychiatrist, University of Nottingham); Dr V. O'Keane (Perinatal Psychiatrist, Institute of Psychiatry); Dr S. Pawlby (Developmental Psychologist, Institute of Psychiatry); Dr S.H.L. Thomas (Clinical Pharmacologist and Medical Director NTIS, University of Newcastle); Dr A. Walsh (Perinatal Psychiatrist, University of Newcastle); Dr A. Wieck (Perinatal Psychiatrist, University of Manchester)

Devolved nation members:
Dr R.Cantwell (Perinatal Psychiatrist, University of Glasgow), Prof D. Hay (Developmental Psychologist, University of Cardiff), Dr I. Jones (Perinatal Psychiatrist, University of Cardiff)

Service user input into the Research Group will be via service users from each of the MHRN Hubs involved in the collaboration and the Action of Puerperal Psychosis Group from who we have a Research Group member.

Remit and Aims:
The pharmacological management of women with severe mental illness (SMI) during pregnancy and postnatally is fraught with difficulties. The impact of psychotropics versus untreated mental illness needs to be considered, both for the mother and the child.

There is increasing evidence that discontinuation of psychotropics during pregnancy is associated with high rates of relapse and that mental illness during pregnancy has lasting adverse effects on the mental and medical health of the baby. Some women are at extremely high risk of developing puerperal disorders but there are no clear guidelines as to how this can be managed. Risk/benefit analysis of prescribing in the puerperal period, especially in breast feeding women, is also complex.

The Department of Health's document "Women's Mental Health: Into the Mainstream" emphasises the importance of providing women with the fullest information. This is hampered by the limited quantity and quality of evidence. The currently available data is poor, based on small numbers of cases, predominantly older drugs now less commonly used, and with extrapolation of data from patients with different underlying diagnoses (e.g. epilepsy) that may differentially affect rates of adverse effects.

There is an urgent need for high quality evidence to help clinicians and users make informed choices about the use of psychotropic medication during the perinatal period.
Significant research is unlikely to be funded by the pharmaceutical industry. However, the UK has one of the best established perinatal psychiatry services in the world, enabling the development of a productive research collaboration to address these issues.
The research questions have proved difficult to examine in single research centres, given that rates of SMI in pregnant women are low overall. Advancement is critically dependant upon a research network.

Current Status & Future Plans:
The Research Group will investigate the risks and benefits of psychopharmacological management of women with SMI during pregnancy and the puerperium, both to wellbeing of the mother and the baby.

Women will be recruited through two routes:
Firstly, women with SMI (depression, bipolar disorder and schizophrenia) who are pregnant or planning to become pregnant will be prospectively identified through Obstetric clinics, Perinatal services and General Psychiatric services.  This cohort will be followed through pregnancy to establish the impact of SMI and treatment on the mental health of the mother, the outcome of the pregnancy and the health and development of the baby.

Secondly, women who are experiencing an episode of postnatal SMI will be identified.  This will be from the antinatally identified prospective cohort plus women identified through Perinatal Psychiatric services.  Risk factors for the development of postpartum illness will be studied, along with pharmacological management of postpartum SMI.

A number of projects will arise out of the Research Group.  Three major studies are as follows:
1.  The impact of psychotropic medication (antidepressants, antipsychotics and mood stabilisers) during pregnancy.
2.  The impact on child health and development of maternal SMI and the effects of treatment with psychotropics during pregnancy.
3.  The pharmacological management of postpartum SMI.