What are the guidelines for prescribing medications during pregnancy, particularly for chronic conditions?

Clinical guidelines recommend an individualised assessment of the benefits and possible risks of treatment for every woman during pregnancy, especially for managing chronic conditions ¹,²,³.

UKTIS, BAP, and NICE advise that maternal mental health conditions should be treated appropriately, considering fetal safety, with ongoing safety data suggesting low absolute risks of adverse effects ¹,³.

For women on medication, frequent review and dose adjustment are recommended, particularly in later pregnancy, to manage chronic mental health conditions effectively ².

Specific medications such as antidepressants should be used with caution, considering the changing risk-benefit ratio, and stopping antidepressants may be considered in mild to moderate depression ¹,²,³.

For antipsychotics, risks such as gestational diabetes and weight gain should be monitored, and the choice of drug should be based on limited safety data, with continued treatment advised if the woman is stable ⁴.

Medications like valproate and carbamazepine are contraindicated or should be avoided due to high fetal risk; if already on these drugs, stopping or switching should be discussed, following safety advice ⁴.

In cases of bipolar disorder, lithium should generally be avoided unless necessary, with careful monitoring if used, and gradual discontinuation considered if pregnancy is planned ⁴.

Overall, the management of chronic conditions during pregnancy involves balancing maternal health needs with fetal safety, with close monitoring and individualised decision-making ¹,²,³,⁴.