Sodium Valproate & other mood stabilisers - query regarding pregnancy

[Accidentally Abstract]

Hiya,

One of my friends has been on sodium valproate for years due to being bipolar and is now thinking about having children in a couple of years time and starting to consider the prospect of coming off the medication (that particular medication can be very dangerous to unborn children).

I've advised her to speak to her Mental Health Team about it, but in the meantime was wondering if anybody had any advice about coming off this drug and whether there were any other mood stabilising drugs which she might be able to go on which wouldn't affect her or the baby during a pregnancy.

Any advice would be much appreciated by both me and her, as she's quite aggitated by the whole situation.

Thanks!

[tiptoes]

I don't have any personal experience other than to be careful whilst on lamotrigine.

I have found this which I thought might help though source

Quote:

8) What about sex, pregnancy and medication?
Medication can affect sexual desire (libido), arousal and your ability to
have an orgasm. Mood stabilisers have not been reported to have a major
adverse effect on sexual function. However if this does happen, you
should discuss it with your doctor as a change in dose may help minimise
the problem.

Pregnancy
The risk of relapse after giving birth is hugely increased in women with a
history of bipolar disorder compared to the general population.25
Also, the
risk of relapse during pregnancy if mood stabilising medication is stopped
is high.26
If you are considering trying for a baby, you are well advised to
contact your doctor and discuss your options around medication and
planning treatment.

Women who are experiencing a manic episode may lose some of their
sexual inhibitions and may have a higher rate of unplanned preganancy
than the general population. As not all pregnancies are planned, it could
be good practice for doctors to discuss the possibility of becoming
pregnant with all women of child-bearing age. Also, it may be best to avoid
medications that are not recommended during pregnancy if you are
woman of child bearing age. If one of these drugs is prescribed, then the
doctor should give you information about the effects that it can have during
pregnancy.


No mood stabiliser is completely safe during pregancy. Therefore it is
important that any decision about treatment during pregnancy weighs up
the individual risks and benefits.

Lithium
Taking lithium during pregnancy has a well known risk of heart problems in
the foetus.27
The time when the foetus is at most risk is 2-6 weeks after
conception, which is before the majority of women will know that they are
pregnant. Lithium should be avoided in pregnancy if possible. If lithium is
to be discontinued, this would preferably be before the baby is conceived.
This would allow gradual stopping of the lithium over a period of time28
– it
is thought that stopping lithium abruptly can increase the risk of relapse.

Valproate 7


It is known that valproate can have harmful effects on the foetus. There is
a particular link with spina bifida.29
NICE guidance recommends that
valproate should not be given routinely to women of child-bearing age. If
they are given it, then they should be advised about the importance of
contraception.30


Carbamazepine
Carbamazepine taken during pregnancy also has a link with increased risk
of foetal abnormalities, particularly spina bifida.31
NICE recommends that it
is not routinely prescribed during pregnancy.32
Women of child bearing
age taking carbamazepine should be aware that it can affect the oral
contraceptive pill.

Lamotrigine
Lamotrigine is linked to an increased risk of cleft palate.33
NICE
recommends that it is not routinely prescribed during pregnancy.
34


Antipsychotics
NICE guidance recommends antipsychotics that are used as mood
stabilisers are preferable to other mood stabilisers during pregnancy.
35


The data on the pregnancy risks associated with antipsychotics is limited.
There is most data on the use of olanzapine. It has been associated with
lower birth weight. There has been reported risk of diabetes for the
expectanct mother during pregnancy. Olanzapine seems to be relatively
safe in terms of physical defects, although it has been associated with hip
joint problems in the baby and a form of spina bifida.36


Limited information suggests that neither risperidone or quetiapine have a
major effect on the growth and development of the foetus. There is little
other information on other atypical antipsychotics.

Breast feeding
There is limited information about the safety of mood stabilisers during
breast feeding. The benefits and risks of breast feeding should be weighed
up. Your options during this period should be discussed with your doctor
or psychiatrist.

[Wellingtons]

I'm bipolar and pregnant, I'm on sertraline and chlorpromazine

[sherlock holmes]

I came off sodium valproate no problem. Though if she wants to get pregnant there's not many mood stabilisers she can take. If her bipolar is severe, and she needs mood stabilisers, then the benefit of taking them can outweigh the potential risk to the baby- as if she was unmedicated she may be a risk to her unborn child.

I'd encourage her to discuss her options with a psychiatrist as they know best.

[Accidentally Abstract]

Yeah I've told her to discuss it with her mental health team and I believe she's going to do so.

I've not seen much evidence of her bipolar being severe, but then she's always been medicated since I've known her.

Thanks for the advice guys & I hope the pregnancy & birth go well for you 'Wellingtons'. :)

[Wellingtons]

There are specialist perinatal services available for pregnant and postnatal women which her regular CMHT can refer her to.

[Accidentally Abstract]

Awesome, thanks! :)