Mental health medication and pregnancy

Pregnancy

As the stigma around mental health continues to improve, people are more likely to seek treatment. A woman who has just learned she’s pregnant may wonder: should I stop taking medicines like Zoloft or Prozac? Will they hurt my baby?

Sarah Shoemaker, a certified nurse midwife at OSF HealthCare, says first of all, you’re not alone. She says around one in five women experience a mental health concern during pregnancy, and many of those women are taking medication for things like anxiety, depression and bipolar disorder. Shoemaker says most of the time, you can and should stay on your medication. But it’s a conversation you should have with your health care team.

Shoemaker implores women to talk about medication with their provider early Ideally, it’s before they conceive. Shoemaker says don’t change or stop your medicine routine until you have that talk. You may have your child’s best interest in mind, but a change could compromise your or your child’s health.

“There are some women who take years to find the perfect combination of medications that keep them stable and healthy. We don’t want to mess with that. Very rarely do we have to completely disrupt somebody’s medication regimen,” Shoemaker says. “Nothing in our field is black and white. There’s no such thing as bad medication or strictly dangerous medication. We weigh the pros and cons and decide what’s best for each patient.

“If you look online, you’re going to find all kinds of information. You’re going to find conflicting sources, old studies and poorly written studies,” Shoemaker adds, referencing the temptation to rely solely on your own research.

Shoemaker says a provider may order one or more ultrasounds before making a decision on medication. If a provider advises that a change is needed, you could go on a supplement. For example, Shoemaker says a medicine like valproic acid (a seizure medicine sometimes used for bipolar disorder) may increase the risk of neural tube defects (NTDs) in your unborn child. Spina bifida, or the abnormal development of the spinal cord, is a common NTD. In this case, a provider may advise adding a folic acid supplement at a high dose. Shoemaker adds that for medications like valproic acid, drugmakers and doctors are vocal up front: don’t start taking it if you’re trying to get pregnant. That way, you don’t have to possibly make a change mid-pregnancy.

If you’re on a medication that’s new to the market, that’s also a definite “must talk about” with your provider. That’s because we don’t know a lot about how new medications impact pregnancy. Shoemaker points out that scientists typically don’t do intense studies on pregnant women so they don’t disrupt the pregnancy. Rather, the research is done after birth.

“We discuss what the woman is on, how we can counteract the risk and what the actual risk is for her specific situation. Then we can make a shared decision about what is best for her and her family,” Shoemaker says. She adds that the woman’s entire care team – their primary care provider, their mental health provider and their OB/GYN or midwife – should be working together.

Shoemaker admits all this can be a tough task. But there are tried-and-true ways to get to the root of a pregnant woman’s mental health concern. Providers also build extra time into appointments to talk about mental health. Shoemaker says she often uses humor to break the tension. She can also use personal experiences to relate to the mom-to-be. And she’s also not afraid to ask a lot of questions: are you sure there’s nothing else we can talk about? How are you doing emotionally?

“If you continue to ask in new and different ways, women eventually open up. They say ‘yeah, this is really bothering me. I wondered if it was normal. I was afraid to talk about it,’” Shoemaker says. “Once you make it clear that the provider is a safe person to talk to and mental health is really important, women will open up.

“More women need to talk about how difficult it can be to be pregnant, to be a mother and to be going through this huge life transition,” Shoemaker adds.

Learn more about how you can a successful pregnancy and birth on the OSF HealthCare website.