For women with mental illness, pregnancy and breastfeeding can be difficult because of feelings of guilt, shame, fear or stress about the medication that they may be using, and its potential effects on the baby. It is important to plan a management strategy to maintain optimal mental health during and after pregnancy. As a genetic counselor, I help women talk through their concerns and identify how to discuss them with their healthcare provider to ensure healthy outcomes for themselves and their babies.
Mental illness is reported in 10 percent of pregnant women and 13 percent of women who have just given birth worldwide, and it is unknown how many more remain undiagnosed.
If you have been diagnosed with a mental illness and are curious about how the medication may affect you and your baby, you may be tempted to turn to the Internet. While the amount of information about the use of medication in pregnancy and breastfeeding is improving, gaps still remain and the data you may find online may be limited or incorrect. For example, common misconceptions may include:
- Certain medications cause birth defects
- Taking no medication at all is the best way to have a healthy pregnancy and baby
- Products labeled “natural” are safe and effective for use in pregnancy
Because it can be difficult to determine what information is accurate, it can be helpful to involve a genetic counselor who has specialized knowledge in what medications may pose concerns for pregnancy or breastfeeding. Genetic counselors with this specialty can help you understand the most current reproduction information on the agents you take. They can also assist in communication between you and your healthcare provider so that you can both be involved in the process to determine the best treatment for you.
Is it Better NOT to Take Medications?
In fact, the benefits of treating a mental illness are often greater than the possible risks to a baby. Severe or uncontrolled mental illness can lead not only to emotional problems, but physical problems as well. For example, pregnancy complications (such as nausea and high blood pressure) occur at a higher rate in women who are depressed versus women who are not. Depression and its symptoms are also linked with fetal growth change and shorter gestation periods and poor self-care.
But, One Size Doesn't Fit All
Finding the right balance among available therapies requires good communication between patients, healthcare providers and, sometimes, genetic counselors. In every pregnancy, a woman starts out with a 3-5 percent chance of having a baby with a birth defect. We call this the background risk. If a woman needs to use medication during pregnancy, it is essential for genetic counselors and healthcare providers to know what medications a woman is taking, how often and at what dose, in order to provide the best possible care for mother and baby.
Finding the right balance among available therapies requires good communication between patients, healthcare providers and, sometimes, genetic counselors
By working closely with a healthcare team, you may make changes to your treatments. Some women are able to safely lower or stop using medications during and after pregnancy. Other times, additional therapies, such as counseling, yoga, therapy, massage and exercise, may help offer relief on their own or in addition to medication.
We encourage you to work with your healthcare team before starting, stopping or changing any therapies.
Although dealing with mental illness during and after pregnancy may be scary, there are experts available who can help. To find a genetic counselor in your area who can help with this, go to NSGC’s “Find a Genetic Counselor” tool.
Chris Colón, MS, is a licensed certified genetic counselor at MotherToBabyAZ and specializes in human teratogens in pregnancy and breastfeeding. She is also a member of several NSGC Special Interest Groups and has been a contributing member to the NSGC newsletter, Perspectives in Genetic Counseling, since 2010.
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