Planning a pregnancy

This information is written for any woman:

  • who has a mental health problem and wants to have a baby
  • who has had a mental health problem in the past and wants to have a baby
  • who is planning a first pregnancy, or who already has children and wants to get pregnant again

...and for their partners and relatives who want to find out more about how pregnancy can affect, or be affected by mental health problems.

Disclaimer

This webpage provides information, not advice. You should read our full disclaimer before reading further.

©  November 2018 Royal College of Psychiatrists 

Deciding to have a baby is one of the most important choices any of us can make. If you have mental health problems there are particular things to think about - you need good information, advice and support.

It can be hard to know when it's the best time for you to have a baby. Even if you are just thinking about having a baby in the future, it’s worth talking to your GP or psychiatrist. They may be able to give you the information you need to decide what to do. If not, they may be able to refer you to a perinatal psychiatrist. This is a doctor who specialises in caring for women with mental health problems during pregnancy and after birth. Perinatal psychiatrists can also see you if you are planning a pregnancy.

It is best for your baby if you can improve your health before you get pregnant.

Planning a pregnancy will give you time to:

  • find out about how pregnancy may affect your mental health
  • get information about medication in pregnancy
  • decide whether you want to change your treatment before you try to get pregnant
  • decide which maternity unit you want to go to
  • find out about mental health services for pregnant women in your area
  • consider what support you will need, especially after birth (e.g. you may need help with night feeds)
  • make sure you get help for any physical health problems
  • get help to stop smoking, drinking or using illegal drugs before you get pregnant
  • make sure you are as well as possible before you get pregnant. 
Getting these things right should help you to enjoy your pregnancy as much as possible.
Your GP is a good person to talk to if you are planning a pregnancy. If you are under the care of a mental health service you should also talk to your psychiatrist.
 
In some areas there are perinatal mental health services. These are specialist services for pregnant women and women with a baby up to one year old. Ask your GP or psychiatrist if they can refer you to a perinatal mental health service so you can see a perinatal psychiatrist for advice when you are planning a pregnancy. This is particularly important if you have had Bipolar Disorder, Schizophrenia, Postpartum Psychosis or any other psychotic illness.1-2 It may also be helpful if you have had other severe mental health problems (e.g. Depression or Obsessive Compulsive Disorder).
 
You may also find it helpful to talk to other women who have had mental health problems and who now have children. The organisations listed at the end of this leaflet offer advice and support.
 
You need to think about your physical health as well as your mental health.
 

You will have a more healthy pregnancy if you:

  • Stop smoking 
  • Cut down or stop drinking alcohol
  • Stop using cannabis and other illegal drugs
  • Lose weight if you are overweight – healthy eating and exercise may help
  • Increase your weight if you are underweight
  • Take folic acid (400mcg daily) for 3 months before you get pregnant and for the first 12 weeks of pregnancy – this can reduce the chance of your baby having a birth defect called spina bifida3
  • Take a higher dose of folic acid (5mg daily) if you are on some medications e.g. Carbamazepine (Tegretol)
  • Take a Vitamin D supplement (10 micrograms of Vitamin D per day)3
  • Have a check-up with your dentist – if you have gum disease you may be more likely to have a premature birth
  • Have a “well-woman” check-up e.g. a smear test and screening for sexually transmitted diseases
  • Get advice about any physical health problems e.g. diabetes or epilepsy
  • Make sure your vaccinations are up to date e.g. Rubella (German Measles) - a virus which can be dangerous for your baby in early pregnancy3
  • Get advice about how to eat healthily and foods you should avoid.
Your GP or psychiatrist can tell you where you can get help and advice in your area - for example, a  service to help you stop smoking. If you have a physical health problem, e.g. diabetes, your GP can refer you for specialist advice.

Many women worry about taking medication in pregnancy. You need to think carefully about what the risks and benefits of medication are for you and your baby.  For many women it may be safer to take medication in pregnancy than to stop. This is more likely if you have had a more severe illness.2 Deciding whether or not to continue or change your medication is not easy.

 If you want to get pregnant, discuss your medication with your psychiatrist or GP.  They can give you up to date information about medications in pregnancy. They can help you to decide what is best for you and your baby. Don’t stop your medication or reduce the dose suddenly. You are more likely to become unwell again if you do this without advice.

Sodium Valproate (also known as Valproic Acid, Epilim or Depakote) is a medication used for the treatment of Bipolar Disorder. Valproate can harm babies by causing birth defects and can cause developmental difficulties.4-7 The risk of harm to an unborn baby from Valproate is much higher than for other medications used to treat Bipolar Disorder. The doctor who prescribes your Valproate should have already told you about the risks of using this during pregnancy. It is very important that you seek advice from a psychiatrist (ideally a perinatal psychiatrist) if you are taking Valproate and want to plan a pregnancy. If you have an unplanned pregnancy when you are taking Valproate you should tell your GP or psychiatrist as soon as possible. You can decide together what medication would be safest to take for the remainder of your pregnancy. For more information see our page: Valproate in girls and women who can potentially get pregnant.

Always check whether herbal or over the counter medicines are safe to use in pregnancy.

It is best to use contraception until you have seen your doctor to discuss your medication. Unplanned pregnancies are common, so many women have to make decisions about medication when they are already pregnant. If you find you are pregnant, try to see your doctor as soon as possible.

To decide about using medication in pregnancy, you will need to think about:

  • How unwell you have been in the past
  • How quickly you become unwell when you stop medication
  • Medications you have taken:
    • which treatments have helped you most?
    • have some medicines caused side-effect? 
  • Up-to-date information about the safety of certain medications in pregnancy.
  • What might happen if you are unwell during pregnancy. This includes:
    • you may not take good care of yourself.
    • you might not attend appointments with your midwife. This means you may not get the care you need.
    • people who use drugs and alcohol may use more when unwell. This can be harmful for your unborn baby.
    • you may need a higher dose of medication if you become ill. Sometimes you may need two or more medications to treat a relapse. This might be more risky for your unborn baby than if you take a standard dose of medication throughout pregnancy.
    • you may need in-patient treatment.
    • you may still be unwell when your baby is born. You may then find it more difficult to care for your baby. It may also affect your relationship with your baby.
    • if your illness is not treated, this may be more harmful for your baby than using medication. Untreated mental illness may cause a number of problems. For example, some research studies have found babies are more likely to have low birth weight if their mother has depression in pregnancy. Untreated mental illness can also affect a baby’s development later on. 
  • Unfortunately 2-3 in every 100 babies are born with an abnormality (8-9), even when the mother has not taken any medication.  
  Your doctor should support you whether you decide to continue, stop or change your medication. 

Breastfeeding is usually good for both mother and baby. You can breastfeed whilst taking many types of psychiatric medication2, but you need to talk this over with your doctor. If your baby is unwell or premature the advice may be different. The doctor looking after your baby can help you with this.

Fully breastfeeding a baby can be very tiring. Some women find it easier to combine breast and bottle feeding. If a partner, friend or family member can do some of the feeds you will be able to get more rest.

Sometimes women feel guilty if they can’t breastfeed. If you are unable to breastfeed you should not worry. It is more important for your baby that you are well. You will still develop a close bond with your baby if you bottle feed.

 

For some women pregnancy may be difficult. Others enjoy pregnancy. Many factors can affect how you feel in pregnancy. These include physical symptoms (e.g. morning sickness), the support you have, and stressful events in your life.

Pregnancy does not protect you from having mental health problems. Most mental health problems are just as common in pregnancy as at other times.1-2

For some mental illnesses (e.g. Bipolar Affective Disorder or previous Postpartum Psychosis)10 there is a particularly high risk of becoming unwell after having a baby. This can happen even if you have been well for many years.

If you plan to get pregnant it is important to tell your GP if you have ever had a mental illness. Your GP or psychiatrist can give you advice about your risk of becoming unwell in pregnancy or after birth. They can tell you what support is available and what will help to keep you well.

For more information see our page on Mental Health in Pregnancy, Postnatal Depression, Perinatal OCD and Postpartum Psychosis.

 

All pregnant women have care from a midwife during pregnancy. When you first see your midwife she will ask about your mental and physical health.1 You should let your midwife know if you have ever had a mental health problem. She can tell you about the support available where you live.

In some areas there are perinatal mental health services. These are specialist mental health services for pregnant women and women with a baby under one year old. They will work with you, your family, your midwife and health visitor and any other professionals involved.

After birth all women see a health visitor to get advice about caring for their baby. Children’s Centres have postnatal groups where you can get help, advice and support and meet other new mums in your area.

 

It usually takes several months to get pregnant. About 80% (80 in every 100) women, under the age of 40, will get pregnant in a year if they do not use contraception and have sex regularly. Half of the rest will get pregnant in the second year.11

Some antipsychotic medications can make it more difficult to get pregnant. This is because they affect a hormone called prolactin. If your prolactin levels are too high you may not be able to get pregnant. If you are finding it difficult to get pregnant your GP can check your prolactin levels. If you have raised prolactin because of the medication you are taking, you may need to change to another drug. Don’t stop medication suddenly without advice. Discuss this with your doctor.

Some physical health problems can make it more difficult to get pregnant. You may find it more difficult to get pregnant if you are overweight - or if your weight is very low. Again, ask your GP about this.

 

Having children is often rewarding and satisfying. Many parents also find it stressful and exhausting at times.  Newborn babies are dependent for all their care on their parents. You need to make sure you have practical and emotional support to help you to manage. If you have mental health problems you may need extra support to make sure your child has the care she or he needs. For example, if you often have admissions to hospital, you need to plan for their father, grandparents or friends to provide consistent and loving care for your child if you are unwell.

Most women with mental health problems look after their children very well. Some families struggle to look after their children. This may mean they put their children at risk, usually without meaning to.  

 Some women are worried about seeking support from Children’s Social Care. Social workers aim to support parents to provide the best care for their children. They work with families to identify any difficulties.  They can help make plans with you so all family members are supported and children are safe if there are problems.

If the professionals caring for you during pregnancy think it would be helpful for Children’s Social Care to be involved with your family they will discuss the reasons for this with you.

See our page on Safeguarding Children for more information.

 

Action on Postpartum Psychosis (www.app-network.org)

National charity providing information and support for women and families affected by postpartum psychosis. On-line peer support and one-to-one support. Run by a team of academics, health professionals and women who have recovered from postpartum psychosis. Tel: 020 3322 900; email: app@app-network.org

The Association for Postnatal Illness (APNI) (https://apni.org/)

Telephone helpline and information leaflets for women with postnatal mental illness. Also a network of volunteers (telephone and postal) who have experienced postnatal mental illness. Email: info@apni.org Tel: 020 7386 0868

Best Use of Medicines in Pregnancy (BUMPS) (www.medicinesinpregnancy.org/)

Factsheets about the use of medications in pregnancy, including antidepressants, antipsychotics and mood stabilisers.

Bipolar Disorder, Pregnancy and Childbirth (www.app-network.org/wp-content/uploads/2014/09/Bipolar-Pregnancy-Childbirth-Booklet.pdf)

Information about pregnancy and childbirth for women with Bipolar Disorder and their families. This guide has been produced by Action on Postpartum Psychosis, Bipolar UK and the National Centre for Mental Health.

Drinkaware

Check the facts about alcohol and pregnancy.

Family Planning Association: (www.fpa.org.uk)

 Information, advice and support about sexual health, contraception and pregnancy. 

Maternal OCD (https://maternalocd.org/)

A charity set up by mothers recovered from perinatal OCD, who can provide support via email, twitter and skype. Contact: info@maternalocd.org

National Childbirth Trust (www.nct.org.uk)

Practical and emotional support in all areas of pregnancy, birth and early parenthood. Antenatal and postnatal courses. Local networks where you can meet other parents. Support line: 0300 330 0700

Netmums (www.netmums.com)

Help advice and support on a wide range of pregnancy and parenting issues, including mental health. 

The Royal College of Obstetricians and Gynaecologists (www.rcog.org.uk/en/patients/patient-leaflets/)

 Information leaflets about pregnancy and birth

Tommys (www.tommys.org/pregnancy-information/im-pregnant/mental-wellbeing/specific-mental-health-conditions)

Information and support about many aspects of pregnancy, including mental health. Advice from midwives: 0800 014 7800 or midwife@tommys.org

1. National Institute for Health and Clinical Excellence Antenatal and postnatal mental health: clinical management and service guidance. NICE Clinical Guideline 192: London 2014. www.nice.org.uk/ guidance/CG192.

2. McAllister-Williams RH, Baldwin DS, Cantwell R, Easter A, Gilvarry E, Glover V  et al. British Association for Psychopharmacology consensus guidance on the use of psychotropic medication preconception, in pregnancy and postpartum.  J Psychopharmacol. 2017; 31: 519-552.

3. National Institute for Health and Care Excellence. Antenatal Care for uncomplicated pregnancies:  Nice Clinical Guideline CG62. London, 2008. www.nice.org.uk/guidance/cg62.

4. Meador K, Reynolds MW, Crean S, Fahrbach K, Probst C. Pregnancy outcomes in women with epilepsy: A systematic review and meta-analysis of published pregnancy registries and cohorts. Epilepsy Res. 2008; 81:1–13.

5. Jentink J, Loane MA, Dolk H, Barisic I, Garne E, Morris JK et al.  Valproic acid monotherapy in pregnancy and major congenital malformations. N Engl J Med. 2010; 362: 2185–2193.

6. Bromley R, Weston J, Adab N, Greenhalgh J, Sanniti A, McKay AJ et al. (2014) Treatment for epilepsy in pregnancy: Neurodevelopmental outcomes in the child. Cochrane Database Syst Rev Issue 10. Article No.: CD010236

7. Velez-Ruiz NJ, Meador KJ. Neurodevelopmental Effects of Fetal Antiepileptic Drug Exposure. Drug safety. 2015 ;38 :271-278. 

8. Dolk H, Loane M, Garne E. The prevalence of congenital anomalies in Europe. Adv Exp Med Biol. 2010;686:349-64. 

9. Public Health England National Congenital Anomaly and Rare Disease Registration Services. Congenital anomaly statistics 2015. PHE publications 2017. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/716574/Congenital_anomaly_statistics_2015_v2.pdf

10. Wesseloo R, Kamperman AM, Munk-Olsen T, Pop VJ, Kushner SA, Bergink V. Risk of Postpartum Relapse in Bipolar Disorder and Postpartum Psychosis: A Systematic Review and Meta-Analysis. Am J Psychiatry. 2016;173:117-27

11. National Institute for Health and Care Excellence. Fertility problems: assessment and treatment. NICE Clinical Guideline CG156. NICE London 2013.
Produced by the RCPsych Public Engagement Editorial Board
 
 
  • Original Authors: Dr Alison Puffett, Dr Olivia Protti, Dr Maddalena Miele-Norton and Dr Lucinda Green on behalf of the London and South Consultant Perinatal Psychiatrists Association
  • Service User Involvement: Maternal Mental Health Alliance
  • Series Editor: Dr Phil Timms  
  • Series Manager: Thomas Kennedy