Prescribing for pregnancy series
Women with long-term conditions need targeted preconception guidance about the impact of their health on pregnancy outcome, the potential impact of pregnancy on their long-term condition and the use of medication in pregnancy and breastfeeding. For some conditions a woman may be able to continue with her existing medication, while for others it may be necessary to change to safer alternatives. It is rarely right to abruptly stop and not replace long-term medication. We have commissioned a series of articles that explores these issues for several long-term conditions. This series has been developed and coordinated by Joanna Girling.
Prescribing for pregnancy: chronic skin diseases Deborah De Caux, Gayathri Mariappa, Gayathri Perera, Joanna Girling Chronic skin disease is common in women of reproductive age. Although skin can improve or remain stable during pregnancy, it is also common for existing conditions to flare and for new conditions to develop. A small number of medications used to control chronic skin disease can potentially have adverse effects on the outcome of the pregnancy. This article forms part of a series on prescribing for pregnancy and highlights the importance of achieving good control of the skin disease prior to conception and during pregnancy. It emphasises the need for patient-centred, open and informed discussions around medication options to achieve good control.
Prescribing for pregnancy: inflammatory rheumatic disease Samantha Steele, Iona Thorne Inflammatory rheumatic disease during pregnancy requires careful management. Key factors for successful pregnancy outcome are disease remission at the time of conception and optimal disease control during pregnancy. This article highlights the importance of prepregnancy care and collaborative working between obstetric and rheumatology specialties as well as focusing on prescribing before, during and after pregnancy.
Prescribing for pregnancy: chronic hypertension Anja Johansen-Bibby This article reviews the management of hypertension during pregnancy. It highlights the importance of preconception counselling to optimise general health, rule out secondary causes, and ensure medication is compatible with pregnancy. The article also discusses the role of consultant-led care as well as the need for additional scans to ensure adequate fetal growth and regular reviews to monitor blood pressure throughout pregnancy.
Prescribing for pregnancy: inflammatory bowel disease Naomi Primrose, Emma Johnston This article reviews the management of inflammatory bowel diseases (IBD) during pregnancy. It highlights the importance of prepregnancy care and collaborative working between obstetric and gastroenterology specialties. The article also focuses on prescribing before, during and after pregnancy and discusses the safety of medicines used to manage IBD.
Prescribing for pregnancy: managing chronic headache and migraine Caroline Ovadia This article discusses migraine and headache disorders in women during pregnancy and postpartum. It stresses the importance of providing preconception counselling to address pregnancy-related concerns and the need to review medication prior to pregnancy. The article covers the choice of drugs for the treatment of acute migraine and for prophylaxis as well as highlighting drugs that should not be used.
Prescribing for pregnancy: managing diabetes Alice Hurrell, Sara L White, Louise Mary Webster This review discusses the effects of diabetes on pregnancy and how pregnancy may impact diabetes. It considers the importance of preconception counselling for women with pre-existing diabetes. The article focuses on prescribing before, during and after pregnancy and explores how glycemic management can be optimised through personalised and regularly reviewed adjustments to medication.
Prescribing for pregnancy: epilepsy Anja Johansen-Bibby This review discusses the concerns women with epilepsy face during pregnancy and, in particular, the need to maintain good seizure control while minimising the risk of congenital anomalies from antiepileptic medication. It highlights the risks associated with uncontrolled epilepsy in pregnancy and explores the type of preconception counselling that should be offered to maximise the chances of safe pregnancies and healthy babies.
Prescribing for pregnancy: asthma Joanna Girling This review discusses how misconceptions around drug safety in pregnancy can contribute, in part, towards non-adherence to inhaled corticosteroids and beta2 agonists during pregnancy, and increase the risk of exacerbations. For most women, asthma will not negatively impact pregnancy or be adversely affected by pregnancy. This review suggests that one of the goals of prepregnancy planning for women with asthma is to ensure that they understand the safety of their medication, the need to continue it during pregnancy and the action to take in the event of an exacerbation.
Prescribing for pregnancy: managing prescribing for women with mental health diagnoses Louise Page This review discusses managing mental illness during pregnancy and in the first year after birth, and reviews the safety of different drug classes. It emphasises the need to prescribe the lowest effective dose, using monotherapy where possible. It recommends preconception care be offered to enable open discussion around mental health and treatment prior to conception.
Prescribing for pregnancy: general prepregnancy care Joanna Girling This review discusses how outcomes for mother and infant can be improved when pregnancy is planned. It highlights the importance of optimising physical and mental health before and during pregnancy. The article recommends that healthcare professionals discuss prepregnancy care with patients at appropriate opportunities, and that women with long-term conditions need targeted preconception guidance about the impact of their health on pregnancy, the potential impact of pregnancy on their medical or mental health disorder and use of their medication in pregnancy and breastfeeding.