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: 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.