Psychotropic Medications in Pregnancy: Prevalence of Prescribing in the Context of an Urban Specialist Maternal Mental Health Service Within Aotearoa New Zealand

Abstract

Psychotropic medications can be a necessary component of treatment for those experiencing mental illness throughout the antenatal period, even though they are associated with an increased risk of comorbid physical health issues. However, limited data exists about the prevalence of prescribing rates in Aotearoa. The objective of this study was to identify the prevalence of psychotropic medication prescribing during pregnancy in an urban maternal mental health service in Aotearoa. This retrospective review included all cases treated by an Auckland Maternal Mental Health service who received care during pregnancy between January 2016 to January 2021. From a cohort of 240 women, 156 (65%) women were prescribed psychotropic medication during pregnancy, most commonly sertraline (30.8%), quetiapine (30.1%), and escitalopram (18.6%). There was a high rate of quetiapine prescribing as both a first and second-line medication, and overall, a high rate of antipsychotics prescribed (46.2%); however, diagnosis rates for psychosis-type disorders were low (4.6%), indicating possible off-label prescribing. This study provides important new data which highlights that within one New Zealand specialist maternal mental health service, approximately two thirds of pregnant women are prescribed psychotropic medication. These results indicate the need for a collaborative and integrated approach to care between maternal mental health services and maternity services and considers the potential benefits of the role of a perinatal mental health nurse specialist in strengthening collaboration between these services. Further recommendations include increased training, improved policies, and guidelines to enhance monitoring of side effects, and detailed antenatal nursing care plans from the time of prescribing.