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Informing patients of the teratogenic potential of mood stabilizing drugs: a case note review of the practice of psychiatrists
Laraine James
Oxleas NHS Foundation Trust, Dartford, Kent, UK
Thomas R.E. Barnes
Department of Psychological Medicine, Imperial College, London, UK
Paul Lelliott
Royal College of Psychiatrists Research Unit, London, UK
David Taylor
South London and Maudsley NHS Foundation Trust, London, UK
Carol Paton
Oxleas NHS Foundation Trust, Dartford, Kent, UK, carol.paton{at}oxleas.nhs.uk
Lithium, carbamazepine and valproate are established human teratogens. Women of childbearing potential who are prescribed these drugs should be informed of their teratogenic potential and advised of the need for adequate contraception and the protective role of folate. We reviewed the clinical records of all women of childbearing age in long-term contact with one specialist mental health Trust providing services for a total population of 750 000. 0ne hundred and thirty eight (16%) of 837 women of childbearing age were prescribed one or more of these drugs. There was documented evidence that 29 (21%) of these women had been informed about teratogenicity and that 33 (24%) had been advised about contraception. Fourteen women (10%) had a confirmed pregnancy while taking lithium, carbamazepine or valproate; eight had a complication of pregnancy. If prescribing practice in this large mental health Trust were typical of the UK, between 7000 and 11 000 women of childbearing potential would be prescribed lithium, carbamazepine or valproate by psychiatrists without documented discussion of the risks.
Key Words: lithium • carbamazepine • valproate • folate • mood stabilizer • pregnancy • teratogenicity • women
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This version was published on November
1, 2007
Journal of Psychopharmacology, Vol. 21, No. 8,
815-819 (2007)
DOI: 10.1177/0269881107077222
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