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Journal of Psychopharmacology
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0269881107077222v1
21/8/815    most recent
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Article

Informing patients of the teratogenic potential of mood stabilizing drugs: a case note review of the practice of psychiatrists

Laraine James1, T R Barnes2, Paul Lelliott3, David Taylor4, and Carol Paton1*

1 Oxleas NHS Foundation Trust, Dartford, Kent, UK
2 Department of Psychological Medicine, Imperial College, London, UK
3 Royal College of Psychiatrists Research Unit, London, UK
4 South London and Maudsley NHS Foundation Trust, London, UK

* To whom correspondence should be addressed.


  Abstract

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. 138 (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. 14 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

First published on September 19, 2007, doi:10.1177/0269881107077222

Journal of Psychopharmacology 2007;21:815.

A more recent version of this article appeared on November 1, 2007

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C. Paton
Prescribing in pregnancy
The British Journal of Psychiatry, May 1, 2008; 192(5): 321 - 322.
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