Teratogenic risk and contraceptive counselling in psychiatric practice: analysis of anticonvulsant therapy
1 Institute of Health and Wellbeing, University of Glasgow, Mental Health and Wellbeing, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, UK
2 ST6 General Adult Psychiatry NHSGG&C, Esteem Service, 60 Mollinsburn Street, Glasgow G21 4SF, UK
3 ST6 General Adult Psychiatry, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow G12 0XH, UK
BMC Psychiatry 2013, 13:234 doi:10.1186/1471-244X-13-234Published: 25 September 2013
Anticonvulsants have been used to manage psychiatric conditions for over 50 years. It is recognised that some, particularly valproate, carbamazepine and lamotrigine, are human teratogens, while others including topiramate require further investigation. We aimed to appraise the documentation of this risk by psychiatrists and review discussion around contraceptive issues.
A retrospective review of prescribing patterns of four anticonvulsants (valproate, carbamazepine, lamotrigine and topiramate) in women of child bearing age was undertaken. Documented evidence of discussion surrounding teratogenicity and contraceptive issues was sought.
Valproate was most commonly prescribed (n=67). Evidence of teratogenic risk counselling at medication initiation was sub-optimal – 40% of individuals prescribed carbamazepine and 22% of valproate. Documentation surrounding contraceptive issues was also low- 17% of individuals prescribed carbamazepine and 13% of valproate.
We found both low rates of teratogenic risk counselling and low rates of contraception advice in our cohort. Given the high rates of unplanned pregnancies combined with the relatively high risk of major congenital malformations, it is essential that a detailed appraisal of the risks and benefits associated with anticonvulsant medication occurs and is documented within patients’ psychiatric notes.