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

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. Te reo Māori translation Ngā Rongoā Whakapiki Wairua i te Hapūtanga: Te Whānui o te Whakahau i te Horopaki o tētahi Ratonga Hauora Hinengaro Whaea Mātanga ā-Tāone i roto i Aotearoa Ngā Ariā Matua Ka noho pea ngā rongoā whakapiki wairua hei ara taketake hei āwhina i ērā kua pāngia e tētahi mate hinengaro i te hapūtanga, ahakoa e haere tahi ana ētahi rarunga hauora ā-tinana pea i te taha o aua rongoā, e ai ki ngā kitenga. Ahakoa tērā he iti noa ngā raraunga mō te whānui o ngā pāpātanga whakahau i Aotearoa. Ko te whāinga o tēnei rangahau kia tautohutia te whānui o te whakahau rongoā whakapiki wairua i tētahi ratonga hauora hinengaro whaea ā-tāone i roto i Aotearoa. I uru ki tēnei arotake whakamuri ngā tūroro katoa i taurimatia e tētahi ratonga hauora hinengaro whaea i te hapūtanga i waenga i Hānuere 2016 ki Hānuere 2021. I roto i te tira nei e 240 ngā wāhine, 156 (65%) i whakahautia he rongoā whakapiki wairua mō rātou i te hapūtanga, ko te sertraline (30.8%) te mea auau rawa, i muri ko quetiapine (30.1%), me te escitalopram (18.6%). He tiketike tonu te pāpātanga whakahau o te quetiapine hei rongoā taumata tuatahi, taumata tuarua, ā, mō te katoa he tiketike te pāpātanga rongoā kaupare wairangi i whakahautia (46.2%). Ahakoa ēnei, he pāpaku rawa ngā rarunga mō ngā mate wairangi i kitea (4.6%), te āhua nei i whakamahia mō ētahi mate kāore i te rārangi mate e mōhiotia ana mō taua rongoā. Hei whakatairanga tēnei rangahau i ētahi raraunga hira hou, e kitea ai kei roto i tētahi ratonga hauora hinengaro whaea ā-tāone mātanga, tata ki te rua hautoru o ngā wāhine hapū i whakahautia he rongoā whakapiki wairua mō rātou. Hei tūtohu ēnei kitenga i te hiahia kia whāia ngā ara pāhekoheko. tōtahi hoki mō te taurima i waenga i ngā ratonga hauora hinengaro me ngā ratonga hapūtanga, hei whakaaro hoki i ngā painga o te whakatū mātanga tapuhi hauora hinengaro whānautanga, hei whakapiki i te pāhekoheko o ēnei ratonga. Ko ētahi atu o ngā tūtohu, kia whakapikia ngā mahi whakangungu, he aratohu mō te whakapai i te aroturuki i ngā pānga i te taha, me ētahi mahere taurima mō mua i te whānautanga mai i te wā o te whakahau rongoā.