Psychotropic prescribing patterns during pregnancy in two South African mental health clinics

Given that there is a significant burden of mental illness during pregnancy, psychotropic polypharmacy during this period is commonly found in clinical practice. In South Africa, however, there is a paucity of data on the use of psychotropics during pregnancy.

This was a retrospective descriptive study of 303 pregnant women attending two specialised maternal mental health clinics from presentation to six weeks postpartum. Demographic data, psychiatric history, medical comorbidity, pregnancy-related, and prescription data were collected and tabulated at treatment-as-usual visits. Polypharmacy prevalence was defined as the prescription of two or more psychotropics for at least 90 days.

A majority of the study group was diagnosed with major depressive disorder (n = 161, 53.1%), and non-tricyclic antidepressants were the most prescribed medication class (n = 195, 64.4%). One-third of the participants received prescriptions in all three trimesters. Polypharmacy criteria were met in 18.8% (n = 57) of the sample population.

The prescription patterns in the study sample appeared to be in line with current international protocols. Prescribing psychotropics during pregnancy remains challenging because of the need to weigh up the potential risks of medication-related effects on the mother and baby against those of discontinuing treatment.

This study may raise awareness and assist medical professionals regarding the rational use of psychotropic medication during pregnancy.