Pregnancy
Pathways containing recommendations for prescribing in pregnancy are available alongside other recommendations for some conditions within the formulary.
BUMPS: Medicines in pregnancy Healthy Start website
Prescribing Notes:
- Patient information leaflets on taking medicines in pregnancy are available from BUMPS.
- All drugs should be avoided if possible in the first trimester. The greatest risk of teratogenicity is from the third to the eleventh week of pregnancy. Further advice can be obtained at the UKTIS website.
- Drugs should only be prescribed if the benefit to the mother is perceived to be greater than the risk to the foetus. The lowest effective dose should be used for the shortest possible period.
- Pregnancy may alter drug disposition. For example, the rate of elimination of renally excreted drugs increases, the volume of distribution changes, and protein binding decreases. Monitoring of plasma concentrations of carbamazepine, sodium valproate, lamotrigine and phenytoin is not usually necessary in pregnancy unless the patient is symptomatic. Monitoring is recommended for patients receiving lithium and the dose adjusted as appropriate.
- Valproate is contraindicated for migraine or bipolar disorder during pregnancy.
- Valproate is contra-indicated for epilepsy during pregnancy unless there is no other effective treatment available.
- For more information including guidance for women planning pregnancy or for women who become pregnant on valproate, refer to MHRA guidance on valproate use by women and girls and Valproate medicines: Pregnancy Prevention Programme online.
- To obtain risk materials for a specific brand of valproate, see the eMC website valproate search and click on “Risk Materials” next to that medicine.
- There is no need to routinely prescribe a combined iron/folic acid or multivitamin preparation in pregnancy.
- Refer to SIGN 169 and NICE clinical guideline 192, for the management of women, with mental health problems, who are planning a pregnancy or are pregnant.
- Folic acid 400micrograms daily should be recommended for all women attempting to conceive and continued until the 12th week of pregnancy to reduce the risk of a neural tube defect. Women at high risk (women with epilepsy (on antiepileptic treatment) or diabetes, those with a previous affected pregnancy or where either partner has a neural tube defect) should take 5mg from pre–conception until 12 weeks.
- Women should be encouraged to take a food supplement of 10micrograms (400units) vitamin D daily. Healthy Start Vitamin tablets (400micrograms folic acid, 10micrograms vitamin D3 and 70mg vitamin C) are available for eligible women from their local community midwives. Eligibility criteria are outlined at the Healthy Start website.
- These products cannot be purchased or obtained from community pharmacies. Healthy Start Vitamin drops can be obtained for babies from local Health Visitors.
History Notes
14/03/2024
Updated weblink to SIGN 169 Perinatal mental health conditions, March 24.
18/05/2022
East Region Formulary content agreed.
As directed by specialist.
As directed by specialist.
As directed by specialist.
As directed by specialist.
As directed by specialist.
As directed by specialist.
As directed by specialist.
As directed by specialist.
As directed by specialist.
Prescribing Notes:
- Dinoprostone is now the drug of choice for induction of labour. It is usually administered as vaginal gel (Prostin E2). Propess is a dinoprostone slow release pessary system used for cervical ripening in patients at term (from 38th week of gestation).
- Misoprostol (Mysodelle) can be used as an alternative to dinoprostone to induce labour in women with an unfavourable cervix, from the 36th week of gestation. Mysodelle is more expensive than dinoprostone products but significantly reduces labour time compared to dinoprostone.
- Oxytocin (injection) is given by slow intravenous infusion for induction and augmentation of labour. It may also be used in the treatment of post-partum haemorrhage.
History Notes
18/05/2022
East Region Formulary content agreed.
Initially 5micrograms/minute for 20 minutes, then increased in steps of 2.5micrograms/minute every 20 minutes until contractions have ceased (more than 10micrograms/minute should seldom be given – 20micrograms/minute should not be exceeded), continue for 1 hour, then reduced in steps of 2.5micrograms/minute every 20 minutes to lowest dose that maintains suppression (maximum total duration 48 hours).
Initially 5micrograms/minute for 20 minutes, then increased in steps of 2.5micrograms/minute every 20 minutes until contractions have ceased (more than 10micrograms/minute should seldom be given – 20micrograms/minute should not be exceeded), continue for 1 hour, then reduced in steps of 2.5micrograms/minute every 20 minutes to lowest dose that maintains suppression (maximum total duration 48 hours).
History Notes
18/05/2022
East Region Formulary content agreed.
As per specialist advice.
800micrograms vaginally as an initial dose for medical abortion of developing intrauterine pregnancy, 36 to 48 hours after 200mg mifepristone orally, up to and including 63 days of amenorrhoea.
400micrograms orally as an initial dose for medical abortion of developing intrauterine pregnancy, 36 to 48 hours after 600mg mifepristone orally, up to and including 49 days of amenorrhoea.
Prescribing Notes:
- Medical management of non-viable pregnancy (including incomplete miscarriage) is performed in specialist licensed units. Currently first choice is mifepristone followed by misoprostol, a prostaglandin.
- Methotrexate is first choice medical treatment for ectopic pregnancy under hospital supervision.
History Notes
18/05/2022
East Region Formulary content agreed.
As per specialist advice.
800micrograms vaginally as an initial dose for medical abortion of developing intrauterine pregnancy, 36 to 48 hours after 200mg mifepristone orally, up to and including 63 days of amenorrhoea.
400micrograms orally as an initial dose for medical abortion of developing intrauterine pregnancy, 36 to 48 hours after 600mg mifepristone orally, up to and including 49 days of amenorrhoea.
Prescribing Notes:
- Medical management of the induction of abortion is performed in specialist licensed units. Currently first choice is mifepristone followed by misoprostol, a prostaglandin.
- Methotrexate is first choice medical treatment for ectopic pregnancy under hospital supervision.
History Notes
18/05/2022
East Region Formulary content agreed.