Introduction: While gestational diabetes mellitus (GDM), or concurrent comorbid diabetes mellitus (DM) during pregnancy puts women at high risk, the added combination of mental illness and antipsychotic medication creates further complexity.
Objectives: The National Register of Antipsychotic Medication in Pregnancy (NRAMP), a world-first research project which tracks women who take antipsychotic medication during pregnancy, aims to establish evidence-based medication safety guidelines and encourage women and their clinicians to support robust maternal health and wellbeing, particularly during the child-bearing years.
Methods: NRAMP mothers are followed during pregnancy and up to the first year of their baby’s life. Descriptive data is collected during interviews and from Medical Records. Information gathered includes, but is not limited to, the presence/absence of GDM and comorbid DM, perinatal antipsychotic medications, family history of DM and previous GDM exposure of self and siblings, plus outcomes for mother and infant at postnatal 12 months.
Results: NRAMP data confirm that pregnant women with mental illness who take antipsychotic medication during pregnancy are at a higher risk of developing GDM overall (20%), compared with the Australian Bureau of Statistics data for the general Australian pregnant population (5-10%). In addition, second generation antipsychotics are particularly weight-promoting, further compounding pre-pregnancy BMI for many women, putting them in either the overweight or obese range before pregnancy, and adding extra stressors where weight gain, medication management, macrosomia, birth complications and infant outcomes are concerned. Furthermore, family history of diabetes is also pronounced in this group (45%).
Conclusions: Our research highlights the need for ongoing work in this important area of women’s mental health, to support healthy mother/infant outcomes, child development and adult biopsychosocial health promotion. Such crucial information will generate a useful source of best-practice guidelines, providing strategies for achieving and maintaining optimum maternal health with minimal fetal risk.