Contraception: advice for people with bipolar, schizophrenia or other psychoses
Indicator
The percentage of women with schizophrenia, bipolar affective disorder or other psychoses under the age of 45 years who have been given information and advice in the previous 12 months about pregnancy, conception or contraception tailored to their pregnancy and contraceptive intentions.
Indicator type
General practice indicator suitable for use outside the Quality and Outcomes Framework. Assessment of available data indicates an average practice population of less than 20 patients.
This document does not represent formal NICE guidance. For a full list of NICE indicators, see our menu of indicators.
To find out how to use indicators and how we develop them, see our NICE indicator process guide.
Rationale
Women with schizophrenia, bipolar affective disorder or other psychoses are at an increased risk of adverse events during and after pregnancy because of their medication. This includes a risk of relapse of mental health symptoms, and potential effects on the fetus during pregnancy and the infant during breastfeeding.
This indicator requires that women are given information and advice tailored to their current reproductive plans. A discussion will therefore need to take place with each women to determine what her plans are and to tailor any subsequent advice according to these. This should take place in the context of a clinical consultation. Verbal advice should be supported by written information where possible.
Valproate must not be used in pregnancy, and it must not be used in girls and women of childbearing potential (including young girls who are likely to need treatment into their childbearing years) unless other options are unsuitable and a pregnancy prevention programme in place, in line with the MHRA safety advice on valproate. This is because of the risk of malformations and developmental abnormalities in the baby.
The MHRA has published temporary advice on the valproate pregnancy prevention programme during the COVID-19 pandemic.
Source guidance
Antenatal and postnatal mental health (2014, updated 2018) NICE clinical guideline 192, recommendation 1.2.1.
Specification
Numerator: The number of women in the denominator who have been given information and advice in the previous 12 months about pregnancy, conception or contraception tailored to their pregnancy and contraceptive intentions.
Denominator: The number of women with schizophrenia, bipolar affective disorder or other psychoses under the age of 45 years.
Calculation: Numerator divided by the denominator, multiplied by 100.
Exclusions: Women who have been sterilised or undergone partial or complete removal of the uterus.
Minimum population: The indicator would be appropriate to assess performance of collaborations or networks of GP practices serving populations of around 30,000 to 50,000.
ISBN: 978-1-4731-6073-6