Ensuring women with schizophrenia are given the right medication during pregnancy is the basis of a national project that has been developed by researchers at the Alfred Hospital.

Researchers from the Alfred Psychiatry Research Centre (APRC) have established a national register that will track women with mental illness during their pregnancy and help to ensure the choices made for their treatment are good for both mother and baby.

The Australian-first National Register for Antipsychotic Medications in Pregnancy (N-RAMP) will become a central store of data that will assist clinicians across the country to make the best decisions for their patients.

APRC Director Professor Jayashri Kulkarni said drug treatment advancements had led to more and more women being able to manage their schizophrenia and lead a normal and independent life.

'This [normal life] may include having a child and, while modern medications used to treat schizophrenia are less likely to cause infertility, there is no data available to guide best-practice treatment for the expectant mother,' Professor Kulkarni said.

'Antipsychotic medications don't carry guarantees in pregnancy and, without assurances from the pharmaceutical companies, knowing how to treat during this delicate time can be difficult.'

Professor Kulkarni said this uncertainty meant the clinician managing the patient with schizophrenia was in the undesirable position of having to 'hope for the best.' 

'Some clinicians take the patient off all medication as they are concerned about the safety of the unborn foetus but that choice can lead to disaster if the mother has a relapse in psychotic symptoms.

'Other doctors may switch modern medications in place of older ones because they feel more comfortable managing a drug that has a long-documented history—despite the increased chance of foetal malformation or other side-effects.' 

While the number of women with schizophrenia in Australia, who were also of child-bearing age, may be less than one per cent of the population the issues were significant, Professor Kulkarni said.

'On one hand we can have a mother who needs medication to control her psychotic symptoms and an unborn child who faces an unknown risk of toxicity from these same drugs.'

The register, which is now operational across the country with the approval of 26 ethics committees, is being project-managed by midwife and mental health nurse Kay McCauley. 

Ms McCauley, who has taken on the project as a PhD study, said the register was slowly building in size.

She urged more women join the register, however, in order to build a larger base of data.

'We are creating a record of medications and associated complications by recording data on the mother and child both during the pregnancy and up to a year after the birth,' Ms McCauley said.

N-RAMP is a national project, developed with the support of the School of Nursing and Midwifery and the School of Psychiatry, Psychology and Psychological Medicine at Monash University.

There are also several researchers across the country.

'While the question of which antipsychotic drug to use during pregnancy may seem a simple one, the issues that surround it have the capacity to change lives,' Ms McCauley said.

'This is why we have gone to such lengths to set up this national register at the Alfred.'

The project has received funding from pharmaceutical companies AstraZeneca and Janssen-Cilag as well as Rotary International.

•          Women interested in being included in the register should contact the APRC on 9276 5464.