NICE clinical guidelines
Issued: February 2007 (last modified: April 2007)
CG45

Antenatal and postnatal mental health: Clinical management and service guidance

This is an extract from the guidance. The complete guidance is available at guidance.nice.org.uk/cg45

Introduction

This guideline makes recommendations for the prediction, detection and treatment of mental disorders in women during pregnancy and the postnatal period (up to 1 year after delivery). It includes advice on the care of women with an existing mental disorder who are planning a pregnancy, and on the organisation of mental health services.

Mental disorders during pregnancy and the postnatal period can have serious consequences for the health and wellbeing of a mother and her baby, as well as for her partner and other family members. The guideline covers the care of women with anxiety disorders, and depression. It also covers the treatment of postnatal psychotic disorders (often referred to as puerperal psychosis), which predominantly comprise bipolar disorder and schizophrenia. Healthcare professionals should refer to the sections on bipolar disorder and schizophrenia for advice on treating any psychotic disorder. The term 'postnatal depression' is not used in this guideline because it is often used inappropriately as a general term for any perinatal mental disorder.

The guideline provides advice on the teratogenic risk of psychotropic medications and on the risks of their use during breastfeeding. The focus is on balancing the risks for each woman and her child against those of leaving the mental disorder untreated or inadequately treated.

The guideline draws on the best available evidence. However, there are significant limitations to the evidence base, including limited data on the risks of psychotropic medication during pregnancy and breastfeeding, particularly with more recently introduced drugs. No psychotropic drug has marketing authorisation specifically for pregnant or breastfeeding women.

The guideline should be read in conjunction with existing NICE guidance on the treatment and management of mental disorders. This also includes advice on the most appropriate organisation of services for the delivery of effective treatment, within a stepped-care framework.