NICE is in the process of updating its guideline on the clinical management of antenatal and postnatal mental health. Since the existing guidance was published in 2007, more information is now available on using drugs to treat mental health problems during pregnancy and on stopping medication. New information is also available on detecting mental health problems in this group. The recommendation on what women and their partners should be offered after a traumatic birth has also been updated.

More than 1 in 10 women will experience depression at some point during their pregnancy. This increases to 1 in 5 women during the first year after giving birth [1]. During pregnancy and the postnatal period, women may also experience anxiety disorder, obsessive compulsive disorder and post-traumatic stress disorder.

Commenting on the new draft guidance Professor Mark Baker, Centre for Clinical Practice director, said: “Mental health problems during and after pregnancy are more common than you would expect. Also women with a history of mental health problems are additionally at risk of relapse when they become pregnant, especially if they stop taking their medication.

“Having a baby is a time of huge change and any woman can find herself needing help. This updated draft guideline is about spotting what is not normal for each individual woman and ensuring she receives the treatment that is right for her.

“Drugs often have an important role in treating antenatal and postnatal mental health disorders however, they are not always suitable. It is really important that a woman is able to make an informed decision about their treatment and she is helped to weigh up the risks and benefits of stopping, starting or changing their drug treatment.

“The draft guideline makes a number of new and updated recommendations, covering not only treatments, but also in providing women who are newly diagnosed or with a history of mental health problems with the information and support they need before they become pregnant.”

The updated draft guideline – which is now open for consultation – makes recommendations for the recognition, care and treatment of mental health problems in women during pregnancy and the postnatal period. It also includes the care of women with an existing mental health problem who are planning a pregnancy, and the organisation of mental health services. Updated draft recommendations include:

Considerations for women of childbearing potential: Discuss with all women of present and future childbearing potential who are newly diagnosed with a mental health problem, have an existing mental health problem or have a history of a mental health problem:

• the use of contraception and any plans for a pregnancy
• how pregnancy and childbirth might affect a mental health problem, including the risk of relapse
• how a mental health problem and its treatment might affect the woman and the fetus or baby.

Treatment decisions, advice and monitoring for women with mental health problems: If detailed advice about possible benefits and harms of treatment is requested or required, the mental health professional providing this advice (preferably a specialist perinatal mental health professional) should discuss with the woman, and if she agrees her partner, family or carer, the following, depending on individual need:

• that there is uncertainty about the benefits, risks and harms of treatments for mental health problems in pregnancy and the postnatal period
• likely benefits of each treatment, taking into account the severity of the mental health problem
• risks or harms to the woman and the fetus or baby associated with each treatment option
• the need for prompt treatment because of the potential effect of an untreated mental health problem on the fetus or baby

Pharmaceutical interventions: When choosing a tricyclic antidepressant (TCA), selective serotonin reuptake inhibitor (SSRI) or (serotonin-) noradrenaline reuptake inhibitor [(S)NRI] , take into account reproductive safety and  the uncertainty about whether any increased risk of fetal abnormalities and other problems for the woman or baby can be attributed directly to these drugs or may be caused by other factors.

Considerations for women and their babies in the postnatal period: discuss with a woman whose baby is stillborn or dies soon after birth, and her partner and family, the options of holding the baby, seeing the baby, seeing a photograph of the baby, or having mementos of the baby. This should be facilitated by an experienced practitioner and the woman and her partner and family should be offered a follow-up appointment in primary or secondary care.

Reviewing treatment for women with severe mental illness: After childbirth, review and assess the need for starting, restarting or adjusting psychotropic medication in a woman with a severe mental illness as soon as she is medically stable (once the fluid balance is established).

The draft guideline will be available on the NICE website from Wednesday 16 July.

Ends

Notes to Editors

Reference

1. Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, et al. Perinatal 4 depression: a systematic review of prevalence and incidence. Obstetrics and 5 Gynecology. 2005;106;1071–83.

About the guidance

The existing guidance is also available on the NICE website. Drugs have an important role in treating antenatal and postnatal mental health disorders, however they may not always be suitable. What is important is that women and their healthcare professionals reach an informed decision about what treatment they should follow. Many patients do not require drug treatments as there are some very effective psychological therapies that may be used. The guideline highlights the importance of understanding the risks and benefits of any potential treatments before deciding the best course of action for an individual person. Through making an informed decision, women can decide whether or not to take medication, whether and when to stop it or to change onto another drug. Drugs have an important role in treating antenatal and postnatal mental health disorders, however they may not always be suitable. What is important is that women and their healthcare professionals reach an informed decision about what treatment they should follow. Many patients do not require drug treatments as there are some very effective psychological therapies that may be used. The guideline highlights the importance of understanding the risks and benefits of any potential treatments before deciding the best course of action for an individual person. Through making an informed decision, women can decide whether or not to take medication, whether and when to stop it or to change onto another drug. The guideline stresses the importance of careful monitoring and follow-up in women taking drugs for a mental health disorder.