Practice Guidelines

Antenatal and postnatal mental health: summary of updated NICE guidance

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g7394 (Published 18 December 2014) Cite this as: BMJ 2014;349:g7394
  1. Louise M Howard, professor, consultant perinatal psychiatrist1,
  2. Odette Megnin-Viggars, systematic reviewer2,
  3. Iona Symington, research assistant34,
  4. Stephen Pilling, director, professor34
  5. On behalf of the Guideline Development Group
  1. 1Section of Women’s Mental Health, Health Service and Population Research Department, King’s College London, London, UK
  2. 2National Collaborating Centre for Mental Health, Royal College of Psychiatrists, London, UK
  3. 3Centre for Outcomes Research and Effectiveness, University College London, London, UK
  4. 4National Collaborating Centre for Mental Health, University College London, London, UK
  1. Correspondence to: S Pilling s.pilling{at}ucl.ac.uk

The bottom line

  • Do not offer valproate for acute or long term treatment of mental health problems in women of childbearing potential

  • Assess women with a known or suspected mental health problem who are referred in pregnancy or the postnatal period for treatment within two weeks of referral; provide psychological interventions within one month of initial assessment

  • At a pregnant woman’s first contact with services, ask about any past or present severe mental illness, previous or current treatment, and any severe postpartum mental illness in a first degree relative

  • Refer all women who have, are suspected to have, or have a history of severe mental illness to a secondary mental health service (preferably a specialist perinatal mental health service) for assessment and treatment

This guideline is an update of the 2007 National Institute for Health and Care Excellence (NICE) guideline on antenatal and postnatal mental health.1 It covers a broad range of mental disorders, including depression, anxiety disorders, eating disorders, drug and alcohol use disorders, and severe mental illness (such as psychosis, bipolar disorder, schizophrenia, and severe depression), which can all occur in the antenatal and postnatal periods. The guidance focuses on aspects of the identification and management of these disorders that are specific to this context. For example, women with bipolar disorder are at increased risk of a relapse in the early postpartum period, and postpartum psychoses (whether in women with bipolar disorder or not) are particularly rapid in onset and severe.2 These problems are managed differently during the antenatal and postnatal periods than at other times because of the impact that the mental disorder and its treatment (for example, the use of psychotropic drugs) can have on the fetus or baby.3 4

This article summarises the most recent recommendations from NICE on the clinical management …

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