This guideline, commissioned by the National Institute for
Health and Clinical Excellence (NICE), covers the care and
treatment of women with mental health problems during pregnancy and
the first postnatal year. This includes depression, anxiety
disorders, and severe mental illnesses such as bipolar disorder and
schizophrenia.
The impact of mental disorders on women, their infants and other
members of their family can be greater during pregnancy and the
postnatal period than at any other time. It is therefore of great
importance that any problem is recognised and managed quickly and
safely. The guideline sets out clear recommendations, based on the
best available evidence, for healthcare staff on how to work with
pregnant and breastfeeding women to significantly improve their
treatment and care.
This book brings together all of the evidence that led to the
recommendations in the guideline. It provides an overview of how
mental health problems manifest during pregnancy and post-natally
and covers prediction and detection, prevention, and psychological
and pharmacological interventions for specific disorders, including
balancing the risks and benefits of drug treatment during pregnancy
and while breastfeeding. The guideline also encompasses the
organisation of perinatal mental health services, making it the
first of its kind to fully integrate the clinical and service
aspects of care into a single volume. The book is illustrated by
women’s experiences of mental health problems, treatment and
services.
“One in seven women will have some kind of psychological problem
during the antenatal and postnatal periods and it is absolutely
vital that healthcare professionals, including midwives and health
visitors, are able to identify those women who are at risk of
developing a mental health problem during pregnancy and after
giving birth. This guideline is an indispensable tool to aid
professionals in that endeavour."
- Dr Gwyneth Lewis, National Clinical Lead for Maternal
Health and Maternity Services and Director of the Maternal Deaths
Enquiry for CEMACH
NICE Mental Health Guidelines
These guidelines from the National Institute for Health and
Clinical Excellence (NICE) set out clear recommendations, based on
the best available evidence, for health care professionals on how
to work with and implement physical, psychological and
service-level interventions for people with various mental health
conditions.
The book contains the full guidelines that cannot be obtained
in print anywhere else. It brings together all of the evidence that
led to the recommendations made, detailed explanations of the
methodology behind their preparation, plus an overview of the
condition covering detection, diagnosis and assessment, and the
full range of treatment and care approaches.
The accompanying free CD-ROM contains all the data used as
evidence, including:
- Included and excluded studies.
- Profile tables that summarise both the quality of the evidence
and the results of the evidence synthesis.
- All meta-analytical data, presented as forest plots.
- Detailed information about how to use and interpret forest
plots.
Full Contents
Guideline Development Group Membership
1. EXECUTIVE SUMMARY
1.1 Principles of care for all
women with mental disorders during pregnancy and the postnatal
period
1.2 Prediction, detection and
initial management of mental disorders
1.3 Prevention of mental
disorders
1.4 Care of women with a mental
disorder during pregnancy and the postnatal period
1.5 The organisation of
services
1.6 Research recommendations
2. INTRODUCTION
2.1 National guidelines
2.2 The national antenatal and
postnatal mental health guideline
2.3 The structure of this
guideline
3. METHODS USED TO DEVELOP THIS
GUIDELINE
3.1 Overview
3.2 The scope
3.3 The Guideline Development
Group
3.4 Clinical questions
3.5 Systematic clinical literature
review
3.6 Health economics review
strategies
3.7 Stakeholder contributions
3.8 Testimonies from women with
mental disorders in the antenatal and postnatal period
3.9 Validation of this
guideline
4. ANTENATAL AND POSTNATAL MENTAL
HEALTH: POPULATION, DISORDERS AND SERVICES
4.1 Scope of the guideline
4.2 Mental disorders during
pregnancy and the postnatal period
4.3 Incidence and prevalence of
perinatal disorders
4.4 Aetiology of antenatal and
postnatal mental disorders
4.5 Consequences of mental
disorder during pregnancy and the postnatal period
4.6 Treatment in the NHS
4.7 The economic burden of mental
disorders in the antenatal and postnatal period
4.8 Explaining risk to women:
helping patients to make decisions about treatment
5. THE PREDICTION AND DETECTION OF
MENTAL ILLNESS DURING PREGNANCY AND THE POSTNATAL
PERIOD
5.1 Introduction
5.2 Prediction – risk factors for
the onset of mental disorder during pregnancy and the postnatal
period
5.3 Methods for predicting mental
disorder during pregnancy and the postnatal period
5.4 Methods for detecting mental
disorder during pregnancy and the postnatal period
5.5 Referral pathways
6. PSYCHOLOGICAL AND PSYCHOSOCIAL
INTERVENTIONS
6.1 Introduction
6.2 Issues in research into
psychological treatments
6.3 Definitions of psychological
and psychosocial interventions
6.4 Overview of clinical
review
6.5 Review of treatments aimed at
preventing the development of mental disorders during the antenatal
and postnatal periods for women with existing risk factors
6.6 Health economics evidence on
psychological and psychosocial interventions aimed at preventing
the development of depression during the antenatal and postnatal
periods in women with identified psychosocial risk factors and/or
sub-threshold depressive symptoms
6.7 Clinical practice and research
recommendations
6.8 Review of treatments aimed at
preventing the development of mental disorders during the antenatal
and postnatal periods for women with no identified risk factors
6.9 Review of non-pharmacological
treatments for depression in the postnatal period
6.10 Health economics evidence on
psychosocial interventions for treatment of depression in the
postnatal period
6.11 Focusing on the infant:
intervening in the mother-infant interaction or measuring
child-related outcomes
6.12 Broader psychosocial
interventions and other treatments
6.13 Treatments for women with
disorders other than depression
7. THE PHARMACOLOGICAL TREATMENT OF
MENTAL DISORDERS IN PREGNANT AND BREASTFEEDING WOMEN
7.1 Introduction
7.2 Risk associated with specific
drugs in pregnancy and the postnatal period
7.3 The pharmacological treatment
of mental disorder during pregnancy and the postnatal period –
review of available studies
7.4 Prescribing psychotropic
medication to pregnant and breastfeeding women
7.5 The pharmacological treatment
of specific mental disorders during pregnancy and the postnatal
period – adaptation of existing guidelines
8. THE ORGANISATION OF PERINATAL
MENTAL HEALTH SERVICES
8.1 Introduction
8.2 The current structure of
services
8.3 Estimating the need for
services
8.4 The functions of services for
women, their partners and carers in the antenatal and postnatal
period
8.5 The structure of perinatal
mental health services
8.6 Implementing the managed
network model: service recommendations
8.7 Research recommendation
9. Appendices
10. References
11. Abbreviations