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NICE recommends more mental health support for women during pregnancy

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Women with a history of mental health problems should be given additional support if they are of childbearing age, new NHS guidance suggests.

Patients who have a current or historic mental health issue should be given extra information and support before they consider getting pregnant, according to draft guidance on ante- and post-natal mental health launched by the National Institute for Health and Care Excellence.

Healthcare workers should discuss their use of contraception and whether these women plan to become mothers in the future, NICE said in the draft, which updates its existing guidance in the area.

They should be told how pregnancy and child birth might affect a mental health problem, including the risk of relapse.

“Mental health problems during and after pregnancy are more common than you would expect”

Mark Baker

Experts should also tell women affected by mental health issues that the problem, and its treatment, may have an effect on themselves, the fetus or their babies.

Meanwhile, health workers should not offer valproate to treat a mental health problem in women of present and future childbearing potential, NICE said. The drug is used for mood disorders, mania and bipolar disorders.

NICE said that if a woman is already taking valproate and is planning a pregnancy she should be advised to gradually stop taking the drug because of the risk of foetal malformations and adverse neurodevelopment after exposure in pregnancy.

The authority, which sets out best practice guidance for the NHS, said that mental health problems “frequently” go unrecognised and untreated in pregnancy and the post-natal period.

The most common mental health problems during pregnancy and after child birth are anxiety and depression.

About one in eight women will suffer depression or anxiety during pregnancy and up to 20% of women are affected by these conditions in the year after childbirth.

Other problems such as schizophrenia or bipolar disorder can re-emerge or be exacerbated during pregnancy and the post-natal period.

Those with a history of eating disorders may struggle with the change in body shape associated with pregnancy.

The new NICE draft guideline states: “If untreated, women can continue to have symptoms, sometimes for many years, and these can also affect their babies and other family members.”

Professor Mark Baker, director of the Centre for Clinical Practice at NICE, said: “Mental health problems during and after pregnancy are more common than you would expect.

Mark Baker

Mark Baker

“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.

“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,” he said.

“Drugs often have an important role in treating antenatal and post-natal mental health disorders, however they are not always suitable,” noted Professor Baker.

He added: “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.”

Jane Munro, quality and audit development adviser at the Royal College of Midwives, said: “The RCM has long recognised the need for better care for pregnant women with mental health problems because they certainly do not seem to be getting the right levels of care at present.

“We have been campaigning for more resources, particularly an increase in the number of midwives, so that they can give women suffering from mental health problems the attention and support they need.”

She added: “There seem to be a lot of positives in this document and we will be studying it and responding to the consultation.”

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