Psychiatric illness and its management in pregnancy and the puerperium

Although pregnancy is generally one of the happiest and healthiest times of a woman's life, women who are pregnant are at high risk of mental illness with possible negative outcomes for both mother and baby. Clinical awareness of the extent of illness in women, particularly in high-risk groups, such as socially and materially deprived or very young or poorly supported mothers, is important in identifying and supporting these mothers. In addition, women with mental illness are more than likely to have children and to experience poor outcome of pregnancy and the puerperium. Their special needs in both planning pregnancy and supporting them through this time are increasingly recognized amongst specialists, but adequate provision for them is lacking. The postnatal period is traditionally associated with a greater risk of new onset mental illness. It is clear that some women only ever develop illness at this time, although for the majority of women it tends to herald further episodes. Good obstetric practice needs to recognize the impact of psychologic disorder on childbearing and work closely with psychiatric colleagues to respond adequately to this particularly distressing and dangerous occurrence.