Guidance

This guideline covers recognising, assessing and treating mental health problems in women who are planning to have a baby, are pregnant, or have had a baby or been pregnant in the past year. It covers depression, anxiety disorders, eating disorders, drug- and alcohol-use disorders and severe mental illness (such as psychosis, bipolar disorder and schizophrenia). It promotes early detection and good management of mental health problems to improve women’s quality of life during pregnancy and in the year after giving birth.

 Valproate: In January 2024, the Medicines and Healthcare products Regulatory Agency (MHRA) published a Drug Safety Update on the risks associated with valproate in men and women under 55. See the MHRA’s advice for healthcare professionals to provide to patients currently taking valproate. NICE is assessing the impact of this alert on recommendations in this guideline.

Recommendations on valproate in this guideline are in line with the MHRA guidance on valproate use by women and girls. Valproate must not be used in women and girls of childbearing potential (including young girls who are likely to need treatment into their childbearing years), unless other options are unsuitable and the Pregnancy Prevention Programme is in place.

MHRA advice on antiepileptic drugs in pregnancy: In May 2021, we linked to the MHRA updated safety advice on antiepileptic drugs in pregnancy in the recommendations on lamotrigine, carbamazepine and prescribing antiepileptics for women or girls of childbearing potential.

Last reviewed: 30 July 2024

We simplified the guideline by removing recommendations on general principles of care that are covered in other NICE guidelines (for example, the NICE guideline on service user experience in adult mental health). This is a presentational change only, and no changes to practice are intended.

This guideline updates and replaces NICE guideline CG45 (February 2007) and section 1.5.6 of NICE guideline CG62 (March 2008).

Next review: This guidance will be reviewed if there is new evidence that is likely to change the recommendations.

Recommendations

This guideline includes recommendations on:

Who is it for?

  • Healthcare professionals
  • Commissioners
  • Social services
  • Voluntary and private sectors
  • Women who have, or are at risk of, mental health disorders during pregnancy and the postnatal period and their partners, families and carers

Guideline development process

How we develop NICE guidelines

Your responsibility

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.