Quality standard

Quality statement 2: Pre‑conception information

Quality statement 2: Pre‑conception information

Quality statement

Women of childbearing potential with a severe mental health problem are given information at their annual review about how their mental health problem and its treatment might affect them or their baby if they become pregnant.

Rationale

Women with a severe mental health problem can make informed decisions about safe treatments and managing their condition if they understand how their mental health problem, or its treatment, could affect them or their baby if they become pregnant.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

Evidence of local arrangements to ensure that women of childbearing potential with a severe mental health problem are given information at their annual review about how their mental health problem and its treatment might affect them or their baby if they become pregnant.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example care protocols.

Process

Proportion of women of childbearing potential with a severe mental health problem given information at their annual review about how their mental health problem and its treatment might affect them or their baby if they become pregnant.

Numerator – the number in the denominator who have received information as part of their annual review about how their mental health problem and its treatment might affect them or their baby if they become pregnant.

Denominator – the number of women of childbearing potential with a severe mental health problem having an annual review.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

What the quality statement means for different audiences

Service providers (general mental health services and specialist secondary care mental health services) have systems in place to ensure that the annual review for women of childbearing potential with a severe mental health problem includes information about how their mental health problem and its treatment might affect them or their baby if they become pregnant.

Mental health professionals provide information at the annual review for women of childbearing potential with a severe mental health problem about how their mental health problem and its treatment might affect them or their baby if they become pregnant.

Commissioners specify and check that annual reviews for women of childbearing potential with a severe mental health problem include giving women information about how their mental health problem and its treatment might affect them or their baby if they become pregnant.

Women with a severe mental health problem who might become pregnant are given information at their annual review about how their mental health problem might affect them or their baby if they become pregnant. It should include the possible benefits and harms of any treatment they are having for their mental health problem. This will help them to make decisions about pregnancy and treatment for their mental health problem.

Source guidance

Antenatal and postnatal mental health. NICE guideline CG192 (2014, updated 2020), recommendations 1.2.1, 1.4.4 and 1.4.6

Definitions of terms used in this quality statement

Annual review

The Care Programme Approach sets out support that women with a severe mental health problem should receive from secondary mental health services. It includes a formal review at least once a year. [NHS Choices Care Programme Approach]

Information

The following information should be discussed with women of childbearing potential who have a mental health problem:

  • the use of contraception and any plans for a pregnancy

  • how pregnancy and childbirth might affect a mental health problem, including the risk of relapse

  • how a mental health problem and its treatment might affect the woman, the fetus and baby

  • how a mental health problem and its treatment might affect parenting.

[NICE's guideline on antenatal and postnatal mental health, recommendation 1.2.1]

Mental health professionals providing detailed advice about the possible risks of mental health problems or the benefits and harms of treatment in pregnancy and the postnatal period should include discussion of the following, depending on individual circumstances:

  • the uncertainty about the benefits, risks and harms of treatments for mental health problems in pregnancy and the postnatal period

  • the likely benefits of each treatment, taking into account the severity of the mental health problem

  • the woman's response to any previous treatment

  • the background risk of harm to the woman and the fetus or baby associated with the mental health problem and the risk to mental health and parenting associated with no treatment

  • the possibility of the sudden onset of symptoms of mental health problems in pregnancy and the postnatal period, particularly in the first few weeks after childbirth (for example, in bipolar disorder)

  • the risks or harms to the woman and the fetus or baby associated with each treatment option

  • the need for prompt treatment because of the potential effect of an untreated mental health problem on the fetus or baby

  • the risk or harms to the woman and the fetus or baby associated with stopping or changing a treatment.

[NICE's guideline on antenatal and postnatal mental health, recommendation 1.4.6]

Healthcare professionals discuss breastfeeding with all women who may need to take psychotropic medication in pregnancy or in the postnatal period. This should include an explanation of the benefits of breastfeeding, the potential risks associated with taking psychotropic medication when breastfeeding and with stopping some medications in order to breastfeed. Healthcare professionals should discuss treatment options that would enable a woman to breastfeed if she wishes and support women who choose not to breastfeed. [NICE's guideline on antenatal and postnatal mental health, recommendation 1.4.4]

Postnatal period

Up to 1 year after childbirth. [NICE's guideline on antenatal and postnatal mental health]

Severe mental health problem

A severe mental health problem includes severe and incapacitating depression, psychosis, schizophrenia, bipolar disorder, schizoaffective disorder or postpartum psychosis. [NICE's guideline on antenatal and postnatal mental health]

Equality and diversity considerations

When information is provided, there must be equal access to information for all women, including those with additional needs, such as physical or learning disabilities, and those who do not speak or read English. Women receiving information should have access to an interpreter or independent advocate if needed.