Perinatal psychiatry

Perinatal psychiatric disorders are common and can result in significant suffering for women and their families: suicide is a leading cause of maternal death. The most severe form of postpartum mood disorder – postpartum psychosis – follows approximately 1 in 1000 deliveries. Women who have a history of bipolar disorder or who have suffered a previous severe postpartum episode have a many-hundred-fold increased risk, and identifying them in the antenatal period is a key aspect of management. Decisions regarding the use of psychotropic medication in pregnancy must be made after a full risk–benefit analysis. The risks of taking many medications remain unknown but include teratogenic effects, withdrawal or toxic symptoms in the newborn and long-term developmental effects. However, these must be balanced against the risks of untreated mental illness and the risk of recurrence from stopping or switching well-established and efficacious medications. More data are needed to inform the difficult choices regarding medication that women with severe mental illness have to make in regard to pregnancy.