Mental health in the perinatal period cannot be ignored, says Christina Nurmahi, lead pharmacist, women and newborn, University Hospital Southampton NHS Foundation Trust.

Up to one in five women experience mental health problems during pregnancy or within one year of giving birth, many with no previous history of mental illness.

The Saving Lives, Improving Mothers’ Care report by MBBRACE-UK in 2015, covering the period 2011-13, identified that one-quarter of all maternal deaths between six weeks and one year after childbirth were related to mental health problems, and one in seven of those women died from suicide.

While many people are familiar with postnatal depression, a range of other mental health conditions may also present during and after pregnancy.

A recently published RCOG report, Maternal Mental Health – Women’s Voices (Feb 2017), based on a UK survey of 2,323 women who had given birth in the past five years, highlighted a wide spectrum of mental health illness that may present: low mood, anxiety disorders, depression, obsessive-compulsive disorder, post-traumatic stress disorder, psychosis, as well as more general emotions and symptoms of anger, absentmindedness, exhaustion and tiredness.

The impact of this is wide-ranging, affecting both the woman and her family, particularly if left untreated.

Overall, 74 per cent of the respondents had no previous history of mental health problems while, of those who did, 95 per cent went on to experience them during or after pregnancy. The report highlighted variances in care and inconsistencies in the management of perinatal mental health across the UK. Improving care for these women is a priority.

Lack of consensus

It was apparent from the survey that, in women with pre-existing mental health problems, there was no clear consensus from healthcare professionals as to how medication should be managed.

The NICE clinical guideline on antenatal and postnatal mental health provides recommendations for pregnant women who are taking medication and all health professionals involved with pregnant women should familiarise themselves with this guidance with a view to having some consistency in the advice offered.

Pharmacists are well placed, as a point of contact for women picking up medication and seeking general advice for themselves and their baby, to provide information on where to get support, and to advise and allay any concerns.

Improving care for these women is a priority