Maternal Mental Health
In vulnerable women, pregnancy exacerbates the risk of developing a mental illness. Approximately one in three women in South Africa have depression and/or anxiety in the perinatal period. Globally, postpartum psychosis affects 1 to 2 women in every 1000 after childbirth. Risk factors for maternal mental illness include past history of mental illness, recent major life event, (e.g. bereavement) e
In vulnerable women, pregnancy exacerbates the risk of developing a mental illness. Approximately one in three women in South Africa have depression and/or anxiety in the perinatal period. Globally, postpartum psychosis affects 1 to 2 women in every 1000 after childbirth.
Risk factors for maternal mental illness include past history of mental illness, recent major life event, (e.g. bereavement) early childhood adversity/ abuse, domestic violence, a history of trauma, displacement from home of origin, low socio-economic status, food insecurity. Women who learn that they are HIV positive during pregnancy have a particular vulnerability to mental health conditions.
Untreated maternal mental illness is associated with the following:
- unplanned and unwanted pregnancy
- poor adherence to health advice; poor uptake of antenatal services
- tobacco, alcohol and other substance use
- self-harm and suicide
- relapse of the mental illness during the pregnancy or postpartum
- gestational hypertension and/or diabetes
- poor pregnancy outcomes, including preterm labour and low birth weight
- increased risk of neonatal morbidity and stillbirth in mothers with bipolar and psychotic disorders
- poor engagement with the infant
- poor family relationships; paternal mental health conditions
- behavioural and neurodevelopmental disorders in the offspring
Suspect maternal mental illness if:
- unreliable antenatal clinic attendance
- continued smoking and/or other substance use during pregnancy
- any odd or eccentric speech or behaviour
- screened positive using the 3-item tool in the Maternity Case Record
Pre-conception care:
- Identify at-risk women – any current or past symptoms of mental illness, emotional problems, substance use, poor social support, abusive relationships, recent trauma, socio-economic deprivation.
- Initiate management for mental disorders/ substance use/ psychosocial stress as needed.
- Use medicines which are safe in pregnancy, unless benefit outweighs risk and patient consents to use (if valproate use, sign acknowledgement of risk form: Valproate Annual Risk Acknowledgement Form)
- Discuss planning for pregnancy and initiate contraception according to individual choice.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2025-9_Version 1.0_26 March 2026
Chapter 6: Obstetrics and Gynaecology_6.9 Maternal Mental Health