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Pregnancy and the arrival of a new baby signal a time of unparalleled change and hope for the future. For many women, however, it is a challenging time; for a minority of mothers this period can be overshadowed by mental illness, aggravated by widespread stigma.1 There is no time in the lifespan that the statement "there is no health without mental health"2 rings truer than in the perinatal period. The perinatal mental health Series in The Lancet reviews the epidemiology and treatment of perinatal mental disorders and their effect on mother and child.3-5 The Series reviews a wide spectrum of disorders that can occur in pregnancy and post partum, from common mental disorders, such as depression and anxiety, to mania and psychosis in early post partum.
The focus of research and policy has, until recently, largely centred on postnatal depression. There is evidence for effective interventions for postnatal depression, and that in low-income and middle-income countries (LMICs) trained non-specialist health workers can provide these.3 However, for more severe perinatal mental disorders, and for disorders other than postnatal depression, there is a more limited evidence base. The recognition and treatment of perinatal mental illness is important not least because suicide is a major cause of maternal deaths in high-income countries.6 Perinatal mental illness might also account for a substantial proportion of maternal deaths in low-income countries if suicide were properly classified and reported.7 The Series emphasises the need for individualised risk-benefit analyses when considering psychotropic medication in the perinatal period to balance risks of untreated illness for the mother and fetus or child with possible adverse effects of medication.
Treating the mother's disorder alone, however, is not always sufficient to mitigate the impact on the child. The final Series paper5 focuses on possible effects of perinatal mental illness on the fetus and child. There is...