UK Guidelines

UK guidelines emphasise the early recognition and management of anxiety disorders during pregnancy and the postnatal period. Recently, many NHS services have extended their definition of the postnatal period to include the two years following childbirth rather than just one year.

Guidelines suggest that healthcare professionals should screen for anxiety at the first perinatal contact and during the early postnatal period using the GAD-2 scale. A score of 3 or more necessitates further assessment using the GAD-7 or referral to a GP or mental health professional. Comprehensive assessments must also evaluate the mother–baby relationship, social support networks, and potential risks, such as self-harm.

Following identification of PNA, psychological therapies are often the preferred first line of treatment because of the altered risk-benefit ratio for pharmacological interventions during this period; however, there are a range of safe pharmacological treatments available to pregnant and breastfeeding parents.

For subthreshold symptoms of PNA, facilitated CBT-based self-help, typically involving six sessions over two to three months, is recommended. Where an official anxiety disorder is identified, initial treatment may include a high-intensity intervention, such as Cognitive Behavioural Therapy (CBT). Specialist support is recommended for specific conditions such as tokophobia (extreme fear of childbirth), while trauma-focused CBT or EMDR is offered for PTSD resulting from traumatic births. Many regions of the UK now have specialised Maternal Mental Health Services to support such conditions.

Pharmacological management must balance the risks to the fetus or baby (if breastfed) against the risks of untreated mental illness. For women already taking antidepressants (e.g., SSRIs or SNRIs), options include gradual withdrawal or continuing if the disorder is severe or has a history of good response to treatment. Some drugs should only be offered for short-term treatment of severe anxiety, whilst others are safe long-term. Pharmacological treatments should be prescribed and monitored by a clinician with suitable expertise in perinatal mental health.

Care should be coordinated through an integrated care plan involving multidisciplinary teams, often including specialist perinatal mental health midwives, obstetricians, and psychological services. Referral to specialist perinatal mental health services is required for those with current or past severe mental illness. All treatment decisions should be shared, providing balanced information on the benefits and harms to both the parent and the child.