Bipolar disorder and childbirth: the importance of recognising risk. Jones and Craddock (2005) BJP 186, 453

Postpartum psychosis (PP) often occurs suddenly, within days after childbirth, and can get worse very quickly.  The illness can have a devastating impact on women and their families, so prompt recognition and treatment are vital.

We know of various risk factors that influence the occurrence of PP, so it should be possible to predict whether some women are likely to have an episode of illness.  In particular, women with bipolar disorder are at greatly increased risk of PP, with episodes following 25-50% of deliveries. Women who have had PP, or who have a close relative who has had PP or bipolar disorder, are also at increased risk of illness. 

It is important that healthcare professionals recognise these risk factors so that vulnerable women can be identified and can benefit from careful management before conception, through pregnancy and after childbirth. All women receiving antenatal care should be screened for known risk factors, because many women with a history of bipolar disorder may be currently well and not in contact with psychiatric services, but are nevertheless at increased risk of experiencing PP.  Close contact and regular review should be maintained for women at risk, so that services can respond quickly to those who become ill. 

**Summary awaiting verification from expert**