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Pregnancy planning for parents with mental illness

There is a growing burden of mental disorder among those of reproductive age, particularly women, as highlighted in the Department of Health and Social Care’s Women’s Health Strategy.

People with mental disorder, especially those in contact with mental health services, are at an increased risk of adverse obstetric and neonatal outcomes, such as low birth weight and prematurity. These adverse outcomes can have lifelong effects on the health of the developing child (Spry et al., 2020; Stein et al., 2014).

Both birthing and non-birthing individuals using mental health services experience some of the worst physical and mental health and are often more likely to be exposed to a range of potentially modifiable risk factors for adverse outcomes, such as violence and abuse, unplanned pregnancy, substance misuse, poor nutrition, obesity and co-morbid physical ill health (Catalao et al., 2020).

Project aims

Why this research is needed

There is an increasing recognition of the impact that ‘preconception’ (prior to pregnancy) health can have on subsequent parental and child health (Stephenson et al., 2018). In addition, many of the modifiable risk factors for adverse outcomes, such as obesity, may take several months or even years to address, necessitating early intervention.

Supporting those using mental health services to plan for healthy pregnancy could improve the health of future generations but will also optimise the health and wellbeing of the reproductive age population regardless of their eventual pregnancy intentions.

What services are currently available?

Since the expansion of community perinatal mental health services in England in response to the NHS England Five Year Forward View and the Long Term Plan, ‘preconception counselling’ is being offered to birthing people with mental disorder actively planning pregnancy, as recommended by NICE (2020, 2021).

However, the impact of this expanded service on pregnancy outcomes — specifically what works and for which particular groups — is not yet known. There is evidence that those from minority ethnic groups, who are already at increased risk of mental disorder and adverse obstetric outcomes, may be less likely to use perinatal mental health services (Pilav et al., 2022).

Preconception clinics within perinatal mental health services (PMHS) usually only serve birthing people actively planning a pregnancy, with a focus on those taking medication. Community mental health teams are in contact with individuals throughout the reproductive life course, so could provide an opportunity for conversations about optimising health for a planned (or often unplanned) pregnancy.

“My research so far has indicated that people using mental health services want support to plan for pregnancy, through conversations which are sensitive and non-judgemental during periods of stability in their mental health.”

Dr Claire Wilson — NIHR academic clinical lecturer and psychiatry specialist registrar, project lead

Evidence also suggests that mental healthcare professionals would like clear, easily accessible resources on supporting healthy pregnancies and training on how to use them (Dolman et al., 2013; Public Health England, 2021). Thus, there is an urgent need to understand how all individuals using mental health services, particularly those from under-served groups, can be supported with planning and fitness for pregnancy.

How the research will be carried out

Researchers will use a mixed methods study including focus groups and semi-structured interviews with clinicians and patients across selected mental health services in South London and North East England, alongside routinely collected data on service use. They will ask three questions:

Researchers will co-design (with patients and clinicians in South London and the North East) a decision-making tool to support health and wellbeing in the context of planning and fitness for pregnancy. Using qualitative methods, acceptability, appropriateness and feasibility of the tool will be assessed. A cluster randomised feasibility trial will assess feasibility of an effectiveness trial across mental health services utilising routinely collected data and focus groups with clinicians.

Potential benefits of the project

How are patients and the public involved?

The project lead will work with a range of individuals and organisations with relevant expertise, community connections, social media skills and network building to recruit to a Patient Advisory Group (PAG).

Our collaborators

This project includes a wide range of collaborators including representatives from:

• ARC North East and North Cumbria
• Northumberland, Tyne and Wear (CNTW) Trust
• South London and Maudsley NHS Trust
• SHRINE (Sexual and Reproductive Health Rights, Inclusion and Empowerment)
• UCL
• King’s Policy Institute

Project lead

Related content

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  Development of a digital preconception care tool for women with severe mental illness (Tommy’s Baby Charity)
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  Informing national policy on perinatal mental health and maternity care
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  Maternity and perinatal mental health research at ARC South London

Original source: arc-sl.nihr.ac.uk — NIHR ARC South London legacy content archived May 2026.