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It is increasingly recognised that many women with psychotic disorders have children 1,2 and that pregnancies of these women are high-risk. Psychotic disorders increase the risk of stillbir th and infant mortality 3 and can affect a woman's ability to care for herself and her infant. 4 Although women with psychoses are less fertile than the general population, 5 partly as a result of hyperprolactinaemia secondary to antipsychotic drugs, the increasing use of newer atypical drugs such as clozapine and olanzapine, which do not have this effect, is likely to lead to a rise in fertility, particularly in women with affective psychosis. 5 Women come into contact with many healthcare professionals during pregnancy and there are therefore many potential opportunities for prevention or attenuation of these risks. The challenge for health workers caring for women who are pregnant is how to ensure mental health problems are recognised and adequately treated. The NICE guideline on antenatal and postnatal mental health (2007) 6 recommends that at a women's first contact with services in the antenatal period, healthcare professionals should ask about past or present severe mental illness, previous treatment by a psychiatrist/specialist mental health team, including inpatient care, and a family history of perinatal mental illness.There is evidence from North America that women with psychotic disorders may start antenatal care later than controls and that women with mental health disorders receive poorer prenatal care. 7,8 Good liaison between services is therefore essential; healthcare professionals need to ensure that adequate systems are in place to ensure continuity of care and effective transfer of information. If a patient in contact with psychiatric services becomes pregnant, psychiatric services need to support the patient in engaging with primary care (including health visitors and community midwives) and obstetric services as early as possible in the pregnancy and liaise closely about the multidisciplinary care plan for the pregnancy and postnatal period. Risk of complications of pregnancyAll pregnancies carry risk, particularly to the fetus, with a base rate of obstetric risk and risk of congenital malformation of between 2 and 4 per cent. Patients with schizophrenia are at increased risk of impaired glucose tolerance and incident diabetes, 9 particularly if they are taking cer tain atypical antipsychotic drugs. 10 They are therefore at high risk of gestational diabetes. Women with psychotic disorders are also more likely to abuse substances, smoke and consume alcohol during pregnancy. 11,12 It is clear from a number of systematic reviews that women with psychotic disorders are at increased risk of obstetric complications 12,13 and stillbirths, 3 though these findings may be explained by confounding factors such as smoking, substance misuse, socioeconomic status, genetic susceptibility, poorer antenatal care, or possible effects of psychotropic medication. Risk of relapse during pregnancy and postpartumWhen counsell...

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Data on the disadvantaged urban child is meagre. A prospective survey of 60 households in Borella North, each with at least one child under 2 years of age, was carried out over 8 months. The socioeconomic status, the physical environment and the health of the population were investigated.One hundred and ten families lived in the 60 households and 29% of the population were under the age of 5 years. Only a minority of families had regular employment. The source of water was the roadside tap for 70% of households. Solid waste and blocked drains were present in the environment. 80% of homes were over-crowded. Family planning was practised only by 17% of parents. 25% of under fives were in grade 2 protein calorie malnutrition and 20% of this age group needed at least one hospital admission during the study period.We conclude that the disadvantaged urban child has health risks that need multidisciplinary interventions.

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