The clinical value of information on the risk of future psychiatric illness in women who have experienced puerperal (post-partum) psychosis has been limited by inconsistencies in terminology and nosology. Here we report rates of subsequent puerperal and non-puerperal episodes, in a well characterised sample of women diagnosed with clearly defined bipolar affective puerperal psychosis (n=103). Out of 54 women having further children, 31(57%; 95% CI 44-69) experienced an additional puerperal psychotic episode, and 64 of 103 women (62%; 95% CI 52-71) experienced a non-puerperal affective episode during the follow-up period (mean duration 9 years). A history of bipolar episodes prior to the puerperal psychosis did not predict risk following subsequent pregnancies, but positive family history of mental illness predicted shorter time to non-puerperal relapse.