The Relationship Between Perinatal Mental Health and Stress: a Review of the Microbiome

  • Nusiebeh Redpath
  • Hannah S. Rackers
  • Mary C. KimmelEmail author
Reproductive Psychiatry and Women's Health (CN Epperson and L Hantsoo, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Reproductive Psychiatry and Women's Health


Purpose of Review

Our current understanding of the underlying mechanisms and etiologies of perinatal mood and anxiety disorders (PMADs) is not clearly identified. The relationship of stress-induced adaptations (i.e., the hypothalamic-pituitary-adrenal (HPA) axis, the autonomic nervous system (ANS), the immune system) and the microbiota are potential contributors to psychopathology exhibited in women during pregnancy and postpartum and should be investigated.

Recent Findings

The stress response activates the HPA axis and dysregulates the ANS, leading to the inhibition of the parasympathetic system. Sustained high levels of cortisol, reduced heart variability, and modulated immune responses increase the vulnerability to PMAD. Bidirectional communication between the nervous system and the microbiota is an important factor to alter host homeostasis and development of PMAD.


Future research in the relationship between the psychoneuroimmune system, the gut microbiota, and PMAD has the potential to be integrated in clinical practice to improve screening, diagnosis, and treatment.


Heart rate variability Psychosocial stress Depression Anxiety Pregnancy Microbiota 


Compliance with Ethical Standards

Conflict of Interest

Nusiebeh Redpath declares no conflict of interest.

Hannah S. Rackers reports grants from the National Institute of Mental Health and the Brain and Behavior Foundation.

Mary C. Kimmel reports grants from the National Institute of Mental Health and the Brain and Behavior Foundation and payment supplied by grant from Sage Therapeutics for lectures on perinatal depression, and personal fees from UpToDate for two articles written.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Nusiebeh Redpath
    • 1
  • Hannah S. Rackers
    • 2
  • Mary C. Kimmel
    • 2
    Email author
  1. 1.Department of Maternal and Child Health, Gillings School of Global Public HealthUniversity of North Carolina at Chapel HillChapel HillUSA
  2. 2.Department of Psychiatry, School of MedicineUniversity of North Carolina at Chapel HillChapel HillUSA

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