Impact of Immediate Peripartum Psychopathology and Parental Psychiatric Disorders

  • Marc Poget
  • Marie-Camille Genet
  • Gisèle Apter


Psychiatric illness is pervasive in the peripartum. Psychiatric disorders can be described as either preexisting conditions or de novo disorders. Both of these circumstances will be studied here with parenthood, parent-infant interactions, and infant emotional development in mind. We will review recent literature in the context of parenthood and the peripartum, on maternal mental illness such as schizophrenia and bipolar disorder and mood and affective disorders. Personality disorder, substance abuse, and eating disorders will also be included.

From a clinical perspective, it could be hypothesized that children are influenced by their mother’s mental health condition through disturbances of mother-baby interaction. A psychiatric disorder is in itself a risk factor for environmental instability, leading to negative interactive loops. Particular attention must thus be paid to all the negative elements that may hinder parental interactions and lead to poorer interactions, where the most deleterious consequence is neglect and child abuse. A description of very early signs of emotional deprivation through neglectful interactions will be provided. We will conclude with some directions for care after assessing parenting disorders and interactive disorders independently from psychiatric pathology.


Perinatal psychiatric disorders Parenthood Parent-infant interaction Severe mental illness Infant neglect System-oriented therapeutic approach 


  1. 1.
    Howard LM, Molyneaux E, Dennis CL, Rochat T, Stein A, Milgrom J (2014) Non-psychotic mental disorders in the perinatal period. Lancet 384(9956):1775–1788PubMedCrossRefGoogle Scholar
  2. 2.
    Jones I, Chandra PS, Dazzan P, Howard LM (2014) Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period. Lancet 384(9956):1789–1799PubMedCrossRefPubMedCentralGoogle Scholar
  3. 3.
    Khalifeh H, Brauer R, Toulmin H, Howard LM (2015) Perinatal mental health: what every neonatologist should know. Early Hum Dev 91(11):649–653PubMedCrossRefGoogle Scholar
  4. 4.
    Stein A, Pearson RM, Goodman SH, Rapa E, Rahman A, McCallum M, Howard LM, Pariante CM (2014) Effects of perinatal mental disorders on the fetus and child. Lancet 384(9956):1800–1819PubMedCrossRefGoogle Scholar
  5. 5.
    Sved Williams A, Apter G (2018). Working with women with borderline personality disorder and their infants. 16th Waimh World Congress Rome May 27–31Google Scholar
  6. 6.
    Howard LM, Piot P, Stein A (2014) No health without perinatal mental health. Lancet 384(9956):1723–1724PubMedCrossRefGoogle Scholar
  7. 7.
    Herrman H (2015) Protecting the mental health of women in the perinatal period. Lancet Psychiatry 2(2):116–118PubMedCrossRefGoogle Scholar
  8. 8.
    Putnam K, Robertson-Blackmore E, Sharkey K, Payne J, Bergink V, Munk-Olsen T, Deligiannidis K, Altemus M, Newport J, Apter G, Devouche E (2015) Heterogeneity of postpartum depression: a latent class analysis. Lancet Psychiatry 2(1):59–67CrossRefGoogle Scholar
  9. 9.
    Hameed MA, Lewis AJ (2016) Offspring of parents with schizophrenia: a systematic review of developmental features across childhood. Harv Rev Psychiatry 24(2):104–117PubMedCrossRefGoogle Scholar
  10. 10.
    Schneid-Kofman N, Sheiner E, Levy A (2008) Psychiatric illness and adverse pregnancy outcome. Int J Gynecol Obstet 101(1):53–56CrossRefGoogle Scholar
  11. 11.
    Vigod SN, Kurdyak PA, Dennis CL, Gruneir A, Newman A, Seeman MV, Rochon PA, Anderson GM, Grigoriadis S, Ray JG (2014) Maternal and newborn outcomes among women with schizophrenia: a retrospective population-based cohort study. BJOG Int J Obstet Gynaecol 121(5):566–574CrossRefGoogle Scholar
  12. 12.
    Robinson GE (2012) Treatment of schizophrenia in pregnancy and postpartum. J Popul Ther Clin Pharmacol 19(3):e380–e386PubMedGoogle Scholar
  13. 13.
    Davidsen KA, Harder S, MacBeth A, Lundy JM, Gumley A (2015) Mother–infant interaction in schizophrenia: transmitting risk or resilience? A systematic review of the literature. Soc Psychiatry Psychiatr Epidemiol 50(12):1785–1798PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Viguera AC, Nonacs R, Cohen LS, Tondo L, Murray A, Baldessarini RJ (2000) Risk of recurrence of bipolar disorder in pregnant and nonpregnant women after discontinuing lithium maintenance. Am J Psychiatr 157(2):179–184PubMedCrossRefGoogle Scholar
  15. 15.
    Sanchez-Gistau V, Romero S, Moreno D, de la Serna E, Baeza I, Sugranyes G, Moreno C, Sanchez-Gutierrez T, Rodriguez-Toscano E, Castro-Fornieles J (2015) Psychiatric disorders in child and adolescent offspring of patients with schizophrenia and bipolar disorder: a controlled study. Schizophr Res 168(1–2):197–203PubMedCrossRefGoogle Scholar
  16. 16.
    Rusner M, Berg M, Begley C (2016) Bipolar disorder in pregnancy and childbirth: a systematic review of outcomes. BMC Pregnancy Childbirth 16(1):331PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Santucci AK, Singer LT, Wisniewski SR, Luther JF, Eng HF, Sit DK, Wisner KL (2017) One-year developmental outcomes for infants of mothers with bipolar disorder. J Clin Psychiatry 78(8):1083–1090PubMedCrossRefGoogle Scholar
  18. 18.
    Logsdon MC, Mittelberg M, Jacob AE, Luther JF, Wisniewski SR, Confer A, Eng H, Wisner KL (2015) Maternal–Infant interaction in women with unipoloar and bipolar depression. Appl Nurs Res 28(4):381–383PubMedPubMedCentralCrossRefGoogle Scholar
  19. 19.
    Battle CL, Weinstock LM, Howard M (2014) Clinical correlates of perinatal bipolar disorder in an interdisciplinary obstetrical hospital setting. J Affect Disord 158:97–100PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    May PA, Chambers CD, Kalberg WO, Zellner J, Feldman H, Buckley D, Kopald D, Hasken JM, Xu R, Honerkamp-Smith G, Taras H (2018) Prevalence of fetal alcohol spectrum disorders in 4 US communities. JAMA 319(5):474–482PubMedPubMedCentralCrossRefGoogle Scholar
  21. 21.
    Brown QL, Sarvet AL, Shmulewitz D, Martins SS, Wall MM, Hasin DS (2017) Trends in marijuana use among pregnant and nonpregnant reproductive-aged women, 2002-2014. JAMA 317(2):207–209PubMedPubMedCentralCrossRefGoogle Scholar
  22. 22.
    Jansson LM, Jordan CJ, Velez ML (2018) Perinatal marijuana use and the developing child. JAMA 320(6):545–546PubMedCrossRefPubMedCentralGoogle Scholar
  23. 23.
    Siqveland TS, Moe V (2014) Longitudinal development of mother–infant interaction during the first year of life among mothers with substance abuse and psychiatric problems and their infants. Child Psychiatry Hum Dev 45(4):408–421PubMedCrossRefGoogle Scholar
  24. 24.
    Siqveland TS, Haabrekke K, Wentzel-Larsen T, Moe V (2014) Patterns of mother–infant interaction from 3 to 12 months among dyads with substance abuse and psychiatric problems. Infant Behav Dev 37(4):772–786PubMedCrossRefGoogle Scholar
  25. 25.
    Stein A, Woolley H, Senior R, Hertzmann L, Lovel M, Lee J et al (2006) Treating disturbances in the relationship between mothers with bulimic eating disorders and their infants: a randomized, controlled trial of video feedback. Am J Psychiatr 163(5):899–906PubMedCrossRefGoogle Scholar
  26. 26.
    Apter G, Devouche E, Gratier M, Valente M, Le Nestour A (2012) What lies behind postnatal depression: is it only a mood disorder. J Personal Disord 26(3):357–367CrossRefGoogle Scholar
  27. 27.
    Genet MC, Golse B, Devouche E, Apter G (2014) Psychopathologie, attachement et devenir des enfants de mères présentant un trouble de personnalité borderline/état-limite: une revue de la littérature. Psychiatr Enfant 57(1):259–329CrossRefGoogle Scholar
  28. 28.
    Blankley G, Galbally M, Snellen M, Power J, Lewis AJ (2015) Borderline personality disorder in the perinatal period: early infant and maternal outcomes. Australas Psychiatry 23(6):688–692PubMedCrossRefGoogle Scholar
  29. 29.
    Pare-Miron V, Czuzoj-Shulman N, Oddy L, Spence AR, Abenhaim HA (2016) Effect of borderline personality disorder on obstetrical and neonatal outcomes. Womens Health Issues 26(2):190–195PubMedCrossRefGoogle Scholar
  30. 30.
    Dayan J, Andro G, Dugnat M (2014) Psychopathologie de la périnatalité et de la parentalité. Elsevier-Masson, Issy-Les-MoulineauxGoogle Scholar
  31. 31.
    Glangeaud-Freudenthal NM, Howard LM, Sutter-Dallay AL (2014) Treatment–mother–infant inpatient units. Best Pract Res Clin Obstet Gynaecol 28(1):147–157PubMedCrossRefGoogle Scholar
  32. 32.
    Kenny M, Conroy S, Pariante CM, Seneviratne G, Pawlby S (2013) Mother–infant interaction in mother and baby unit patients: before and after treatment. J Psychiatr Res 47(9):1192–1198PubMedCrossRefGoogle Scholar
  33. 33.
    Andersson L, Sundstrom-Poromaa I, Wulff M, Astrom M, Bixo M (2004) Implications of antenatal depression and anxiety for obstetric outcome. Obstet Gynecol 104:467–476PubMedCrossRefGoogle Scholar
  34. 34.
    Wu J, Viguera A, Riley L, Cohen L, Ecker J (2002) Mood disturbance in pregnancy and the mode of delivery. Am J Obstet Gynecol 187:864–867PubMedCrossRefGoogle Scholar
  35. 35.
    Dayan J, Creveuil C, Dreyfus M, Herlicoviez M, Baleyte JM, O’Keane V (2010) Developmental model of depression applied to prenatal depression: role of present and past life events, past emotional disorders and pregnancy stress. PLoS One 5(9):e12942PubMedPubMedCentralCrossRefGoogle Scholar
  36. 36.
    Cooper PJ, Murray L (1995) Course and recurrence of postnatal depression. Evidence for the specificity of the diagnostic concept. Br J Psychiatry 166:191–195PubMedCrossRefGoogle Scholar
  37. 37.
    Di Florio A, Putnam K, Altemus M, Apter G, Bergink V, Bilszta J, Brock R, Buist A, Deligiannidis KM, Devouche E, Epperson CN (2017) The impact of education, country, race and ethnicity on the self-report of postpartum depression using the Edinburgh postnatal depression scale. Psychol Med 47(5):787–799PubMedCrossRefGoogle Scholar
  38. 38.
    Putnam KT, Wilcox M, Robertson-Blackmore E, Sharkey K, Bergink V, Munk-Olsen T, Deligiannidis KM, Payne J, Altemus M, Newport J, Apter G, Postpartum Depression: Action Towards Causes and Treatment (PACT) Consortium (2017) Clinical phenotypes of perinatal depression and time of symptom onset: analysis of data from an international consortium. Lancet Psychiatry 4(6):477–485PubMedPubMedCentralCrossRefGoogle Scholar
  39. 39.
    Murray L, Arteche A, Fearon P, Halligan S, Croudace T, Cooper P (2010) The effects of maternal postnatal depression and child sex on academic performance at age 16 years: a developmental approach. J Child Psychol Psychiatry 51(10):1150–1159PubMedCrossRefGoogle Scholar
  40. 40.
    Murray L, Arteche A, Fearon P, Halligan S, Goodyer I, Cooper P (2011) Maternal postnatal depression and the development of depression in offspring up to 16 years of age. J Am Acad Child Adolesc Psychiatry 50(5):460–470PubMedCrossRefGoogle Scholar
  41. 41.
    Goodman SH, Rouse MH, Connell AM, Broth MR, Hall CM, Heyward D (2011) Maternal depression and child psychopathology: a meta-analytic review. Clin Child Fam Psychol Rev 14(1):1–27PubMedCrossRefGoogle Scholar
  42. 42.
    Gonçalves H, Pearson RM, Horta BL, González-Chica DA, Castilho E, Damiani M, Lima RC, Gigante DP, Barros FC, Stein A, Victora CG (2016) Maternal depression and anxiety predicts the pattern of offspring symptoms during their transition to adulthood. Psychol Med 46(2):415–424PubMedCrossRefGoogle Scholar
  43. 43.
    Weissman MM, Wickramaratne P, Gameroff MJ, Warner V, Pilowsky D, Kohad RG, Verdeli H, Skipper J, Talati A (2016) Offspring of depressed parents: 30 years later. Am J Psychiatr 173(10):1024–1032PubMedCrossRefGoogle Scholar
  44. 44.
    Huizink AC, Mulder EJ, Buitelaar JK (2004) Prenatal stress and risk for psychopathology: specific effects or induction of general susceptibility? Psychol Bull 130(1):115–142PubMedCrossRefGoogle Scholar
  45. 45.
    Hock E, Shirtzinger MB (1992) Maternal separation anxiety: its developmental course and relation to maternal mental health. Child Dev 63:93–102PubMedCrossRefGoogle Scholar
  46. 46.
    Winnicott DW (1971) Playing and reality. Tavistock, LondonGoogle Scholar
  47. 47.
    Van Batenburg-Eddes, T., de Groot, L., Huizink, A.C., Steegers, E.A., Hofman, A., Jaddoe, V.W., et al. (2009). Maternal symptoms of anxiety during pregnancy affect infant neuromotor development: the Generation R study. Dev Neuropsychol, 34(4), 476–493Google Scholar
  48. 48.
    Lamour M (1985) Des nourrissons avec leurs mères psychotiques. Rev Pédiatr 7:327–334Google Scholar
  49. 49.
    Lamour M (1989) Les nourrissons de parents psychotiques. In: Lebovici S, Weil-Halpern F (eds) Psychopathologie du bébé. PUF, Paris, pp 655–673Google Scholar
  50. 50.
    Teasdale JD, Fogarty S, William JM (1980) Speech rate as a measure of short-term variation in depression. Br J Clin Psychol 19:271–278CrossRefGoogle Scholar
  51. 51.
    Sherer KR (1986) Vocal affect expression: a review and a model for future research. Psychol Bull 99:143–165CrossRefGoogle Scholar
  52. 52.
    Beebe B, Badalamenti A, Jaffe J, Feldstein S, Marquette L, Helbraun E et al (2008) Distressed mothers and their infants use a less efficient timing mechanism in creating expectancies of each other’s looking patterns. J Psycholinguistic Res 37(5):293–307CrossRefGoogle Scholar
  53. 53.
    Libert J, Lewinsohn P (1973) The concept of social skill with special reference to the behavior of depressed persons. J Consult Clin Psychol 40:304–312CrossRefGoogle Scholar
  54. 54.
    Champagne FA (2010) Early adversity and developmental outcomes: interaction between genetics, epigenetics, and social experiences across the life span. Perspect Psychol Sci 5(5):564–574PubMedCrossRefGoogle Scholar
  55. 55.
    Champagne FA, Meaney MJ (2006) Stress during gestation alters postpartum maternal care and the development of the offspring in a rodent model. Biol Psychiatry 59(12):1227–1235PubMedCrossRefGoogle Scholar
  56. 56.
    Lester BM, Tronick E, Nestler E, Abel T, Kosofsky B, Kuzawa CW, Marsit CJ, Maze I, Meaney MJ, Monteggia LM, Reul JM (2011) Behavioral epigenetics. Ann N Y Acad Sci 1226(1):14–33PubMedPubMedCentralCrossRefGoogle Scholar
  57. 57.
    Szyf M, Weaver I, Meaney M (2007) Maternal care, the epigenome and phenotypic differences in behavior. Reprod Toxicol 24(1):9–19PubMedCrossRefGoogle Scholar
  58. 58.
    Devlin AM, Brain U, Austin J, Oberlander TF (2010) Prenatal exposure to maternal depressed mood and the MTHFR C677T Variant affect SLC6A4 Methylation in infants at birth. PLoS One 5(8):1–8CrossRefGoogle Scholar
  59. 59.
    Zucchi FC, Yao Y, Ward ID, Ilnytskyy Y, Olson DM, Benzies K, Kovalchuk I, Kovalchuk O, Metz GA (2013) Maternal stress induces epigenetic signatures of psychiatric and neurological diseases in the offspring. PLoS One 8(2):1–9CrossRefGoogle Scholar
  60. 60.
    Provençal N, Binder EB (2015) The effects of early life stress on the epigenome: from the womb to adulthood and even before. Exp Neurol 268:10–20PubMedCrossRefGoogle Scholar
  61. 61.
    Taylor SE, Way BM, Seeman TE (2011) Early adversity and adult health outcomes. Dev Psychopathol 23(3):939–954PubMedCrossRefGoogle Scholar
  62. 62.
    Apter G, Genet MC, Alecian M, Devouche E (2017) Interactions précoces: modèles et recherches en psychopathologie développementale. EMC Psychiatr/Pédopsychiatrie 14(4):1–9Google Scholar
  63. 63.
    Degraux C, Pelsser V (2011) La grille de Steinhauer: explications, utilisations et limites dans l’accompagnementGoogle Scholar
  64. 64.
    Garret-Gloanec N., Gloanec Y. (2007) De la psychiatrie périnatale à la psychiatrie néonatale. EMC (Elsevier Masson SAS, Paris), Psychiatrie/Pédopsychiatrie, 37-200-B-25CrossRefGoogle Scholar
  65. 65.
    Moayedoddin A, Moser D, Nanzer N (2013) The impact of brief psychotherapy centred on parenthood on the anxio-depressive symptoms of mothers during the perinatal period. Swiss Med Wkly 143:w13769PubMedGoogle Scholar
  66. 66.
    Apter G, Devouche E (2013) The multifaceted question of the prescription of antidepressants during pregnancy. Shanghai Arch Psychiatry 25(5):317PubMedPubMedCentralGoogle Scholar
  67. 67.
    Apter G, Devouche E, Becquemont L (2015) Impact of pregnancy on psychotropic medication prescription: a French cohort study. Therapie 70(3):251–257PubMedCrossRefGoogle Scholar
  68. 68.
    Langan R, Goodbred AJ (2016) Identification and management of peripartum depression. Am Fam Physician 93(10):852–858PubMedGoogle Scholar
  69. 69.
    van der Ham J, Berry K, Hoehn E, Fraser J (2013) A collaborative approach to perinatal and infant mental health service delivery in Australia. Australas Psychiatry 21(4):371–375PubMedCrossRefGoogle Scholar
  70. 70.
    Lee VWW, Newman LK (2018) A model for the provision of integrated perinatal and infant mental health services in regional settings. Australas Psychiatry 6(5):531–533CrossRefGoogle Scholar
  71. 71.
    Williams AS, Apter G (2017) Helping mothers with the emotional dysregulation of borderline personality disorder and their infants in primary care settings. Aust Fam Physician 46(9):669Google Scholar
  72. 72.
    Manzano J, Palacio Espasa F, Zilkha N (1999) Les scenarios narcissiques de la parentalité. PUF, ParisGoogle Scholar
  73. 73.
    Manzano J, Righetti-Veltema M, Perreard EC (1997) Le syndrome de dépression du pré-partum. Résultat d’une recherche sur les signes précurseurs de la dépression du post-partum. Psychiatr Enfant 40(2):533–552Google Scholar
  74. 74.
    Apter G, Bobin A, Genet MC, Gratier M, Devouche E (2017) Update on mental health of infants and children of parents affected with mental health issues. Curr Psychiatry Rep 19(10):72PubMedCrossRefGoogle Scholar
  75. 75.
    Prenoveau JM, Craske MG, West V, Giannakakis A, Zioga M, Lehtonen A et al (2017) Maternal postnatal depression and anxiety and their association with child emotional negativity and behavior problems at two years. Dev Psychol 53(1):50PubMedPubMedCentralCrossRefGoogle Scholar
  76. 76.
    Lipscomb ST, Leve LD, Harold GT, Neiderhiser JM, Shaw DS, Ge X, Reiss D (2011) Trajectories of parenting and child negative emotionality during infancy and toddlerhood: a longitudinal analysis. Child Dev 82(5):1661–1675PubMedPubMedCentralCrossRefGoogle Scholar
  77. 77.
    Masten AS, Cicchetti D (2010) Developmental cascades. Dev Psychopathol 22(3):491–495PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Marc Poget
    • 1
  • Marie-Camille Genet
    • 2
  • Gisèle Apter
    • 3
  1. 1.Centre Hospitalier de la Polynésie françaiseTahitiFrench Polynesia
  2. 2.Formatrice COPES, Unité Aubier, EPS ErasmeAntonyFrance
  3. 3.Groupe Hospitalier du Havre, Université de Rouen NormandieRouenFrance

Personalised recommendations