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Perinatal Mental Health: Opportunities and Challenges for Psychiatry

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Mental Health".

Deadline for manuscript submissions: closed (28 August 2023) | Viewed by 28224

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Special Issue Editors

Dr. Anne-Laure Sutter-Dallay

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Charles Perrens Hospital, Perinatal Psychiatry Network, University Department of Child and Adolescent Psychiatry, University of Bordeaux, INSERM U1219, F-33000 Bordeaux, France
Interests: perinatal joint care; pathways to care; antenatal exposure to parental mental disorders; antenatal exposure to psychotropic drugs
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Dr. Florence Gressier

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Department of Psychiatry, Bicêtre University Hospital, Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris Saclay, CHU de Bicêtre (AP-HP, GH Paris Saclay), 78 Rue du Général Leclerc, 94275 Le Kremlin Bicêtre, France
Interests: perinatal psychiatry; prenatal psychotropic exposure; pharmacogenetics; maternal mental health; paternal mental health; suicidality; perinatal telepsychiatry

Special Issue Information

Dear Colleagues,

The field of perinatal mental health and perinatal psychiatry lies at the interface of three disciplines: adult psychiatry, fetal and infant development, and infant psychopathology. It focuses on parental mental disorders, specific aspects of these disorders during the perinatal period, and the understanding of the pathophysiological mechanisms linking these disorders, interaction disorders and the developmental disorders of young children.

This Special Issue aims to update the current perspectives on practice and research in perinatal psychiatry, and to offer an opportunity for the development of existing knowledge regarding the prevention of parental psychiatric disorders and child development. Indeed, knowledge about perinatal brain maturation, and the underlying genetic, epigenetic, inflammatory and immune processes of perinatal onset/relapses of mood disorders, with a particular focus on links with other perinatal pathologies such as hyperemesis, hypertension, or diabetes, is expanding.

In terms of challenges, the prevention of maternal suicide and the protection of child development are crucial and topical, in addition to older challenges that persist and require our full attention. Among them, absolute priority is given to, on the one hand, the improvement of research methods, allowing a better understanding of the interrelated mechanisms underlying the effects of parental psychiatric disorders and their treatments on the development of children. On the other hand, priority is also given to the specificities of joint care in terms of the techniques and organization of care pathways, with a focus on the ante-conceptional period.

You may choose our Joint Special Issue in Brain Sciences.

Dr. Anne-Laure Sutter-Dallay
Dr. Florence Gressier
Guest Editors

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Keywords

perinatal mental health
parental mood disorders
maternal brain
psychotropics during pregnancy
child development
joint care
maternal suicidality
fetal programming

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Published Papers (9 papers)

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Research

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19 pages, 580 KiB

Open AccessFeature PaperArticle

Unique Characteristics of Women and Infants Moderate the Association between Depression and Mother–Infant Interaction

by Sandra J. Weiss, Sherryl H. Goodman, Sharon A. Kidd, Margaret Tresch Owen, Diana I. Simeonova, Christine Youngwon Kim, Bruce Cooper, Katherine L. Rosenblum and Maria Muzik

J. Clin. Med. 2023, 12(17), 5503; https://doi.org/10.3390/jcm12175503 - 24 Aug 2023

Cited by 2 | Viewed by 2019

Abstract

Research has shown mixed results regarding the association between women’s postpartum depression and mother–infant interactions, suggesting that a woman’s unique experience and context may moderate how depression shapes these interactions. We examined the extent to which a woman’s comorbid anxiety, her exposure to adversity, and infant characteristics moderate the relationship between depressive symptoms of women and interactions with their infants at 6 (n = 647) and 12 months (n = 346) postpartum. The methods included standardized coding of mother–infant interactions and structural regression modeling. The results at 6 months of infant age indicated that infant male sex and infant negative affectivity were risk factors for mothers’ depression being associated with less optimal interactions. At 12 months of infant age, two moderators appeared to buffer the influence of depression: a woman’s history of trauma and infant preterm birth (≤37 weeks gestation). The results reinforce the salience of infant characteristics in the relationship between maternal depression and mother–infant interactions. The findings also suggest that experiences of trauma may offer opportunities for psychological growth that foster constructive management of depression’s potential effect on mother–infant interactions. Further research is needed to clarify the underlying processes and mechanisms that explain the influence of these moderators. The ultimate goals are to reduce the risk of suboptimal interactions and reinforce healthy dyadic relations. Full article

(This article belongs to the Special Issue Perinatal Mental Health: Opportunities and Challenges for Psychiatry)

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16 pages, 1380 KiB

Open AccessArticle

Evaluation of the Michigan Clinical Consultation and Care Program: An Evidence-Based Approach to Perinatal Mental Healthcare

by Maria Muzik, Rena A. Menke, Meriam Issa, Chelsea Fisk, Jordan Charles and Jennifer M. Jester

J. Clin. Med. 2023, 12(14), 4836; https://doi.org/10.3390/jcm12144836 - 22 Jul 2023

Cited by 3 | Viewed by 2175

Abstract

Mood and anxiety disorders affect pregnant individuals and their families at increased rates throughout the perinatal period. Geographic, financial, and social barriers often preclude adequate diagnosis and treatment. The aim of this manuscript is to describe the consultation and care arms of the Michigan Clinical Consultation and Care (MC3) program, a statewide program designed to facilitate access to perinatal mental healthcare for OB/Gyn patients, and to describe the participants engaged in the program, examine the predictors of participant retention, and provide preliminary data regarding participants’ mental health outcomes. We enrolled 209 participants to the clinical care arm, of which 48 were lost to follow-up, while 107 remained enrolled at the time of data analysis. A total of 54 participants met their treatment goals. A total of 97% of participants asserted they were satisfied with the services they received. Black race and public insurance predicted faster attrition from the care arm treatment; risks for interpersonal violence exposure and substance use were unrelated to attrition. Preliminary mental health outcomes showed significant decreases in anxiety and depression, with the most dramatic decreases in the first month of treatment. Overall, the MC3 clinical care arm shows promising rates of adherence, excellent program satisfaction, and a positive impact on perinatal mental health, supporting continued program implementation and ongoing evaluation. Full article

(This article belongs to the Special Issue Perinatal Mental Health: Opportunities and Challenges for Psychiatry)

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15 pages, 1250 KiB

Open AccessArticle

Pathways between Risk/Protective Factors and Maternal Postnatal Depressive Symptoms: The ELFE Cohort

by Mélanie Bales, Elodie Pambrun, Charlotte Maguet, Judith van der Waerden, Nine Glangeaud-Freudenthal, Marie-Aline Charles, Corinne Bois, Maria Melchior, Jeannette Milgrom, Bruno Falissard, Hélène Verdoux and Anne-Laure Sutter-Dallay

J. Clin. Med. 2023, 12(9), 3204; https://doi.org/10.3390/jcm12093204 - 29 Apr 2023

Cited by 3 | Viewed by 2630

Abstract

Objective: The risk factors for postnatal depressive symptoms (PNDS) are numerous, but little is known about the protective factors or the interactions between different exposures. The present study explored the pathways between maternal, infant and parenthood vulnerabilities or risk/protective factors and PNDS at 2 months postpartum (PP) in a large sample of women from the general population. Methods: We used data from the French ELFE cohort, a nationally representative cohort of children followed-up from birth. The available information about vulnerabilities or risk/protective factors for PNDS was collected during the maternity ward stay (mother or medical records) and at 2 months PP (mother by phone). PNDS were evaluated with the Edinburgh Postnatal Depression Scale (EPDS) at 2 months. A measurement model was built based on the psychosocial model for PNDS of Milgrom and colleagues using exploratory factor analysis. The Structural Equation Model was used to investigate the pathways between vulnerability, risk/protective factors and PNDS at 2 months PP. Results: In the study sample (n = 11,583), a lack of a partner’s perceived antenatal emotional support, consultation with a mental health specialist before pregnancy, family financial difficulties, prenatal psychological distress and a difficult pregnancy experience were directly associated with the severity of maternal PNDS at 2 months PP, as well as lack of perceived postnatal support. Family financial difficulties and consultation with a mental health specialist before pregnancy were also indirectly associated with the intensity of PNDS through a lack of perceived antenatal emotional support, a difficult pregnancy experience, prenatal psychological distress and a lack of perceived postnatal support. Regarding infant and parenthood characteristics, infant self-regulation difficulties, maternal difficulty in understanding infant crying and infant hospitalisation were directly associated with PNDS severity at 2 months PP, while maternal difficulty in understanding an infant’s cries was also indirectly associated with infant self-regulation difficulties. Conclusions: Perinatal professional support should begin antenatally and target the couple’s prenatal functioning, with particular attention to women presenting a history of psychiatric disorders, especially those of low socioeconomic status. After delivery, addressing infant and parenthood characteristics is also recommended. Full article

(This article belongs to the Special Issue Perinatal Mental Health: Opportunities and Challenges for Psychiatry)

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10 pages, 627 KiB

Open AccessArticle

The Level of Stress and Anxiety in Pregnant Women Depending on Social Support and Physical Activity

by Joanna Kowalska

J. Clin. Med. 2023, 12(9), 3143; https://doi.org/10.3390/jcm12093143 - 27 Apr 2023

Cited by 4 | Viewed by 3515

Abstract

Social support and physical activity are mentioned among the numerous factors affecting the emotional state of pregnant women. Therefore, the aim of the study was to assess the level of perceived stress and anxiety in pregnant women depending on social support and their physical activity both before and during pregnancy and find the factors that affected the level of perceived stress. Methods. A total of 373 pregnant women were qualified for the study. The Perceived Stress Scale (PSS-10), the State-Trait Anxiety Inventory (STAI), and a self-administered questionnaire were used. Results. In the study group, a high level of stress and anxiety were noted. A comparative analysis showed that physically active women before pregnancy, women attending childbirth classes and remaining in a relationship, were characterized by a lower level of stress and anxiety compared to physically inactive women, women who did not participate in childbirth classes and were single. A multiple linear regression analysis showed that participation in childbirth classes, physical activity before pregnancy, the level of anxiety as a trait, and women’s age had the most significant impact on the stress level of surveyed women. Conclusions. Further research among pregnant women and women in the postpartum period is needed to confirm the benefits of physical activity and to identify as many factors as possible that may affect the emotional state of pregnant women. Full article

(This article belongs to the Special Issue Perinatal Mental Health: Opportunities and Challenges for Psychiatry)

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18 pages, 1404 KiB

Open AccessArticle

Maternal Mental Health Care Matters: The Impact of Prenatal Depressive and Anxious Symptoms on Child Emotional and Behavioural Trajectories in the French EDEN Cohort

by Kadri-Ann Kallas, Ketevan Marr, Simi Moirangthem, Barbara Heude, Muriel Koehl, Judith van der Waerden and Naomi Downes

J. Clin. Med. 2023, 12(3), 1120; https://doi.org/10.3390/jcm12031120 - 31 Jan 2023

Cited by 5 | Viewed by 4785

Abstract

Few studies have investigated longitudinal trajectories of child socioemotional and behavioural development in relation to maternal prenatal mental health exposure or taken into consideration of the potential buffering effects of psychological intervention during pregnancy. Using data from 1135 mother–child dyads from the EDEN cohort from the general French population, Group-based trajectory modelling was used to model trajectories of behavioural and emotional characteristics measured at four timepoints via a parent-administered Strengths and Difficulties Questionnaire. Using propensity scores and inverse probability weighting to account for confounding factors, multinomial logistic regressions were used to quantify the associations with maternal symptoms of prenatal depression and anxiety. Stratified analyses were conducted by reporting psychologist and psychiatrist consultations during pregnancy. Compared to those without psychological problems, children of mothers with comorbid anxiety and depression retained a higher probability of following high and intermediate trajectories of emotional problems and a high trajectory of conduct problems throughout childhood. This increased risk was not present in the children of mothers who sought support through a prenatal psychologist or psychiatrist consultation. This article adds to a body of evidence underlining the importance of mental health care for expecting mothers. Full article

(This article belongs to the Special Issue Perinatal Mental Health: Opportunities and Challenges for Psychiatry)

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13 pages, 500 KiB

Open AccessArticle

Impact of the Timing of Maternal Peripartum Depression on Infant Social and Emotional Development at 18 Months

by Jaqueline Wendland, Xavier Benarous, Héloïse Young, Takoua Brahim, Gisèle Apter, Nicolas Bodeau, David Cohen and Priscille Gérardin

J. Clin. Med. 2022, 11(23), 6919; https://doi.org/10.3390/jcm11236919 - 23 Nov 2022

Cited by 5 | Viewed by 2185

Abstract

The study assessed how the timing of maternal perinatal depressive symptoms affects infant socio-emotional characteristics at age 18 months. The study was a longitudinal cohort study that included six assessment points from the third trimester of pregnancy up to age 18 months (±1 month). Assessment of mothers included the Edinburgh Postnatal Depression Scale and the State-Trait Anxiety Inventory, while assessments of infant included the Infant Toddler Social and Emotional Assessment (ITSEA) at 18 months. Mothers were categorized into one of the following groups: mothers who presented postnatal depression only (n = 19); mothers who presented both prenatal and postnatal depression (n = 14), and mothers who never showed perinatal depression symptoms (n = 38). Mothers who presented both prenatal and postnatal depression showed significantly higher levels of depressive score, reactivity to stress and level of anxiety trait compared to mothers of the two other groups. Infants of prenatally and postnatally depressed mothers had higher scores on the internalizing subscore of the ITSEA. The number of depression episodes during the study period was positively correlated with the externalizing and internalizing subscores of the ITSEA. These findings support the need to provide specific screening to identify women with prenatal depression. Full article

(This article belongs to the Special Issue Perinatal Mental Health: Opportunities and Challenges for Psychiatry)

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Review

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10 pages, 251 KiB

Open AccessReview

The Management of Perinatal Borderline Personality Disorder

by Anne Sved Williams and Rebecca Hill

J. Clin. Med. 2023, 12(21), 6850; https://doi.org/10.3390/jcm12216850 - 30 Oct 2023

Viewed by 3210

Abstract

Borderline personality disorder (BPD) is highly prevalent in clinical perinatal mental health settings, although there are few systematic programmes to identify BPD at this time. Retrospective studies show compromised birth outcomes for women with this condition, and several authors have highlighted a significant range of problem outcomes for offspring identifiable from early infancy through the adult years, including the intergenerational transfer of mental health problems from mother to child. A literature review identifies the varying prevalence rates found in non-clinical and clinical settings and the paucity of published studies on the management of perinatal BPD, in particular focused both on the mother and mother-infant relationships. A case study is presented to show both the potential benefits of inpatient mother-baby unit protocols and of specialised longer-term group therapy. Many knowledge gaps can be identified for further clinical research that could potentially benefit families with perinatal BPD, including systematic identification of perinatal BPD and intensive programmes that not only could perhaps improve birth outcomes but also provide skills to mothers to help with their emotional regulation and potentially improve mother-infant relationships and longer-term offspring developmental pathways. Full article

(This article belongs to the Special Issue Perinatal Mental Health: Opportunities and Challenges for Psychiatry)

12 pages, 602 KiB

Open AccessReview

Perinatal Psychoactive Substances Use: A Rising Perinatal Mental Health Concern

by Gihan ELNahas and Florence Thibaut

J. Clin. Med. 2023, 12(6), 2175; https://doi.org/10.3390/jcm12062175 - 10 Mar 2023

Cited by 6 | Viewed by 4699

Abstract

Introduction: A significant increase in psychoactive drugs use was observed in women of childbearing age and during the perinatal period worldwide. Yet, the use of illicit drugs, alcohol and tobacco during pregnancy is a serious health risk for the mother, developing fetus and newborn. Methods: This review of current trends and consequences of psychoactive substance use in the general population and in pregnant women was conducted using the English and French literature published during the years 2000 to 2022, supplemented by guidelines, meta-analyses and reviews. Results: According to current rates of prenatal substances use, it was calculated that 380,000 offspring were exposed to illicit substances, more than 500,000 to alcohol and over one million to tobacco during uterine life. Alarmingly, drug-related pregnancy-associated mortality has shown a staggering 190% rise between 2010 and 2019 in the USA. Different drugs of abuse, when used during pregnancy, increase the risk of stillbirth, neonatal abstinence syndrome and sudden infant death. Adverse effects on pregnancy include premature rupture of membranes, placental abruption, preterm birth, low birth space? weight and small-for-gestational-age infants. There is also an increased risk of morbidity and mortality for the pregnant women. Long-term negative adverse effects of perinatal exposure to substances also include a number of neurocognitive, behavioral and emotional dysfunctions in infants. Each type of substance has its own specificities, which will be briefly summarized. Conclusion: All childbearing age women must be informed about the potential harm of the prenatal use of psychoactive substances and should be encouraged to stop their use when pregnancy is planned and, at least, when pregnancy is known. Questioning women about their alcohol consumption should be systematic at the first prenatal visit and then at every prenatal visit until delivery. Multidisciplinary prevention approaches as well as intervention measures targeted to each type of psychoactive substance can save mothers’ lives and mitigate serious adversities to the offspring. Full article

(This article belongs to the Special Issue Perinatal Mental Health: Opportunities and Challenges for Psychiatry)

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Other

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6 pages, 721 KiB

Open AccessOpinion

Placental Cortisol Dysregulation in Mothers with Experiences of Childhood Adversity: Potential Mechanisms and Clinical Implications

by Joshua George, Maria Muzik and Courtney Townsel

J. Clin. Med. 2024, 13(7), 2020; https://doi.org/10.3390/jcm13072020 - 30 Mar 2024

Viewed by 1553

Abstract

Adverse childhood experiences (ACEs) are extremely prevalent in the United States population. Although ACEs occurs in childhood, exposure to them has been associated with adverse future pregnancy outcomes and an increased risk of poorer social determinants of health, which further drive the risk of negative pregnancy outcomes. In addition, maternal ACE exposure has been linked to poor infant and child outcomes, highlighting the intergenerational transmission of risk from mother to child. While alterations along the Maternal–Placental–Fetal Hypothalamic–pituitary–adrenal (HPA) axis is hypothesized to be involved, the exact biological pathway underlying this intergenerational passage of risk is mostly unknown. This present work will highlight what is known about pregnancy-related stress hormone physiology, discuss the potential mechanisms of action of ACEs on cortisol regulation, and suggest opportunities for further clinical and translational studies. Full article

(This article belongs to the Special Issue Perinatal Mental Health: Opportunities and Challenges for Psychiatry)

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