Severe Mental Illness and Reproductive Health

  • Thinh NguyenEmail author
  • Geetha Desai
Reference work entry
Part of the Mental Health and Illness Worldwide book series (MHIW)


Severe mental illness (SMI) during pregnancy and the postpartum has the potential to impact negatively on the well-being of the mother, the mother-infant dyad, and her family. Untreated SMI can lead to poor attendance to antenatal care, impair mother-infant attachment, and, in rare cases, lead to suicide and infanticide. The wider usage of newer antipsychotics, deinstitutionalization, lessened stigma, and greater opportunities for social interaction have allowed many women with preexisting severe mental illness to embrace the possibility of, and plan for, parenthood. However, mothers with SMI in general continue to experience multifaceted risks such as unplanned pregnancies, obstetric complications, comorbid substance abuse, poor social support, and interpersonal violence which impact on outcomes and stretch available health resources. Mental health services and clinicians need to be aware that their female patients with SMI of reproductive age can and often do become pregnant and that preventative strategies (preconception counseling) for those who plan to become pregnant and contingent strategies (timely referral pathways and specialist consultations) for those who have unplanned pregnancies should become part of their core business. Obstetric and child health services need to work in conjunction with mental health services in identifying the needs of high-risk women, who may develop index episodes of severe mental illness during their perinatal period, particularly in the postpartum. As psychotropic medication is the mainstay of treatment for women with SMI, a necessary impetus is on the need for robust safety data in pregnancy and breastfeeding, so the woman and her family can make informed choices. Equally important though are the relational and sociocultural forces that pervade the lives of pregnant women with SMI, which need to be explored and addressed. Despite advocacy from caregivers, women’s groups, and health professionals, services for mothers with mental illness are unevenly distributed worldwide with majority of the services only available in developed or high-income countries. In low- and middle-income countries (LAMICs), where high rates of maternal morbidity have been reported, the focus is predominantly on physical health with a less emphasis on mental health services. Strategies to overcome this challenge will be needed. In this chapter, we focus on the spectrum of perinatal healthcare for women with SMI.


Severe mental illness Pregnancy Postpartum Mother-infant dyads Perinatal services 


  1. Abel KM, Morgan V (2011) In: Tsuang MT, Tohen M, Jones PB (eds) Mental illness, women, mothers and their children. Textbook in psychiatric epidemiology. Wiley, Chichester, pp 483–507CrossRefGoogle Scholar
  2. Acera Pozzi R, Yee LM, Brown K, Driscoll KE, Rajan PV (2014) Pregnancy in the severely mentally ill patient as an opportunity for global coordination of care. Am J Obstet Gynecol 210(1):32–37PubMedCrossRefGoogle Scholar
  3. Anderson EL, Reti IM (2009) ECT in pregnancy: a review of the literature from 1941 to 2007. Psychosom Med 71(2):235–242PubMedCrossRefGoogle Scholar
  4. Austin MP, Highet N, Expert Working Group (2017) Mental health care in the perinatal period: Australian clinical practice guideline. Centre of Perinatal Excellence, MelbourneGoogle Scholar
  5. Baron EC, Hanlon C, Mall S, Honikman S, Breuer E, Kathree T, Luitel NP, Nakku J, Lund C, Medhin G, Patel V, Petersen I, Shrivastava S, Tomlinson M (2016) Maternal mental health in primary care in five low- and middle-income countries: a situational analysis. BMC Health Serv Res 16:53PubMedPubMedCentralCrossRefGoogle Scholar
  6. Ben-Sheetrit J, Huller-Harari L, Rasner M, Magen N, Nacasch N, Toren P (2018) Psychiatric disorders and compliance with prenatal care: a 10-year retrospective cohort compared to controls. Eur Psychiatry 49:23–29PubMedCrossRefGoogle Scholar
  7. Bergink V, Burgerhout KM, Weigelt K, Pop VJ, de Wit H, Drexhage RC, Kushner SA, Drexhage HA (2013) Immune system dysregulation in first-onset postpartum psychosis. Biol Psychiatry 73(10):1000–1007PubMedCrossRefGoogle Scholar
  8. Bergink V, Burgerhout KM, Koorengevel KM, Kamperman AM, Hoogendijk WJ, Lambregtse-van den Berg MP, Kushner SA (2015) Treatment of psychosis and mania in the postpartum period. Am J Psychiatry 172(2):115–123PubMedCrossRefGoogle Scholar
  9. Bergink V, Rasgon N, Wisner KL (2016) Postpartum psychosis: madness, mania, and melancholia in motherhood. Am J Psychiatry 173(12):1179–1188PubMedCrossRefGoogle Scholar
  10. 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
  11. Bloomfield J, Rasmussen T (2012) The evolution of trauma-informed practice at the Jean Tweed Centre. In: Poole N, Greaves L (eds) Becoming trauma informed. Centre for Addiction and Mental Health, TorontoGoogle Scholar
  12. Boden R, Lundgren M, Brandt L, Reutfors J, Andersen M, Kieler H (2012) Risks of adverse pregnancy and birth outcomes in women treated or not treated with mood stabilisers for bipolar disorder: population based cohort study. BMJ 345:e7085PubMedPubMedCentralCrossRefGoogle Scholar
  13. Boyce P (2017) 50 years of perinatal psychiatry. Aust N Z J Psychiatry 51(9):860–862PubMedCrossRefGoogle Scholar
  14. Boyce P, Buist A (2016) Management of bipolar disorder over the perinatal period. Aust Fam Physician 45(12):890–893PubMedGoogle Scholar
  15. Brockington I (2017) Suicide and filicide in postpartum psychosis. Arch Womens Ment Health 20(1):63–69PubMedCrossRefGoogle Scholar
  16. Brockington I, Chandra P, Dubowitz H, Jones D, Moussa S, Nakku J, Quadros Ferre I (2011) WPA guidance on the protection and promotion of mental health in children of persons with severe mental disorders. World Psychiatry 10(2):93–102PubMedPubMedCentralCrossRefGoogle Scholar
  17. Chandra PS, Desai G, Reddy D, Thippeswamy H, Saraf G (2015) The establishment of a mother-baby inpatient psychiatry unit in India: adaptation of a Western model to meet local cultural and resource needs. Indian J Psychiatry 57(3):290–294PubMedPubMedCentralCrossRefGoogle Scholar
  18. Choi KR, Seng JS (2016) Predisposing and precipitating factors for dissociation during labor in a cohort study of posttraumatic stress disorder and childbearing outcomes. J Midwifery Womens Health 61(1):68–76PubMedPubMedCentralCrossRefGoogle Scholar
  19. Christl B, Reilly N, Yin C, Austin MP (2015) Clinical profile and outcomes of women admitted to a psychiatric mother-baby unit. Arch Womens Ment Health 18(6):805–816PubMedCrossRefGoogle Scholar
  20. Cox JL, Holden JM, Sagovsky R (1987) Detection of postnatal depression. Development of the 10-item Edinburgh postnatal depression scale. Br J Psychiatry 150:782–786PubMedPubMedCentralCrossRefGoogle Scholar
  21. De Genna NM, Feske U, Larkby C, Angiolieri T, Gold MA (2012) Pregnancies, abortions, and births among women with and without borderline personality disorder. Womens Health Issues 22(4):e371–e377PubMedPubMedCentralCrossRefGoogle Scholar
  22. Di Prinzio P, Morgan VA, Bjork J, Croft M, Lin A, Jablensky A, McNeil TF (2018) Intellectual disability and psychotic disorders in children: association with maternal severe mental illness and exposure to obstetric complications in a whole-population cohort. Am J Psychiatry 175(12): 1232–1242PubMedCrossRefGoogle Scholar
  23. Dolman C, Jones I, Howard LM (2013) Pre-conception to parenting: a systematic review and meta-synthesis of the qualitative literature on motherhood for women with severe mental illness. Arch Womens Ment Health 16(3):173–196PubMedCrossRefGoogle Scholar
  24. Dossett EC, Wusirika L, Burt V (2017) No perfect choice. JAMA 318(1):29–30PubMedCrossRefGoogle Scholar
  25. Einarson A (2014) Critical evaluation of the literature: understanding the complexities of observational research. In: Galbally M, Lewis AJ, Snellen M (eds) Psychopharmacology and pregnancy: treatment efficacy, risks, and guidelines. Springer, Berlin/Heidelberg, pp 19–31Google Scholar
  26. Fisher J (2016) Perinatal psychiatric care needs of women who die by suicide. Lancet Psychiatry 3(3):191–192PubMedCrossRefGoogle Scholar
  27. Fisher J, Cabral de Mello M, Patel V, Rahman A, Tran T, Holton S, Holmes W (2012) Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: a systematic review. Bull World Health Organ 90(2):139G–149GPubMedCrossRefGoogle Scholar
  28. Forbes F, Wynter K, Wade C, Zeleke BM, Fisher J (2018) Male partner attendance at antenatal care and adherence to antenatal care guidelines: secondary analysis of 2011 Ethiopian demographic and health survey data. BMC Pregnancy Childbirth 18(1):145PubMedPubMedCentralCrossRefGoogle Scholar
  29. Frayne J, Nguyen T, Allen S, Rampono J (2009) Motherhood and mental illness-part 2-management and medications. Aust Fam Physician 38(9):688–692PubMedGoogle Scholar
  30. Frayne J, Brooks J, Nguyen TN, Allen S, Maclean M, Fisher J (2014) Characteristics of men accompanying their partners to a specialist antenatal clinic for women with severe mental illness. Asian J Psychiatr 7(1):46–51PubMedCrossRefGoogle Scholar
  31. Frayne J, Nguyen T, Bennett K, Allen S, Hauck Y, Liira H (2017) The effects of gestational use of antidepressants and antipsychotics on neonatal outcomes for women with severe mental illness. Aust N Z J Obstet Gynaecol 57(5):526–532PubMedCrossRefGoogle Scholar
  32. Galbally M, Snellen M, Walker S, Permezel M (2010) Management of antipsychotic and mood stabilizer medication in pregnancy: recommendations for antenatal care. Aust N Z J Psychiatry 44(2):99–108PubMedCrossRefGoogle Scholar
  33. Galbally M, Snellen M, Lewis AJ (2014) Psychopharmacoloy and pregnancy: treatment efficacy, risks and guidelines. Springer, Berlin/HeidelbergGoogle Scholar
  34. Galbally M, Nguyen TN, Snellen M (2017) Commentary on RANZCP clinical practice guidelines for the management of schizophrenia and related disorders. Aust N Z J Psychiatry 51(3): 289–290PubMedCrossRefGoogle Scholar
  35. Galbally M, Frayne J, Watson SJ, Morgan V Snellen M (2019) The association between gestational diabetes mellitus, antipsychotics and severe mental illness in pregnancy: a multicentre study. Aust N Z J Obstet GynaecolGoogle Scholar
  36. Glangeaud-Freudenthal NM, Sutter-Dallay AL, Thieulin AC, Dagens V, Zimmermann MA, Debourg A, Amzallag C, Cazas O, Cammas R, Klopfert ME, Rainelli C, Tielemans P, Mertens C, Maron M, Nezelof S, Poinso F (2013) Predictors of infant foster care in cases of maternal psychiatric disorders. Soc Psychiatry Psychiatr Epidemiol 48(4):553–561PubMedCrossRefGoogle Scholar
  37. Hale TW (2017) Medications and Mothers’ Milk 2017. Springer Publishing Company LLC. New York, NY 10036Google Scholar
  38. Hall KS, Steinberg JR, Cwiak CA, Allen RH, Marcus SM (2015) Contraception and mental health: a commentary on the evidence and principles for practice. Am J Obstet Gynecol 212(6):740–746PubMedCrossRefGoogle Scholar
  39. Harris EL, Frayne J, Allen S, Renganathan K, Nguyen TN (2018) Psychiatric admission during pregnancy in women with schizophrenia who attended a specialist antenatal clinic. J Psychosom Obstet Gynaecol 40:211–216PubMedCrossRefGoogle Scholar
  40. Harrison C, O’callaghan J (2014) A review of pre-birth child protection planning in a tertiary maternity hospital: engaging vulnerable pregnant women. Dev Pract 39:80–86Google Scholar
  41. Haskey C, Galbally M (2017) Mood stabilizers in pregnancy and child developmental outcomes: a systematic review. Aust N Z J Psychiatry 51(11):1087–1097PubMedCrossRefGoogle Scholar
  42. Hauck Y, Allen S, Ronchi F, Faulkner D, Frayne J, Nguyen T (2013) Pregnancy experiences of Western Australian women attending a specialist childbirth and mental illness antenatal clinic. Health Care Women Int 34(5):380–394PubMedCrossRefGoogle Scholar
  43. Hauck Y, Nguyen T, Frayne J, Garefalakis M, Rock D (2015) Sexual and reproductive health trends among women with enduring mental illness: a survey of Western Australian community mental health services. Health Care Women Int 36(4):499–510PubMedCrossRefGoogle Scholar
  44. Health, Department of (2018) Clinical practice guidelines: pregnancy care. Government of Australia, Department of Health, CanberraGoogle Scholar
  45. Henshaw C, Cox J, Barton J (2017) Modern management of perinatal psychiatric disorders. RCPsych Publications, LondonGoogle Scholar
  46. Howard LM, Kumar C, Leese M, Thornicroft G (2002) The general fertility rate in women with psychotic disorders. Am J Psychiatry 159(6):991–997PubMedCrossRefGoogle Scholar
  47. Howard L, Hunt K, Slade M, O’Keane V, Senevirante T, Leese M, Thornicroft G, Wiseman M (2008) Camberwell assessment of need for mothers. Royal College of Psychiatrists, LondonGoogle Scholar
  48. Howard LM, Ryan EG, Trevillion K, Anderson F, Bick D, Bye A, Byford S, O’Connor S, Sands P, Demilew J, Milgrom J, Pickles A (2018) Accuracy of the whooley questions and the Edinburgh postnatal depression scale in identifying depression and other mental disorders in early pregnancy. Br J Psychiatry 212(1):50–56PubMedPubMedCentralCrossRefGoogle Scholar
  49. Huybrechts KF, Hernandez-Diaz S, Patorno E, Desai RJ, Mogun H, Dejene SZ, Cohen JM, Panchaud A, Cohen L, Bateman BT (2016) Antipsychotic use in pregnancy and the risk for congenital malformations. JAMA Psychiat 73(9):938–946CrossRefGoogle Scholar
  50. Jablensky AV, Morgan V, Zubrick SR, Bower C, Yellachich LA (2005) Pregnancy, delivery, and neonatal complications in a population cohort of women with schizophrenia and major affective disorders. Am J Psychiatry 162(1):79–91PubMedCrossRefGoogle Scholar
  51. 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):1789–1799PubMedCrossRefGoogle Scholar
  52. Judd F, Komiti A, Sheehan P, Newman L, Castle D, Everall I (2014) Adverse obstetric and neonatal outcomes in women with severe mental illness: to what extent can they be prevented? Schizophr Res 157(1–3):305–309PubMedCrossRefGoogle Scholar
  53. Judd F, Newman LK, Komiti AA (2018) Time for a new zeitgeist in perinatal mental health. Aust N Z J Psychiatry 52(2):112–116PubMedCrossRefGoogle Scholar
  54. Kahneman D (2011) Thinking fast and slow. Farrar Strauss Giroux, New YorkGoogle Scholar
  55. KEMH (2018) Clinical guidelines: childbirth and mental illness clinic. Obstetrics 131:e140CrossRefGoogle Scholar
  56. Kendell RE, Chalmers JC, Platz C (1987) Epidemiology of puerperal psychoses. Br J Psychiatry 150:662–673PubMedCrossRefGoogle Scholar
  57. Kendler KS, Ohlsson H, Svikis DS, Sundquist K, Sundquist J (2017) The protective effect of pregnancy on risk for drug abuse: a population, co-relative, co-spouse, and within-individual analysis. Am J Psychiatry 174(10):954–962PubMedPubMedCentralCrossRefGoogle Scholar
  58. Kessler ML, Ackerson BJ (2005) Wraparound services: an effective intervention for families impacted by severe mental illness. J Fam Soc Work 8(4):29–45CrossRefGoogle Scholar
  59. Kimmel MC, Ferguson EH, Zerwas S, Bulik CM, Meltzer-Brody S (2016) Obstetric and gynecologic problems associated with eating disorders. Int J Eat Disord 49(3):260–275PubMedCrossRefPubMedCentralGoogle Scholar
  60. Knight M, Bunch K, Tuffnell D, Jayakody H, Shakespeare J, Kotnis R, Kenyon S, Kurinczuk JE, on behalf of MBRRACE-UK (2018) Saving lives, improving mothers’ care – lessons learned to inform maternity care from the UK and Ireland confidential enquiries into maternal deaths and morbidity 2014–16. National Perinatal Epidemiology Unit, OxfordGoogle Scholar
  61. Lewis AJ, Galbally M, Gannon T, Symeonides C (2014) Early life programming as a target for prevention of child and adolescent mental disorders. BMC Med 12:33PubMedPubMedCentralCrossRefGoogle Scholar
  62. Lysell H, Dahlin M, Viktorin A, Ljungberg E, D’Onofrio BM, Dickman P, Runeson B (2018) Maternal suicide – register based study of all suicides occurring after delivery in Sweden 1974–2009. PLoS One 13(1):e0190133PubMedPubMedCentralCrossRefGoogle Scholar
  63. MacCabe JH, Martinsson L, Lichtenstein P, Nilsson E, Cnattingius S, Murray RM, Hultman CM (2007) Adverse pregnancy outcomes in mothers with affective psychosis. Bipolar Disord 9(3):305–309PubMedCrossRefGoogle Scholar
  64. Marvin R, Cooper G, Hoffman K, Powell B (2002) The circle of security project: attachment-based intervention with caregiver-pre-school child dyads. Attach Hum Dev 4(1):107–124PubMedCrossRefGoogle Scholar
  65. Massey SH, Wisner KL (2018) Understanding Pregnancy’s protective effect on drug use within a developmental framework. Am J Psychiatry 175(3):286–287PubMedPubMedCentralCrossRefGoogle Scholar
  66. McAllister-Williams RH, Baldwin DS, Cantwell R, Easter A, Gilvarry E, Glover V, Green L, Gregoire A, Howard LM, Jones I, Khalifeh H, Lingford-Hughes A, McDonald E, Micali N, Pariante CM, Peters L, Roberts A, Smith NC, Taylor D, Wieck A, Yates LM, Young AH, endorsed by the British Association for Psychopharmacology (2017) British Association for Psychopharmacology consensus guidance on the use of psychotropic medication preconception, in pregnancy and postpartum 2017. J Psychopharmacol 31(5):519–552PubMedCrossRefGoogle Scholar
  67. McCullough LB, Coverdale JH, Chervenak FA (2002) Ethical challenges of decision making with pregnant patients who have schizophrenia. Am J Obstet Gynecol 187(3):696–702PubMedCrossRefGoogle Scholar
  68. Mehta TM, Van Lieshout RJ (2017) A review of the safety of clozapine during pregnancy and lactation. Arch Womens Ment Health 20(1):1–9PubMedCrossRefGoogle Scholar
  69. Miller LJ, Finnerty M (1996) Sexuality, pregnancy, and childrearing among women with schizophrenia-spectrum disorders. Psychiatr Serv 47(5):502–506PubMedCrossRefGoogle Scholar
  70. Mota NP, Chartier M, Ekuma O, Nie Y, Hensel JM, MacWilliam L, McDougall C, Vigod S, Bolton JM (2019) Mental disorders and suicide attempts in the pregnancy and postpartum periods compared with non-pregnancy: a population-based study. Can J Psychiatr 64:482. Scholar
  71. Muir E, Lojkasek M, Cohen N (1999) Watch, wait, and wonder: a manual describing adyadic infant led approach to problems in infancy and early childhood. The Hincks-Dellcrest Institute, TorontoGoogle Scholar
  72. Munk-Olsen T, Liu X, Viktorin A, Brown HK, Di Florio A, D’Onofrio BM, Gomes T, Howard LM, Khalifeh H, Krohn H, Larsson H, Lichtenstein P, Taylor CL, Van Kamp I, Wesseloo R, Meltzer-Brody S, Vigod SN, Bergink V (2018) Maternal and infant outcomes associated with lithium use in pregnancy: an international collaborative meta-analysis of six cohort studies. Lancet Psychiatry 5(8):644–652PubMedPubMedCentralCrossRefGoogle Scholar
  73. Nahar A, Kondapuram N, Desai G, Chandra PS (2017) Catatonia among women with postpartum psychosis in a mother-baby inpatient psychiatry unit. Gen Hosp Psychiatry 45:40–43PubMedCrossRefGoogle Scholar
  74. Nguyen TN, Faulkner D, Frayne JS, Allen S, Hauck YL, Rock D, Rampono J (2013) Obstetric and neonatal outcomes of pregnant women with severe mental illness at a specialist antenatal clinic. Med J Aust 199(3 Suppl):S26–S29PubMedGoogle Scholar
  75. Nguyen T, Brooks J, Frayne J, Watt F, Fisher J (2015) The preconception needs of women with severe mental illness: a consecutive clinical case series. J Psychosom Obstet Gynaecol 36(3):87–93PubMedCrossRefGoogle Scholar
  76. Nguyen T, Mordecai J, Watt F, Frayne J (2019) Obstetric and neonatal outcomes of clozapine exposure in pregnancy: a consecutive case series. Arch Womens Ment Health. Jun 15. (Epub ahead of print)Google Scholar
  77. NICE (2016) Antenatal and postnatal mental health. National Institute for Health and Care ExcellenceGoogle Scholar
  78. Oates M (2003) Suicide: the leading cause of maternal death. Br J Psychiatry 183:279–281PubMedCrossRefGoogle Scholar
  79. 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
  80. Park JM, Solomon P, Mandell DS (2006) Involvement in the child welfare system among mothers with serious mental illness. Psychiatr Serv 57 (4):493-497Google Scholar
  81. Patel V (2007) Mental health in low- and middle-income countries. Br Med Bull 81–82:81–96PubMedCrossRefGoogle Scholar
  82. Patel V, Hanlon C (2018) Where there is no psychiatrist: a mental health care manual. Cambridge University Press, CambridgeGoogle Scholar
  83. Patorno E, Huybrechts KF, Bateman BT, Cohen JM, Desai RJ, Mogun H, Cohen LS, Hernandez-Diaz S (2017) Lithium use in pregnancy and the risk of cardiac malformations. N Engl J Med 376(23):2245–2254PubMedPubMedCentralCrossRefGoogle Scholar
  84. Phillips L, Thomas D (2015) The first antenatal appointment: an exploratory study of the experiences of women with a diagnosis of mental illness. Midwifery 31(8):756–764PubMedCrossRefGoogle Scholar
  85. Poels EMP, Bijma HH, Galbally M, Bergink V (2018) Lithium during pregnancy and after delivery: a review. Int J Bipolar Disord 6(1):26PubMedPubMedCentralCrossRefGoogle Scholar
  86. Rahman A, Fisher J, Bower P, Luchters S, Tran T, Yasamy MT, Saxena S, Waheed W (2013a) Interventions for common perinatal mental disorders in women in low- and middle-income countries: a systematic review and meta-analysis. Bull World Health Organ 91(8):593–601IPubMedPubMedCentralCrossRefGoogle Scholar
  87. Rahman A, Surkan PJ, Cayetano CE, Rwagatare P, Dickson KE (2013b) Grand challenges: integrating maternal mental health into maternal and child health programmes. PLoS Med 10(5):e1001442PubMedPubMedCentralCrossRefGoogle Scholar
  88. Seeman MV (2012) Intervention to prevent child custody loss in mothers with schizophrenia. Schizophrenia Research and Treatment 1–6Google Scholar
  89. Seeman MV (2013) Clinical interventions for women with schizophrenia: pregnancy. Acta Psychiatrica Scandinavica 127(1):12–22Google Scholar
  90. Sharma V, Pope CJ (2012) Pregnancy and bipolar disorder: a systematic review. J Clin Psychiatry 73(11):1447–1455PubMedCrossRefGoogle Scholar
  91. Snellen M, Thompson G, Murdoch N (2014) The process of obtaining Informed consent when prescribing psychopharmacology in pregnancy. In: Galbally M, Snellen M, Lewis AJ (eds) Psychopharmacology and pregnancy: treatment efficacy, risks, and guidelines. Springer, Heidelberg, pp 5–18Google Scholar
  92. 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
  93. Stephenson J, Heslehurst N, Hall J, Schoenaker D, Hutchinson J, Cade JE, Poston L, Barrett G, Crozier SR, Barker M, Kumaran K, Yajnik CS, Baird J, Mishra GD (2018) Before the beginning: nutrition and lifestyle in the preconception period and its importance for future health. Lancet 391(10132):1830–1841PubMedPubMedCentralCrossRefGoogle Scholar
  94. Thippeswamy H, Dahale A, Desai G, Chandra PS (2015) What is in a name? Causative explanatory models of postpartum psychosis among patients and caregivers in India. Int J Soc Psychiatr 61(8):818–823Google Scholar
  95. Thippeswamy H, Desai G, Chandra P (2018) Help-seeking patterns in women with postpartum severe mental illness: a report from southern India. Arch Womens Ment Health 21:573PubMedCrossRefGoogle Scholar
  96. Turnell A, Edwards S (1999) Signs of safety: a solution and safety oriented approach to child protection casework. W.W. Norton, New YorkGoogle Scholar
  97. Ursini G, Punzi G, Chen Q, Marenco S, Robinson JF, Porcelli A, Hamilton EG, Mitjans M, Maddalena G, Begemann M, Seidel J, Yanamori H, Jaffe AE, Berman KF, Egan MF, Straub RE, Colantuoni C, Blasi G, Hashimoto R, Rujescu D, Ehrenreich H, Bertolino A, Weinberger DR (2018) Convergence of placenta biology and genetic risk for schizophrenia. Nat Med 24(6):792–801PubMedCrossRefPubMedCentralGoogle Scholar
  98. Vesga-Lopez O, Blanco C, Keyes K, Olfson M, Grant BF, Hasin DS (2008) Psychiatric disorders in pregnant and postpartum women in the United States. Arch Gen Psychiatry 65(7):805–815PubMedPubMedCentralCrossRefGoogle Scholar
  99. Viguera AC, Newport DJ, Ritchie J, Stowe Z, Whitfield T, Mogielnicki J, Baldessarini RJ, Zurick A, Cohen LS (2007) Lithium in breast milk and nursing infants: clinical implications. Am J Psychiatry 164(2):342–345PubMedCrossRefPubMedCentralGoogle Scholar

Copyright information

© Crown 2020

Authors and Affiliations

  1. 1.Division of PsychiatrySchool of Medicine, The University of Western Australia, Peel and Rockingham Kwinana Mental Health ServiceRockinghamAustralia
  2. 2.Department of PsychiatryNational Institute of Mental Health and Neurosciences (NIMHANS)BengaluruIndia

Personalised recommendations