182. Childhood Maltreatment, Postnatal Symptoms, and Neonatal Behavior in Postpartum Psychosis

Abstract

Abstract Background: Individuals at risk of psychosis unrelated to gestation are reported to experience more childhood maltreatment, which has also been associated with more severe positive and affective symptoms (Thompson et al., 2009). Furthermore, maternal experience of childhood maltreatment is associated with increased risk of perinatal psychopathology (Lang et al., 2006; Mezey et al., 2005) and worse offspring outcomes (Roberts et al., 2004; Miranda et al., 2011). Therefore, it is particularly important to examine the relationship between maternal experience of childhood maltreatment and early postnatal psychopathology and offspring outcome in those women who are at high risk of developing postpartum psychosis (PP) after giving birth. Methods: We assessed pregnant women (n = 104) at 25 weeks gestation: 41 were at risk of PP because of a diagnosis of bipolar disorder (n = 35), schizoaffective disorder (n = 4) or a previous PP (n = 2), and 63 were healthy women. Maternal experience of childhood maltreatment was assessed using the Childhood Experience or Care and Abuse Questionnaire (CECA-Q). Maternal affective and psychotic postnatal symptoms were assessed at 6 days postpartum using standardized scales. Infant behavior was also assessed at 6 days postpartum using the Neonatal Behavioral Assessment Scale (NBAS). Results: Compared to healthy women, women at risk of PP experienced significantly more childhood maltreatment (17% vs. 49%, χ2(1) = 11.4, P < .01), particularly sexual abuse (3% vs. 28%, χ2(1) = 13.3, P < .01) and antipathy (7% vs. 24%, χ2(1) = 6, P = .03). Furthermore, women who experienced childhood maltreatment had significantly more postpartum psychotic symptoms than those who did not experience childhood maltreatment (31% vs. 5%, χ2(1) = 4.6, P = .05).Compared to the infants of healthy women, infants of women at risk of PP had worse social interactive (U = 761.5, Z =−2.0, P = 0.05) and autonomic stability (U = 719.0, Z = −2.3, P = .02) scores. However, maternal experience of childhood maltreatment was not associated with infant behavior. Conclusion: The results suggest that women at risk of PP experience more childhood maltreatment than women not at risk and that experience of childhood maltreatment is associated with more psychotic symptoms in the early postpartum. These findings are in line with the literature on psychosis unrelated to gestation and suggest that experience of childhood maltreatment might play a role in the risk for postpartum psychopathology in women at risk of PP. Infants of women at risk of PP had less optimal social interactive and autonomic stability scores on the NBAS, suggesting they were less alert, less able to attend to auditory and visual stimuli and less physiologically stable than infants born to healthy women. The fact that maternal experience of childhood maltreatment was not associated with infant behavior suggests this may not be the mechanism underlying these impairments.