(1) Background: Women in the peripartum period are at increased vulnerability to the development or worsening of mental disorders. However, data from specialized psychiatric settings in Southeast Europe on this topic remain limited. In this study, we assessed the distribution of perinatal mental health disorders, diagnostic changes, hospitalizations, obstetric complications, and breastfeeding among women treated at the Perinatal and Reproductive Psychiatry Unit in Belgrade, Serbia. (2) Methods: A retrospective review of medical records from 287 patients (2015–2024), including sociodemographics, ICD-10 diagnoses, hospitalizations, obstetric complications, and breastfeeding data, was performed. (3) Results: The mean age of the women in this cohort was 33.1 ± 5.6 years. Mood disorders (F30–F39) were most common (39.6% before, 42.2% during, and 32.1% after pregnancy), followed by neurotic and stress-related disorders (F40–F48). Postpartum F50–F59 diagnoses (especially mental and behavioral disorders associated with the puerperium, not elsewhere classified—F53) rose significantly (p < 0.001). Overall, 38.7% of patients had at least one psychiatric hospitalization; hospitalization was recorded before pregnancy in 30.0%, during pregnancy in 5.9%, and postpartum in 6.6%, with overlap between periods. Leading obstetric complications were emergency cesarean (1.0%) and fetal loss (1.4%). Only 41.3% of the women whose data were available breastfed (mean 4.7 months). (4) Conclusions: Mood disorders predominate in specialized psychiatric perinatal care. The results of this study indicate the frequency of perinatal mental disorders and the need for both outpatient and inpatient treatment. It is, therefore, essential to continue developing mental health care systems for women in Serbia and to provide ongoing education for health professionals in order to ensure timely diagnosis and treatment of pregnant and postpartum women.

(1) Background: The peripartum period increases vulnerability to mental disorders. Data from specialized psychiatric settings in Southeast Europe remain limited. This study assessed prevalence and distribution of perinatal mental health disorders, diagnostic changes, hospitalizations, obstetric complications, and breastfeeding among women treated at the Perinatal and Reproductive Psychiatry Unit in Belgrade, Serbia. (2) Methods: Retrospective review of medical records from 287 patients (2015–2024), including socio-demographics, ICD-10 diagnoses, hospitalizations, obstetric complications, and breastfeeding data. (3) Results: Mean age was 33.1 ± 5.6 years. Mood disorders (F30–F39) were most common (39.6% before, 42.2% during, 32.1% after pregnancy), followed by neurotic and stress-related disorders (F40–F48). Postpartum F50–F59 diagnoses (especially F53) rose significantly (p < 0.001). Hospitalizations peaked before pregnancy (35.2%) and were rare during pregnancy (3.1%) and postpartum (0.3%). Leading obstetric complications were emergency cesarean (1.9%) and fetal loss (1.4%). Only 41.3% of women with data breastfed (mean 4.7 months). (4) Conclusions: Mood disorders predominate in specialized perinatal care. Results highlight the need for sys-tematic screening, specialized outpatient services, and multidisciplinary support to improve outcomes for women in Serbia.