Understanding the Risk Factors for Perinatal Mood and Anxiety Disorders (PMADs)
Bringing a new baby into the world is often described as a joyful, magical time—but for many new and expecting parents, this season can also bring unexpected emotional challenges. It certainly did for me. I had twins! Spontaneously! Perinatal Mood and Anxiety Disorders (PMADs) are the most common complication of childbirth, affecting up to 1 in 5 people during pregnancy or within the first year postpartum (Wisner et al., 2013) and can alter the experience of becoming a mother.
Being able to recognize the risk factors of PMADs helps with prevention, early identification, and healing.
What Are PMADs?
PMADs is an umbrella term that includes a range of mental health conditions during pregnancy and the postpartum period, including:
Postpartum depression (PPD)
Postpartum anxiety
Postpartum OCD
Postpartum PTSD
Postpartum psychosis (less common, but very serious)
These disorders can impact anyone—regardless of background, support system, or parenting experience. However, certain factors increase the likelihood of developing a PMAD.
Risk Factors for PMADs
While no single cause leads to a PMAD, research points to a combination of biological, psychological, and social factors that may raise someone’s risk.
1. Personal or Family History of Mental Health Conditions
A personal or family history of depression, anxiety, bipolar disorder, or other mental health issues significantly increases PMAD risk (O'Hara & McCabe, 2013). Even if symptoms were well-managed before pregnancy, hormonal and lifestyle shifts can reactivate underlying vulnerabilities.
2. Trauma History
Experiencing trauma—especially childhood abuse, sexual assault, or birth trauma—can predispose someone to postpartum depression and anxiety (Seng et al., 2013).
3. Pregnancy or Birth Complications
Complications such as hyperemesis gravidarum, preeclampsia, cesarean delivery, or NICU admission increase emotional stress and PMAD risk (Beck, 2004; Vigod et al., 2010).
4. Lack of Support
Social isolation and low perceived partner support are strong predictors of postpartum depression (Dennis & Letourneau, 2007).
5. Life Stressors
Major life events—such as financial strain, housing insecurity, or job loss—during the perinatal period are associated with higher rates of PMADs (Lancaster et al., 2010).
6. Unplanned or High-Risk Pregnancy
Unintended pregnancies or those following infertility or pregnancy loss can increase anxiety and depression during pregnancy and postpartum (Cheng et al., 2009; Côté-Arsenault & Donato, 2011).
7. Sleep Deprivation
Sleep disruption in the postpartum period—especially chronic or severe—is both a symptom and a contributing factor to mood disorders (Goyal et al., 2009).
8. Perfectionism or High Expectations
High self-imposed standards and maternal guilt have been linked to anxiety and depressive symptoms postpartum (Milgrom et al., 2008).
You Are Not Alone—And Help Is Available
Recognizing these risk factors doesn’t mean a PMAD is inevitable. It means you can be proactive. If you or someone you love is navigating the perinatal period and noticing significant emotional or behavioral shifts, know that you’re not alone—and support is available.
Therapy, support groups, medication, and lifestyle interventions can all be part of a healing path. As a therapist who specializes in perinatal mental health, I help clients explore their experiences with care, compassion, and evidence-based tools like mindfulness, the NeuroAffective Relational Model (NARM), and cognitive behavioral therapy (CBT).
Final Thoughts
If you’re in the thick of new parenthood and finding it harder than you expected, that doesn’t mean you’re doing anything wrong—it means you’re human. Understanding your risk factors can help you take the first steps toward support, healing, and connection.
If you’re ready to talk, I’m here.
References
Beck, C. T. (2004). Post-traumatic stress disorder due to childbirth: The aftermath. Nursing Research, 53(4), 216–224.
Cheng, D., Schwarz, E. B., Douglas, E., & Horon, I. (2009). Unintended pregnancy and associated maternal preconception, prenatal and postpartum behaviors. Contraception, 79(3), 194–198.
Côté-Arsenault, D., & Donato, K. L. (2011). Emotional cushioning in pregnancy after perinatal loss. Journal of Reproductive and Infant Psychology, 29(1), 81–92.
Dennis, C. L., & Letourneau, N. (2007). Global and relationship-specific perceptions of support and the development of postpartum depressive symptomatology. Social Psychiatry and Psychiatric Epidemiology, 42(5), 389–395.
Goyal, D., Gay, C., & Lee, K. A. (2009). How much does low sleep quality contribute to postpartum depressive symptoms? Women’s Health Issues, 19(2), 117–124.
Lancaster, C. A., Gold, K. J., Flynn, H. A., Yoo, H., Marcus, S. M., & Davis, M. M. (2010). Risk factors for depressive symptoms during pregnancy: A systematic review. American Journal of Obstetrics and Gynecology, 202(1), 5–14.
Milgrom, J., Gemmill, A. W., Bilszta, J. L., et al. (2008). Antenatal risk factors for postnatal depression: A large prospective study. Journal of Affective Disorders, 108(1-2), 147–157.
O’Hara, M. W., & McCabe, J. E. (2013). Postpartum depression: Current status and future directions. Annual Review of Clinical Psychology, 9, 379–407.
Seng, J. S., Low, L. K., Sperlich, M., Ronis, D. L., & Liberzon, I. (2013). Prevalence, trauma history, and risk for posttraumatic stress disorder among nulliparous women in maternity care. Obstetrics & Gynecology, 122(5), 1114–1125.
Vigod, S. N., Villegas, L., Dennis, C. L., & Ross, L. E. (2010). Prevalence and risk factors for postpartum depression among women with preterm and low-birth-weight infants: A systematic review. BJOG: An International Journal of Obstetrics & Gynaecology, 117(5), 540–550.
Wisner, K. L., Sit, D. K. Y., McShea, M. C., et al. (2013). Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry, 70(5), 490–498.
