Which New Moms Are at Highest Risk for Postpartum Depression?

First-time moms and new mothers of twins may be among those at greatest risk of postpartum depression symptoms, a large new study suggests.

Postpartum depression is a common illness. In the United States alone, about one in eight women report depression symptoms soon after giving birth, according to the U.S. Centers for Disease Control and Prevention.

Research suggests there is a genetic component to postpartum depression, and the hormonal changes of pregnancy may help trigger a depressive episode in vulnerable women, said Dr. Jennifer Payne, who directs the Reproductive Psychiatry Research Program at the University of Virginia School of Medicine, in Charlottesville.

But additional factors can sway postpartum depression risk. And in the new study of more than 1 million new moms worldwide, Payne's team identified a few.

One is age: Depression was most common among women under 25, and rates dipped thereafter.

Among those youngest mothers, 10% reported depression symptoms within three months of giving birth. That compared with 8.5% of 25- to 29-year-olds, and 6% to 7% of older women, the findings showed.

Past research, Payne said, yielded mixed conclusions on the relationship between age and postpartum depression. Some had suggested that both the youngest and oldest moms are at increased risk.

The new study found something different: In general, relatively older women had a lower prevalence of depression symptoms — unless they gave birth to twins.

Overall, moms of twin newborns more often reported depression symptoms than those who'd had one baby (about 11%, versus 8%). But age mattered, too: Of mothers aged 40 or older, 15% reported depression symptoms, compared to less than 10% of women in their late 30s who had twins.

It's not clear why, Payne said. But one question, she noted, is whether infertility treatment plays a role. In theory, there could be effects from the hormonal medications, Payne said. Plus, trying to become pregnant, perhaps after multiple tries, can take a psychological toll.

Payne also pointed to another possibility: Women who have their first baby in their 40s — and twins, at that — are facing a huge change in their lives, which could contribute to depression.

First-time motherhood was, in fact, a risk factor for depression across the whole study group. Within each age category, the researchers found, first-time moms had somewhat higher rates of depression symptoms than other women.

The findings — published in the March 15 issue of the Journal of Affective Disorders — are based on responses from more than 1 million women in 138 countries who took an "after childbirth" survey via smartphone app.

Roughly 10% reported suffering depression symptoms since giving birth about 90 days prior to the survey.

That doesn't mean all of those women had full-on postpartum depression, according to Payne. Some may have had "baby blues" that did not rise to the level of a clinical diagnosis.

The point, Payne said, is that women and providers alike should know that postpartum depression is common, and all new moms should be screened for it.

Guidelines say screening can be done by both obstetricians and pediatricians, who typically see moms more often. The American Academy of Pediatrics recommends screening moms during babies' routine check-ups over the first six months of life.

Knowing that certain women are at particular risk is helpful, according to Wendy Davis, executive director of the advocacy group Postpartum Support International, in Portland, Ore.

Davis, who was not involved in the study, said it "sheds new light on specific risk and how to make wise investments in prevention."

"One of the best prevention strategies is equipping pregnant and postpartum individuals with support and referral resources, and with the message that there is hope and help," Davis said. "This study helps us identify where and with whom those messages will have the most impact."

Payne said getting help for postpartum depression is vital not only for women themselves, but for their babies, too.

But no one, she stressed, should see depression as some sort of parental failing.

"People often seem to think you just have to 'pull yourself together,'" Payne said. "But this is a real illness."

According to Dr. Zsakeba Henderson, senior vice president and deputy medical officer of maternal and child health impact at the March of Dimes, "Postpartum depression is the most common complication for women who have just had a baby … The sooner you see your provider about postpartum depression, the better. You can get started on treatment so you can take good care of yourself and your baby. Some treatment options can include counseling, support groups or medicine, such as antidepressants."

SOURCES: Jennifer Payne, MD, director, Reproductive Psychiatry Research Program, University of Virginia School of Medicine, Charlottesville; Wendy Davis, PhD, executive director, Postpartum Support International, Portland, Ore.; Zsakeba Henderson, MD, senior vice president and maternal and child health impact deputy medical officer, March of Dimes, Atlanta; Journal of Affective Disorders, March 15, 2022