Newborns whose mothers screened positive for depressive symptoms after giving birth had nearly three times the risk of dying before their first birthday, according to a study of 414,890 singleton births. The findings link those symptoms with infant mortality.

The Rutgers School of Public Health study, published in JAMA Network Open, linked birth records from 2016 to 2020 with infant death records through 2021. It examined depressive symptoms rather than confirmed diagnoses of postpartum depression.

Study Findings

Researchers found an infant mortality rate of 7.2 deaths per 1,000 births among infants whose mothers had depressive symptoms, compared with 2.0 per 1,000 among those whose mothers did not. The difference was seen before other risk factors were taken into account.

After adjustment for maternal and infant demographic and socioeconomic factors, the risk of death within 364 days was 2.89 times higher. The higher risk was seen among infants whose mothers had depressive symptoms.

After further adjustment for maternal and infant risk factors, the estimated risk was lower, with an adjusted relative risk of 1.97. The study therefore showed an association rather than proof that depressive symptoms caused infant deaths.

The association remained across maternal race and ethnicity, education and insurance groups, and among infants born both prematurely and at full term. The pattern was consistent across these groups.

Maternal depressive symptoms were also associated with higher risks of death from the four leading causes examined. The adjusted relative risk was 4.07 for prematurity-related conditions and 5.12 for perinatal conditions.

The risk was 3.56 times higher for deaths involving congenital malformations and chromosomal abnormalities, while the risk of sudden infant death syndrome was 2.08 times higher. These findings covered specific causes of death examined by the researchers.

In total, 906 infants in the study died before reaching their first birthday. Of those deaths, 107 occurred among infants whose mothers had depressive symptoms.

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Why the Link Matters

The study measured depressive symptoms using the Edinburgh Postnatal Depression Scale, a screening tool administered after delivery. A score of 10 or higher was used to identify mothers with potential depression.

This distinction is important because the research examined screening results rather than confirmed clinical diagnoses of postpartum depression. The findings therefore do not show that mothers with a diagnosis caused their babies' deaths.

Researchers said the relationship could involve both biological and social factors. Depression may affect stress hormones during pregnancy, while poverty, unstable housing and limited access to care may affect both maternal mental health and infant wellbeing.

Global reviews have also linked maternal depression with slower infant growth and greater illness risk in low-resource settings. Hormonal shifts, including changes in stress-related cortisol, have been cited as one possible biological pathway.

Separate Singapore research linked maternal mental health during pregnancy with early cognitive development and later depressive symptoms in children. Its authors said supporting maternal wellbeing may be important to early childhood outcomes.

Specialists say mothers experiencing depressive symptoms should discuss them with their obstetrician, who can refer them for further mental health care. Postpartum Support International can also help connect parents with local resources.

Partners and relatives can provide practical support, while specialists stress that mothers should not feel pressured to appear constantly happy during pregnancy. Sadness, anxiety and grief can occur even when someone is otherwise mentally healthy.

Researchers say further studies following women before, during and after pregnancy are needed to clarify the association and identify ways to reduce infant mortality. This could clarify how maternal mental health and infant outcomes are connected.

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