The postpartum period is characterised by its complexities, challenges, and vulnerabilities across all areas of life. Unsurprisingly, these difficulties extend to mental health (Fisher et al., 2012) with an increased risk of low mood, psychosis, obsessive-compulsive disorders, and anxiety (Meltzer-Brody et al., 2018). Not just the ‘baby blues’, postpartum anxiety is a common and distressing condition with an estimated global prevalence exceeding 12% (Feldman et al., 2025).
It is no wonder that postpartum anxiety is associated with a myriad of negative consequences for both parents and infants. Whilst some are limited to the short-term, such as breastfeeding difficulties (Fallon et al., 2016), others are more long-lived. For instance, there is evidence of reduced language development in 12-month-old infants of mothers with postpartum anxiety (Reck et al., 2018), and an increased risk of adverse emotional problems in later childhood (Rees et al., 2019).
Developing a better understanding of postpartum anxiety is clearly of great importance, but the field faces multiple challenges – from the debated definition of ‘postpartum’, to the question of where to draw the line between normative and pathological levels of post-birth anxiety. However, there has been a recent surge in research interest in this field. Consequently, the time is right for an updated, comprehensive review of the state of the evidence. As explained by the authors of the article summarised below (Feldman et al., 2025), it is vital to understand what we know and what we don’t know if we are to identify what we need to find out next.
The postpartum period is associated with increased vulnerability to mental health challenges: what do we know, and what remains uncertain?
Methods
Feldman and colleagues searched the PubMed database in August 2022 for peer-reviewed English-language articles that assessed anxiety in the postpartum period, which they clearly defined as the time between 48 hours and one year after birth.
Their search strategy was relatively broad, referencing both anxiety and worries. Reviews, book chapters, opinions pieces, and theses were all excluded. Studies were included regardless of whether or not participants had a clinically diagnosed anxiety disorder.
The article, published in The Lancet Psychiatry, is a broad narrative-style review of the current evidence that aims to identify gaps in the knowledge base. As such, it did not follow standard systematic methods; the search was limited to a single database, studies were not quality assessed, and inclusion/exclusion criteria were loosely defined. Whilst these points should be kept in mind when interpreting the author’s conclusions, they do not detract from its credibility as this style of review is typical for this publication.
Results
Searches identified 8,214 articles, of which an impressive 850 were included in the review. There was considerable variation in their geographical location, definition and measurement of postpartum anxiety, and study design.
The authors calculated the average global prevalence of anxiety, with estimates from each study weighted by their sample size. At 12.3%, they found that anxiety disorders are more common during the postpartum period than amongst the general population but note that there is little disorder-specific data.
Across studies, there was no consensus as to the timeline of postpartum anxiety, likely due to different methodologies, small sample sizes, and true variation in its presentation from person to person. It is likely that anxiety follows different trajectories from pregnancy to post-birth, but larger longitudinal research is needed to explore this idea.
Studies identified many different factors that are correlated with postpartum anxiety and thus could increase vulnerability. These ranged from poverty, primiparity (being pregnant or giving birth for the first time), and younger maternal age, to traumatic childbirth experiences and infant admission to the NICU. The authors note that future studies should extend their scope to assess the effects of IVF, pregnancy loss, termination, and sudden infant death syndrome (SIDS). All of these factors have a plausible link to postpartum mental health difficulties, but there is currently not enough evidence to form more concrete conclusions.
Additionally, there appeared to be an effect between postpartum anxiety and bonding, but it remains unclear whether bonding leads to subsequent anxiety or whether the presence of anxiety has a negative influence on bonding – or indeed, if both relationships could be true. Similarly, whilst there seems to be a link between anxiety and breastfeeding difficulty, the specific nature of the relationship has not yet been defined. Biological risk factors are also likely at play, but to date these have mainly been studied in rat models and therefore their findings cannot be directly applied to birthing mothers.
Studies used a number of different scales of anxiety, but most did not differentiate between the postpartum and antenatal periods. Of particular clinical relevance, whilst medication is a first-line treatment for those experiencing postpartum anxiety, just five studies explored effects in humans. This highlights a key area in which more research is urgently needed. Comparatively, more studies assessed psychological interventions and other forms of support (e.g., education and skin-to-skin time). They reported mixed outcomes, although skin-to-skin contact and CBT had relatively consistent evidence for their efficacy.
Negative outcomes were numerous, affecting infants (e.g., emotional and behavioural problems, motor and language development), mothers (e.g., greater functional impairment and risk of postpartum depression), and the interactions between them (e.g., reduced maternal sensitivity to infant signals). These detrimental outcomes emphasise the necessity for better understanding of and treatment for postpartum anxiety.
This state-of-the-art review found that globally, 12% of postpartum mothers experience anxiety; a higher figure than the general population.
Conclusions
The authors highlight the high prevalence of postpartum anxiety, the significant progress that has been made in our understanding, and the remaining gaps in the knowledge base. They position the review as a “call to action” for further research, noting that the “time has come for a rigorous and coordinated study of postpartum anxiety”.
Despite the inclusion of 850 articles, many questions about postpartum anxiety remain unanswered.
Strengths and limitations
The strengths of this review include its large number of included studies (with a strong representation of non-Western regions), broad breadth, and comprehensive synthesis. With clear aims and outcomes, it sets out key areas for further study and highlights gaps in the knowledge base. By providing a concise overview of the current state of the evidence for postpartum anxiety, it is of considerable value for both researchers and clinicians.
Whilst the broad scope of the article is one of its main strengths, this comes at the cost of an in-depth assessment of each included study – meaning that its conclusions may not be based on the most robust evidence. Consequently, whilst this review was not designed to be systematic, it would be beneficial for future studies to conduct risk of bias assessments on the studies they include. These should focus on factors other than just sample size – such as pre-registration, missing data, randomisation, and reporting practices.
Additionally, the authors highlight “the absence of a well-defined set of clinical features” of postpartum anxiety, and call for the field to develop a “shared understanding”. This is an important insight, representing what is arguably one of the most valuable conclusions of the review. However, it nonetheless raises questions that should be taken into consideration. If studies have measured different definitions of postpartum anxiety at different times with different tools, to what extent can their findings be combined in a way that is meaningful?
The scope of this review is both a strength and a weakness. It includes a large number of diverse studies, but this comes at the cost of an in-depth critical appraisal of included studies.
Implications for practice
On one hand, this review paints a dreary picture of a field of study clouded by confused definitions, a poor understanding of phenomenology and symptom trajectory, and a concerning lack of agreement between studies. Yet on the other hand, it simultaneously highlights the increased attention being paid to this area and the slow but steady improvement in our understanding of postpartum anxiety.
Where researchers have identified risk factors, they have also identified windows of opportunity for preventative intervention, earlier identification, and improved treatment outcomes. Some of this work is already underway; for example, recent studies have advocated for better care pathways for families going through NICU admission (Osborne et al., 2025), and for women who experience a traumatic birth (Roberts et al., 2025). There is better awareness of the needs of populations that have been historically overlooked – such as non-birthing (Howat et al., 2023) and non-binary parents (Goldberg & Frost, 2025). Research is moving with the challenges of today’s unstable world, considering the difficulties faced by parents in conflict-affected regions (Mor et al., 2025), refugees (Rodríguez-Muñoz & Chrzan-Dętkoś, 2025), and families affected by climate change (Barkin et al., 2024)
This progress is considerable; these are great steps towards better care for postpartum anxiety and related disorders. However, there is a large amount of work still to do. As stressed by Feldman and colleagues, improvement is being hindered by the lack of consensus as to the very definition of postpartum anxiety. Until we have a thorough understanding of its key symptoms (and importantly, how these can differ across cultural and social contexts) and can accurately measure clinical anxiety, clinicians will struggle to effectively identify and treat those who need further care. As such, this review’s call for consensus is vital and timely.
Furthermore, Feldman et al. (2025) have identified the need to step away from ‘one-size-fits-all’ explanations towards individualised approaches. This is a take-away message that should be at the centre of research and clinical practice: postpartum anxiety is a complex condition that looks different from person to person. Therefore, it is not the case that one treatment approach will work for everyone, and there is not a single risk factor that applies universally. With this in mind, interventions should be tailored to the specific cultural, social, and situational context of each individual and their wider support network.
This review reminds us that whilst progress has been made, there is still a long way to go. Our understanding of postpartum anxiety is still in its infancy – and there’s no better time than now to begin filling in the gaps.
Postpartum anxiety is a complex condition that looks different from person to person: a one-size fits all approach is futile.
Statement of interests
The author reports no conflicts of interest.
Links
Primary paper
Feldman, N., Hibara, A., Ye, J., Macaranas, A., Larkin, P., Hendrix, E., Aydinian, T., Mittal, L., Wiegartz, P., Silbersweig, D., & Liu, C. H. (2025). Postpartum anxiety: a state-of-the-art review [Article]. The Lancet Psychiatry. https://doi.org/10.1016/S2215-0366(25)00197-X
Other references
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