Perinatal mood and anxiety disorders (PMADs)

Perinatal mood and anxiety disorders (PMADs)

What are PMADs?

Perinatal mood and anxiety disorders (PMADs) refer to a variety of mental health conditions that can emerge during and after pregnancy. These conditions affect about 1 in 7 pregnant people across all cultures, ages, socioeconomic levels and ethnicities — regardless of their medical history, including whether they’ve been pregnant before. Without the right treatment, PMAD conditions can significantly impact your ability to care for yourself and your child. These conditions can:

  • Range from mild to severe anxiety or depression.
  • Start with distressing feelings or thoughts and significant mood swings
  • Include changes in mood, anxiety and in some cases obsessive-compulsive disorders

In rare cases (about 1 in 1,000), an individual may experience perinatal or postpartum psychosis.

Screening and treatment are available for all types of PMADs.

If you have concerns or questions, please contact your health care providers. They can help you and your family members get the right evaluation, follow-up care, and treatment. You can also contact Harvard Pilgrim’s Care Management team for support by email at:


PMAD risk factors

Factors that may increase your risk of developing PMADs include:

  • Personal or family history of anxiety or mood disorders
  • Lack of adequate social support, including support caring for your child
  • Lack of a culturally sensitive support network
  • Complications for you, your child or both of you during pregnancy and delivery
  • Newborn medical complications or hospitalization
  • Loss of a pregnancy
  • Financial stress
  • Hyperthyroidism or hypothyroidism or other medical issues that you may have


Common PMADs and symptoms

You may have more than one health care provider during pregnancy. Any of them can provide screening to identify PMADs and help coordinate an early care and treatment plan. Common PMADs and their symptoms are listed below. Symptoms may occur during or after pregnancy.

Perinatal or postpartum mood disorder1 (including depression)

  • Marked increase in irritability
  • Loss of energy
  • Difficulty falling asleep or sleeping too much
  • Trouble concentrating, remembering things or making decisions
  • Loss of interest in daily activities of caring for yourself
  • Loss of appetite or overeating
  • Frequent crying
  • Excessive worry about or not enough concern for your baby
  • Loss of interest in activities or things you typically enjoy
  • Withdrawing socially from family or friends
  • Feelings of guilt or worthlessness
  • Racing and intrusive thoughts
  • Possible thoughts of harming your baby or yourself


Perinatal or postpartum anxiety disorder12

  • Constant and pervasive worry
  • Intense feelings of fear or uneasiness
  • Feeling that something bad is going to happen
  • Racing and intrusive thoughts
  • Trouble falling asleep or sleeping too much
  • Loss of appetite or overeating
  • Restlessness or inability to sit still
  • Physical symptoms like dizziness, nausea, headaches, racing heartbeat and breathing fast


Perinatal or postpartum obsessive-compulsive disorder (OCD)12

  • Obsessive, intrusive and upsetting thoughts (often related to your baby)
  • Compulsive behaviors to reduce fears and obsessions (e.g., cleaning, checking, counting, reordering things)
  • Heightened alertness and preoccupation with protecting your baby
  • A sense of extreme discomfort about your obsessive thoughts
  • Fear of being left alone with your baby


Less common PMAD related issues and symptoms

Perinatal or postpartum psychosis1

Perinatal and postpartum psychosis are extremely rare. They occur in about 1 in 1,000 individuals, and symptoms can include:

  • Extreme confusion
  • Hopelessness
  • Feeling distrustful or suspicious of other people
  • Inability to sleep, or excessive energy and not needing to sleep
  • Seeing things or hearing voices that are not there
  • Experiencing thoughts that lose touch with reality (delusional thinking)
  • Rapid mood swings


Additional resources

Postpartum depression — Office of Women’s Health

Perinatal depression — National Institute of Mental Health

Postpartum Support International

Children’s Hospital of Philadelphia. (2023). Perinatal or Postpartum Mood and Anxiety Disorders.

Postpartum Support International. (2024). Depression During Pregnancy & Postpartum.

This information does not replace the advice of a doctor.

Call 911 right away if you are having a life-threatening emergency.

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Harvard Pilgrim has a large and growing network of behavioral health providers who offer expertise across dozens of behavioral health care specialties. Search our online directory to find a provider near you.