Predicting Postpartum Depression Before It Starts
Postpartum depression affects somewhere between 10 and 15 percent of people who give birth. For those from marginalized communities, the numbers are even higher. It's one of the most common complications of childbirth, and yet it still catches many families completely off guard.
Part of the reason for that is timing. By the time PPD symptoms show up, a person is already in the thick of new parenthood — exhausted, overwhelmed, and trying to figure out why they don't feel the way they expected to feel. Getting support at that point is absolutely possible, and it works. But what if we could identify risk even earlier?
What We've Known About PPD Risk
For years, perinatal mental health clinicians have used a set of well-established risk factors to identify people who may be more vulnerable to PPD. These fall into a few broad categories:
Personal and historical factors:
Personal or family history of depression or mood disorders
Previous experience with perinatal depression or anxiety
History of trauma or abuse
Stressful life events
Circumstantial and social factors:
Poor or limited social support
Intimate partner violence or relationship stress
Unintended pregnancy
Difficult delivery or pregnancy complications
Sleep disorders
Low confidence in parenting abilities
These factors are meaningful and clinically useful. They help providers and patients have proactive conversations about mental health before symptoms emerge. But they don't tell the whole story — because PPD is also biological.
What New Research Found
A study published in 2025 in Neuropsychopharmacology by Osborne et al. looked at a different kind of predictor: the hormones circulating in a pregnant person's body during the third trimester.
During pregnancy, progesterone rises steadily and then drops sharply after delivery. This hormonal shift has long been associated with PPD, which is part of why the first FDA-approved treatment for PPD — brexanolone, and more recently zuranolone — works by targeting the brain's response to this hormonal change.
What the researchers found goes a step further. They measured specific neuroactive steroids — hormones that act directly on the brain — across pregnancy and tracked who went on to develop PPD postpartum. When they looked at people who were emotionally well during pregnancy, they found that those who later developed PPD had measurably different hormone ratios in the third trimester compared to those who didn't.
Specifically, people who developed PPD showed signs that their bodies were producing less of the calming, GABA-supporting hormones (known as positive allosteric modulators) and more of the hormones that work against them. GABA is the brain's primary "brake" system — it regulates stress response, mood, and emotional regulation. When the balance tips in the wrong direction during pregnancy, it may leave the brain less equipped to handle the dramatic hormonal drop that comes with delivery.
In plain terms: for some people, the groundwork for PPD is laid months before birth, at a hormonal level, before a single symptom appears.
Why This Matters Clinically
This research doesn't mean a hormone test is around the corner as a standard screening tool — the study was relatively small and more research is needed. But it does add important weight to something perinatal mental health clinicians already know intuitively: PPD is not a character flaw, a failure to adjust, or a sign that someone isn't cut out for parenthood. It has biological underpinnings that exist independent of circumstance or mindset.
It also reinforces the value of early intervention. If biological vulnerability can be present months before symptoms emerge, then waiting until the postpartum period to start thinking about mental health support means waiting longer than necessary.
The goal of perinatal mental health care isn't to treat a crisis after it happens. It's to understand your full picture — your history, your circumstances, your biology — and build support around it proactively.
You Don't Have to Wait Until Something's Wrong
Whether you have several of the known risk factors, a history of depression, a previous difficult postpartum experience, or simply a feeling that you want to be prepared — reaching out before your baby arrives is one of the most valuable things you can do for yourself and your family.
Our therapists specialize in perinatal mental health and work with people at every stage of the journey: preconception, pregnancy, and postpartum. If you're ready to get support in place before your due date, we'd love to connect.
If you’re not ready to make the call, you can find some helpful resources under our downloads.
Reference
Osborne, L.M., Etyemez, S., Pinna, G., Alemani, R., Standeven, L.R., Wang, X.Q., & Payne, J.L. (2025). Neuroactive steroid biosynthesis during pregnancy predicts future postpartum depression: a role for the 3α and/or 3β-HSD neurosteroidogenic enzymes? Neuropsychopharmacology, 50, 904–912. https://doi.org/10.1038/s41386-025-02052-z
