A study in JAMA Network Open reveals a strong connection between maternal depressive symptoms and infant mortality. Infants whose mothers experience depression-related symptoms face nearly three times the risk of death within their first year compared to infants whose mothers show no such symptoms. The research, based on New Jersey birth records from 2016 to 2020, examined nearly 415,000 births and recorded 906 infant deaths within 364 days—0.2% of the total. Among those deaths, 11.8% involved mothers with depressive symptoms.
The raised risk remained even after excluding deaths in the first week of life, with infants of mothers with symptoms showing a 2.1 times higher mortality rate between 8 and 364 days after birth. Researchers used the Edinburgh Postnatal Depression Scale (EPDS) to assess symptoms, which are frequently underdiagnosed. Only 3.8% of mothers in the dataset had documented depressive symptoms, though experts estimate fewer than half of affected mothers receive a formal diagnosis.
The findings expose racial and socioeconomic disparities. Infants who died were more likely to have mothers under 30 or over 40, Black mothers, those enrolled in the WIC supplemental nutrition program, or living in low-income areas. Additional risk factors included maternal tobacco or substance use, hypertension, low birth weight, and preterm birth. These patterns align with known complications of perinatal depression, such as preterm birth, preeclampsia, and intrauterine growth restriction—all of which independently increase infant mortality risk.
How New Jersey’s Screening Revealed Hidden Risks
Perinatal depression is the most common maternal health concern in the U.S., yet its direct impact on infant deaths had rarely been studied before. Previous research relied on health records, which often miss undiagnosed cases. New Jersey’s mandatory mental health screening for pregnant women allowed researchers to track symptoms systematically. Lead author Rebecca Woofter, a postdoctoral associate at Rutgers School of Public Health, noted that the state’s approach provides a rare opportunity to assess depressive symptoms at scale.
The study establishes an association rather than causation, but experts emphasize that untreated perinatal depression disrupts critical pathways for infant health. Elizabeth Britt DeVore, an assistant professor at the University of Michigan, explained that depression during pregnancy is linked to behaviors like smoking and substance use, as well as medical complications that directly harm fetal development. The risks extend beyond the first month, with higher mortality tied to prematurity, congenital malformations, and sudden infant death syndrome (SIDS).
Related Post: Hospitals Strengthen Care Amid Global Health Crisis
The adjusted relative risk for deaths related to prematurity was over four times higher for infants of mothers with symptoms, while risks for perinatal conditions and chromosomal abnormalities exceeded three times the baseline.
Biological and Behavioral Links to Infant Deaths
Maternal depression has been associated with physiologic changes, including neuroendocrine dysregulation and microbiome disruption. Additionally, the association may be bidirectional; mothers may develop depressive symptoms after learning about serious fetal or infant health problems.
Early detection and treatment of perinatal depression is essential for both maternal and infant health. Untreated perinatal depression is associated with lower adherence to prenatal care, obstetric complications like preeclampsia and preterm birth, and impacts on infant development.
Call for Nationwide Mental Health Care Expansion
While the research was conducted in New Jersey, where perinatal mental health screening is mandated, the results show the need for broader implementation of screening and treatment programs. The American College of Obstetricians and Gynecologists already recommends universal depression screening during pregnancy and postpartum, but implementation varies widely. Improving access to perinatal mental health care, especially for groups facing disparities, could help mitigate some of these risks.