Postpartum depression dominates the conversation about perinatal mental health. Postpartum anxiety (PPA) receives far less attention — despite emerging evidence suggesting it may be equally or even more prevalent. For many new mothers, the predominant experience is not sadness but an unrelenting, exhausting state of worry, hypervigilance, and dread.
Prevalence — more common than most people realise
Estimates of postpartum anxiety prevalence vary depending on the measurement tool and population studied, but the emerging picture is consistent: PPA is common. A 2025 cross-sectional study of over 2,000 postpartum women found a self-reported prevalence of 20.8% for PPA, compared with 12.9% for postpartum depression.1 A 2024 French national cohort study reported PPA symptom prevalence of 27.6% at two months postpartum.2
A 2025 meta-analysis drawing on 122 studies and over 560,000 women across 43 countries found that approximately 9% of postpartum women experienced comorbid anxiety and depression simultaneously.3 This comorbidity is clinically significant — women with both conditions tend to have more severe symptoms, greater functional impairment, and poorer treatment outcomes than those with either condition alone.
What postpartum anxiety looks like
PPA presents differently from generalised anxiety. In the postpartum context, anxiety often centres on the infant's safety and wellbeing, manifesting as:
Hypervigilance: An inability to relax, constant monitoring of the infant's breathing, an exaggerated startle response, and a persistent sense that something terrible is about to happen.
Catastrophic thinking: Persistent worst-case scenario thinking — imagining sudden infant death, accidents, or illness despite no evidence of risk.
Physical symptoms: Heart racing, chest tightness, nausea, dizziness, and an inability to eat or sleep even when the infant is sleeping. These physical symptoms are often mistaken for normal new-parent fatigue.
Avoidance and control: Reluctance to leave the infant with anyone else, excessive checking behaviours, difficulty delegating care tasks, and withdrawal from situations perceived as risky.
A 2025 Lancet review described PPA as a condition where some symptoms of clinical anxiety — such as a prevalence of intrusive thoughts approaching 100% — may overlap with common and non-pathological postpartum experiences, making the diagnostic boundary particularly challenging.4
Intrusive thoughts — normal vs pathological
Intrusive thoughts about infant harm are reported by 70 to 100% of new mothers.5 These thoughts are ego-dystonic — meaning they are unwanted, distressing, and fundamentally inconsistent with the mother's values and intentions. Common content includes thoughts of dropping the baby, the baby being harmed in an accident, or the mother herself harming the infant. Research consistently shows that experiencing these thoughts is not associated with an increased risk of actually harming the infant.5
The distinction between common intrusive thoughts and postpartum obsessive-compulsive disorder (OCD) lies in frequency, intensity, and the degree of behavioural disruption. Clinical postpartum OCD affects an estimated 1.7 to 9% of new mothers, typically beginning within the first eight weeks postpartum.6 In a prospective cohort study, up to 37% of women demonstrated subclinical obsessions or compulsions at two weeks postpartum.7
Postpartum OCD is characterised by aggressive obsessional themes — present in 62% of postpartum OCD cases compared with 17% of pregnancy-onset OCD and 23% of non-perinatal OCD.8 These aggressive themes are almost always directed toward the infant, are profoundly distressing to the mother, and crucially, do not represent intent. This distinction from postpartum psychosis — where thoughts may be ego-syntonic and accompanied by detachment from reality — is clinically critical.6
Screening gaps
The ACOG 2023 Clinical Practice Guidelines recommend screening for both depression and anxiety using validated instruments.9 However, the most commonly used tool — the Edinburgh Postnatal Depression Scale (EPDS) — was designed to detect depression. Its three anxiety-specific items (the EPDS-3A subscale) can flag anxiety symptoms but are not a substitute for a dedicated anxiety screen.2
The Generalised Anxiety Disorder 7-item scale (GAD-7) is increasingly used alongside the EPDS in perinatal settings. A 2025 systematic review of risk factors for PPA highlighted that a history of psychological or psychiatric care, nulliparity, and stressful life events during pregnancy were among the most consistent predictors.10
Treatment
PPA responds to evidence-based treatment. Cognitive behavioural therapy (CBT) has the strongest evidence base for postpartum anxiety disorders, including postpartum OCD. Exposure and response prevention (ERP) is the gold-standard psychological treatment for OCD specifically. Selective serotonin reuptake inhibitors (SSRIs) are first-line pharmacotherapy when medication is indicated, with sertraline and paroxetine having the most extensive safety data in breastfeeding mothers.9
The barrier to treatment is not the absence of effective options — it is recognition. Many women do not disclose their symptoms because they fear being judged as unfit mothers. Many clinicians do not screen for anxiety specifically, focusing instead on depression alone. The result is a condition that is common, treatable, and frequently missed.
The SHORE planner's Module 4 (Mental Health & PMADs) includes the GAD-7 alongside the EPDS, providing structured tracking for both depression and anxiety symptoms with auto-scoring to support early identification.
