Depression during pregnancy

By trimester

Weeks 1–13

1st trimester

Depression can start or intensify in the first trimester, and it's easy to miss because normal early-pregnancy fatigue, appetite change, and sleep disruption overlap with depression's physical symptoms. Clinicians are advised to weigh non-somatic signs instead, like a lack of interest in the pregnancy itself, guilty rumination, or passive thoughts of death, which point more clearly to depression than tiredness alone.

Weeks 14–27

2nd trimester

By the second trimester, routine perinatal screening is the standard way this gets caught: one large health-system study found about 11% of pregnant patients screened positive and 12.6% were identified with depression during pregnancy overall, though identification rates varied notably by age, insurance type, and race, a gap researchers link to underrecognition rather than a true difference in who is affected.

Weeks 28–birth

3rd trimester

In the third trimester, depression left unaddressed carries its own documented risks worth weighing alongside any concern about medication: a higher chance of preterm delivery, low birth weight, and preeclampsia are all linked with depression that goes unaddressed, on top of a higher chance of a mood disorder continuing into the postpartum months.

What does the evidence show for depression?

• Core signs of perinatal depression, including the form that occurs during pregnancy, are a persistent sad, anxious, or empty mood most of the day nearly every day for at least two weeks, along with fatigue, trouble concentrating, sleep problems, and, in serious cases, thoughts of death or of harming oneself or the baby. 1
• Between 12% and 15% of women meet criteria for depression at some point during pregnancy or the postpartum period combined, and the condition is frequently missed because normal pregnancy symptoms overlap with depression's physical signs, which is why clinicians are advised to weigh non-somatic signs like a lack of interest in the pregnancy, guilty rumination, or passive thoughts of death. 2
• Up to 26% of pregnant adolescents are found to have major depression, and stopping antidepressant medication right around conception carries a considerably higher chance of the depression coming back. 2
• Depression that goes unaddressed during pregnancy is linked with lower birth weight, preterm delivery, lower Apgar scores, smaller head circumference, and disruption to the baby's stress-hormone regulation system. 2
• MotherToBaby's fact sheet lists a higher chance of miscarriage, preterm delivery, low birth weight, preeclampsia, and gestational diabetes among the documented risks when depression during pregnancy goes unaddressed, and notes that people who get effective care for their depression tend to have better outcomes for themselves and their babies. 3
• A large health-system study found about 11% of pregnant patients screened positive for depression, with 12.6% identified with depression during pregnancy overall; Black women were found less than half as likely as White women to be identified even with comparable screening results in that same study, pointing to a gap in recognition rather than in who actually experiences depression. 4
• That same health-system data found depression identified in close to 20% of pregnant patients age 24 and under, roughly twice the rate among single patients (20.5%) compared with married patients (9.0%), and among patients with public insurance (17.8%) compared with private insurance (10.3%). 4

Identification rates varied sharply by group in one large health-system study

When should I call my provider about depression?

Call 911 or go to an emergency department now if you may act on thoughts of harming yourself or someone else, cannot stay safe, or have hallucinations or severe confusion. Call or text 988 for immediate crisis support. The National Maternal Mental Health Hotline at 1-833-852-6262 offers additional support. Thoughts of death, self-harm, or harming the pregnancy need help right away: call or text 988, or reach the National Maternal Mental Health Hotline at 1-833-852-6262 anytime. A persistent sad, anxious, or empty mood most of the day for two weeks or more, a loss of interest in the pregnancy itself, or guilty rumination that doesn't let up are reasons to get evaluated rather than wait for a routine visit. Depression that is getting in the way of eating, sleeping, prenatal appointments, or daily functioning also warrants reaching out sooner. If you are ever unsure which side of the line you are on, make the call. Obstetric teams handle these check-ins as routine, not as overreacting.