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February 16, 2022

Flo and Johns Hopkins University School of Medicine Study Identifies Key Risk Factors to PostPartum Depression

Study of more than one million women finds first-time moms, moms under 25, and moms of twins have elevated risk; moms 40+ years with twins at highest risk

SAN FRANCISCO, Feb 16, 2022 — Flo, the leading women’s health app, and Johns Hopkins recently published a study identifying the key risk factors of postpartum depression symptoms. The study, published in the Journal of Affective Disorders, examines the biological risk factors associated with postpartum depressive symptoms, including maternal age, number of children, number of pregnancies, and sex of the infant. With more than 1M participants from 138 countries, this study marks the first of its kind to examine relationships between risk factors during the perinatal period and depressive symptoms.

Postpartum depression includes major and minor depressive episodes that occur during pregnancy or in the first 12 months after delivery. It is one of the most common medical complications during pregnancy and the postpartum period, with 1 in 8 women experiencing symptoms of postpartum depression in the United States1. Among this population, 20% of postpartum cases result in suicide. In addition, issues such as fear of harming the baby (36%), weak attachment to the baby (34%) and even, in extreme cases, child suicide attempts have been reported.2 Postpartum depression has also been associated with undesirable outcomes in exposed children including lower IQ, slower language development, and adverse childhood behaviors.3

To date, postpartum depression studies have been controversial and conducted on small, homogenous sample sizes. Outcomes from the Flo & Johns Hopkins study identified four main groups to be at high risk of postpartum depression, including: first-time moms, moms younger than 25 years, and moms of twins. Notably, moms of twins aged greater than 40 years were at markedly high risk. Given the extremely limited research on postpartum depression, this study furthers research and clinical aims to identify and treat maternal depression more effectively.

"This study marks a significant step forward for postpartum depression research," said Jennifer Payne, senior study author and Professor and Vice Chair of Research in the Department of Psychiatry and Neurobehavioral Sciences at the of University of Virginia Schoolof Medicine (formerly at Johns Hopkins University School of Medicine). "Most prior studies examining maternal and infant risk factors for postpartum depression are small, country-specific, or are based upon a collection of smaller studies employing inconsistent assessments of postpartum depression. With these findings, we hope to help clinicians around the world take proactive steps to prevent and treat this devastating illness."

With concurrent delay of motherhood and increasing availability of reproductive technologies, findings from our study suggest clinicians take special consideration and proactive assessment when caring for these particularly high risk groups. Some medical experts believe that the rate of postpartum depression could be at least twice as much than what is actually reported and diagnosed.4 Of the cases that have been diagnosed, only a limited number of women actually receive treatment. Currently, the major component of the routine 6-week postpartum checkup in the United States is limited to vaginal examinations and contraceptive education. In a national survey, about one third of mothers who received a postpartum checkup felt their health concerns were not addressed.5

“While postpartum depression has received more attention in recent years, it is still not always caught by doctors and nurses,” said Sonia Ponzo, Science Director of Flo Health.  “Given the potential risks to both infants and mothers, it's crucial that clinicians and health professionals are aware of the factors influencing development of postpartum depression, especially in more vulnerable groups. Our study with Johns Hopkins is a critical step forward in identifying and treating maternal depression more effectively.”

The study used Flo app technology to survey over one million women from January 2018 to April 2020. Flo provided strictly de-identified, aggregated data to Johns Hopkins University School of Medicine research team. At the time of data collection for this study, the Flo application had an estimated 26 million active users residing in 150 countries.


Flo is the most popular women’s health app globally; it is #1 OB-GYN-recommended app for period and cycle tracking based on the survey among US OB-GYNs. Over 220 million people  have downloaded Flo, and 45 million people use it on a monthly basis. With over 100+ medical experts, Flo supports women during their entire reproductive lives and provides curated cycle and ovulation tracking, personalized health insights, expert tips, and a private community for women to share their questions and concerns. Flo prioritizes safety and keeps a sharp focus on being the most trusted digital source for​ ​women's health information. Flo health app is available in more than​ 20 languages on iOS and Android. For more information, please visit https://flo.health.