Although every woman is at risk, women with the following are at higher risk: Baby blues (eg, rapid mood swings, irritability, anxiety, decreased concentration, insomnia, crying spells) Prior episode of postpartum depression Prior diagnosis of depression Family history of depression Significant life stressors (eg, marital conflict, stressful events in the last year, financial difficulties, parenting with no partner, partner with depression) Lack of support from partner or family members (eg, financial or child care support) History of mood changes temporally associated with menstrual cycles or oral contraceptive use Prior or current poor obstetric outcomes (eg, previous miscarriage, preterm delivery, neonate admitted to the neonatal intensive care unit, an infant with a congenital malformation) Prior or continuing ambivalence about the current pregnancy (eg, because it was unplanned or termination was considered) Problems with breastfeeding The exact etiology of postpartum depression is unknown; however, prior depression is the major risk, and hormonal changes during the puerperium, sleep deprivation, and genetic susceptibility may contribute.