Cortisol and mental health in the perinatal period: A systematic review of maternal, infant, and dyadic associations

The perinatal period is a critical window for maternal and infant mental health, during which stress physiology may influence psychological and developmental outcomes. Cortisol, the end product of the hypothalamic–pituitary–adrenal axis, is widely used as a biomarker of stress regulation, although its relationship with mental health in mother–infant dyads remains unclear. A systematic review was conducted in accordance with PRISMA 2020 guidelines. Four electronic databases (PubMed, PsycINFO, Scopus, and Web of Science) were searched for studies published between January 2015 and March 2025, resulting in 27 studies that met the inclusion criteria. This systematic review examined the associations between cortisol and mental health during the perinatal period, focusing on maternal psychological functioning, infant socioemotional outcomes, mother–infant physiological synchrony, and the potential influence of maternal cortisol on later infant development. The findings indicate that associations between cortisol and mental health are complex and context dependent. Maternal cortisol was linked to symptoms of depression, anxiety, and trauma, although studies reported heterogeneous patterns. Infant cortisol was associated with maternal psychological distress, caregiving experiences, and socioemotional functioning, but findings varied across contexts and developmental stages. Evidence from dyadic studies suggested physiological coupling between mothers and infants, supporting the idea that stress regulation processes may be transmitted across generations. Some studies also indicated that maternal cortisol during pregnancy may be related to later infant physiological and behavioral outcomes, although results were not consistent. Overall, cortisol appears to provide valuable information about stress regulation during the perinatal period, but current evidence does not support its use as a specific biomarker of perinatal mental health. Instead, the findings support a biopsychosocial perspective in which cortisol reflects the dynamic interplay among biological stress regulation, maternal psychological functioning, caregiving experiences, and the broader relational environment. Further longitudinal and dyadic research is needed to clarify the mechanisms linking stress physiology and mental health in mothers and infants.