Purpose <p>To examine the association between maternal perinatal mood and anxiety disorder (PMAD) treatment status and infant outcomes.</p> Methods <p>We used a US-based, geographically diverse administrative dataset of commercially insured birthing individuals with newly diagnosed PMAD in the 12-months prior to delivery 2016–2020, with a live linked newborn in Optum’s Clinformatics^® Data Mart Database. Our independent variable of interest was evidence of treatment for PMAD diagnosis. Our outcomes of interest were preterm birth (PTB), neonatal intensive care unit (NICU) admission, and neonatal abstinence syndrome (NAS).</p> Results <p>Treatment with psychotherapy only was significantly associated with 21% lower odds of PTB compared to no evidence of treatment (aOR: 0.79). Medication-only treatment and combined treatment were not associated with increased risk of PTB. Individuals in the combined treatment group had 24% greater odds of infant NICU admission (aOR: 1.24) compared to those without treatment. Individuals in the medication-only group had 4.18 times the odds of having an infant diagnosed with NAS compared to individuals without treatment (4.4% vs. 1%), while individuals in the combined treatment group had 4.32 times the odds (4.5% vs. 1%), respectively (aOR: 4.18, 4.32).</p> Conclusions <p>Pharmacotherapy use and combination treatments for PMAD may indicate higher disease severity, a risk factor for poor infant outcomes. Discussion of risks associated with pharmacotherapy use must also include a discussion of risks associated with untreated perinatal mental health conditions for birthing individuals and their infants.</p> Clinical trial number <p>Not applicable.</p>