Pregnancy and birth complications and long-term maternal mental health outcomes: A systematic review and meta-analysis

Background: Few studies have examined the associations between pregnancy and birth complications and long-term (>12 months) maternal mental health outcomes. Objectives: To review the published literature on pregnancy and birth complications and long-term maternal mental health outcomes. Search strategy: Systematic search of Cumulative Index to Nursing and Allied Health Literature (CINAHL), Excerpta Medica Database (Embase), PsycInfo®, PubMed® and Web of Science from inception until August 2022. Selection criteria: Three reviewers independently reviewed titles, abstracts and full texts. Data collection and analysis: Two reviewers independently extracted data and appraised study quality. Random-effects meta-analyses were used to calculate pooled estimates. The Meta-analyses of Observational Studies in Epidemiology (MOOSE) guidelines were followed. The protocol was prospectively registered on the International Prospective Register of Systematic Reviews (PROSPERO: CRD42022359017). Main results: Of the 16 310 articles identified, 33 studies were included (3 973 631 participants). Termination of pregnancy was associated with depression (pooled adjusted odds ratio, aOR 1.49, 95% CI 1.20–1.83) and anxiety disorder (pooled aOR 1.43, 95% CI 1.20–1.71). Miscarriage was associated with depression (pooled aOR 1.97, 95% CI 1.38–2.82) and anxiety disorder (pooled aOR 1.24, 95% CI 1.11–1.39). Sensitivity analyses excluding early pregnancy loss and termination reported similar results. Preterm birth was associated with depression (pooled aOR 1.37, 95% CI 1.32–1.42), anxiety disorder (pooled aOR 0.97, 95% CI 0.41–2.27) and post-traumatic stress disorder (PTSD) (pooled aOR 1.75, 95% CI 0.52–5.89). Caesarean section was not significantly associated with PTSD (pooled aOR 2.51, 95% CI 0.75–8.37). There were few studies on other mental disorders and therefore it was not possible to perform meta-analyses. Conclusions: Exposure to complications during pregnancy and birth increases the odds of long-term depression, anxiety disorder and PTSD.