The impact of pre-pregnancy BMI on maternal depressive and anxiety symptoms during pregnancy and the postpartum period: A systematic review and meta-analysis

Background: Studies have reported conflicting results on the association between maternal pre-pregnancy weight and adverse mental health outcomes during pregnancy and the postpartum period. This systematic review and meta-analysis aim to provide the current state of evidence concerning the association between maternal pre-pregnancy BMI and the risk of antenatal and postnatal depressive and anxiety symptoms. Methods: PubMed, EMBASE, Web of Science and Scopus databases were searched from their inception through August 31, 2020. Observational studies assessing the association between maternal pre-pregnancy BMI and risk of depression and/anxiety during pregnancy and the postpartum period were included. We used random-and quality-effects meta-analyses to estimate risks. Subgroup, sensitivity and meta-regression analyses were performed. Results: Pre-pregnancy obesity was associated with a 33% increased risk of antenatal depressive symptoms (pooled OR = 1.33 [95% CI; 1.20-1.48]). The pooled ORs for the association between underweight, overweight and obesity and postnatal depressive symptoms were 1.71 [95% CI; 1.27 2.31], 1.14 [95% CI; 1.0 1.30] and 1.39 [95% CI; 1.23 - 1.57], respectively. Low to moderate level of between-study heterogeneity was noted. The association between pre-pregnancy BMI and perinatal anxiety symptoms remain uncertain. Conclusions: Pre-pregnancy obesity was associated with an increased risk of maternal depressive symptoms both in pregnancy and the postpartum period. The findings suggest that women with both high and low pre-pregnancy weight may benefit from receiving mental health screening and interventions during prenatal care.

Automated summary

The study found that pre-pregnancy obesity is associated with an increased risk of maternal depressive symptoms during both pregnancy and the postpartum period, while underweight, overweight, and obesity are also linked to postnatal depressive symptoms. However, the association between pre-pregnancy BMI and perinatal anxiety symptoms remains uncertain. Women with high or low pre-pregnancy weight may benefit from mental health screening and interventions during prenatal care.