Association between maternal depressive symptoms during pregnancy and the risk of preeclampsia: a meta-analysis

Background Depression during pregnancy is common and has been proposed as a potential risk factor for preeclampsia, but observational studies have reported inconsistent findings. This meta-analysis aimed to evaluate the association between maternal depressive symptoms during pregnancy and the subsequent risk of developing preeclampsia. Methods PubMed, Embase, and Web of Science were systematically searched for observational studies evaluating depressive symptoms during pregnancy (measured before any assessment for preeclampsia) and reporting clinically diagnosed preeclampsia. Pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random-effects model accounting for the potential influence of heterogeneity. Results Nine cohort studies involving 44,559 pregnant women, of whom 6,934 (15.6%) had depressive symptoms during pregnancy, were included. Maternal depressive symptoms was associated with a higher risk of preeclampsia (OR: 1.89; 95% CI: 1.17–3.03; p < 0.001; I² = 66%). The association was consistent across study design (prospective vs. retrospective), maternal age (< 29 vs. ≥ 29 years), and preeclampsia definition (hypertension plus proteinuria vs. hypertension plus organ involvement, p for subgroup difference all > 0.05). Stronger associations were observed in studies adjusting for parity (OR: 3.42 vs. 1.35; p for subgroup difference = 0.02). Adjustment for maternal body mass index attenuated the association (OR: 1.43 vs. 2.93; p for subgroup difference = 0.05). Conclusions Depressive symptoms during early pregnancy is associated with an increased risk of subsequent preeclampsia. These findings highlight the importance of screening and monitoring depressive symptoms in routine prenatal care. Systematic Review Registration PROSPERO, identifier CRD420251250417.