The prevalence and associated factors of postpartum depression in women with hypertensive disorders of pregnancy: a systematic review and meta-analysis

Hypertensive disorders of pregnancy (HDP) affect 5–10% of pregnancies worldwide and are associated with adverse maternal and neonatal outcomes. Postpartum depression (PPD) is a common and debilitating mental health condition. However, the global burden of PPD among women with HDP is not yet well understood. PubMed, Embase, Web of Science, Cochrane Library, PsycINFO, CINAHL, SinoMed, CNKI, VIP, and Wanfang Data were searched from inception to November 2025. This review addressed three questions with distinct methods: (a) to estimate the prevalence, we pooled data from studies reporting PPD cases among women with HDP using a random-effects model with Freeman-Tukey transformation; (b) to quantify the HDP-PPD association, we included studies with normotensive controls and pooled adjusted odds ratios; and (c) to summarize associated factors, we conducted a narrative synthesis with structured evidence tables. Quality was assessed using the Newcastle-Ottawa Scale and AHRQ checklist. All analyses were conducted using Stata software (version 19.5). Twenty-one studies (4,268 HDP women) were included, of whom 923 (21.6%) screened positive for PPD. For prevalence, the pooled estimate was 23% (95% CI 19–27%, I² = 88.31%); the prediction interval ranged from 8% to 42%. For the HDP versus non-HDP comparison, the primary analysis (crude ORs, nine studies) showed HDP was associated with nearly twice the odds of PPD (OR 1.96, 95% CI 1.66–2.31, I² = 0.0%); a supplementary analysis (adjusted ORs, three studies) yielded a consistent estimate (aOR 2.27, 95% CI 1.44–3.56). For associated factors, narrative synthesis identified perinatal death, low educational level, lack of partner/family support, and postpartum hypertension as consistently associated with PPD. Women with HDP have a high prevalence of screening-positive PPD (approximately 23%) and nearly twice the odds of PPD compared with normotensive women, although the wide prediction interval (8%–42%) suggests substantial variability across populations. Routine mental health assessment for women with HDP is a reasonable precautionary measure. This review was registered in PROSPERO (Registration ID CRD420251171343).