Substance use during pregnancy and risk of postpartum depression: a systematic review and meta-analysis

Malein Pacho; Claudia Aymerich; Borja Pedruzo; Gonzalo Salazar de Pablo; Eva Sesma; Marta Bordenave; Rodrigo Dieguez; Itziar Lopez-Zorroza; Jon Herrero; Maria Laborda; Aranzazu Fernandez-Rivas; Clemente Garcia-Rizo; Miguel Angel Gonzalez-Torres; Ana Catalan

doi:10.3389/fpsyt.2023.1264998

Substance use during pregnancy and risk of postpartum depression: a systematic review and meta-analysis

Front Psychiatry. 2023 Nov 9:14:1264998. doi: 10.3389/fpsyt.2023.1264998. eCollection 2023.

Authors

Malein Pacho^#¹, Claudia Aymerich^#^{1

2

3}, Borja Pedruzo¹, Gonzalo Salazar de Pablo^{4

5

6}, Eva Sesma^{1

2

3

7}, Marta Bordenave¹, Rodrigo Dieguez¹, Itziar Lopez-Zorroza¹, Jon Herrero¹, Maria Laborda¹, Aranzazu Fernandez-Rivas^{1

2

3

7}, Clemente Garcia-Rizo⁸, Miguel Angel Gonzalez-Torres^{1

2

3

7}, Ana Catalan^{1

2

3

4

9

10}

Affiliations

¹ Psychiatry Department, Basurto University Hospital, Osakidetza, Basque Health Service, Bilbao, Spain.
² Biobizkaia Health Research Institute, Barakaldo, Spain.
³ CIBERSAM, Centro Investigación Biomédica en Red de Salud Mental, Madrid, Spain.
⁴ Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
⁵ Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
⁶ School of Medicine, Universidad Complutense, IiSGM, CIBERSAM, Madrid, Spain.
⁷ Facultad de Medicina y Odontología, University of the Basque Country, UPV/EHU, Leioa, Spain.
⁸ Barcelona Clinic Schizophrenia Unit, Hospital Clinic of Barcelona, Department of Medicine, Institut de Neurociències, Universitat de Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain.
⁹ NIH Oxford Health Biomedical Research Centre, Oxford, United Kingdom.
¹⁰ Neuroscience Department, University of Basque Country (UPV/EHU), Leioa, Spain.

^# Contributed equally.

Abstract

Introduction: Postpartum depression (PPD) is a prevalent mental health condition affecting women globally within the first year following childbirth. Substance use during pregnancy has been associated with an increased risk of developing PPD, but the evidence remains inconclusive. This meta-analysis aims to comprehensively assess the effects of different substances on PPD risk, exploring potential modifiers and confounding factors.

Objectives: To examine the proportion of PPD among substance users during pregnancy, compared to non-users, and investigate the specific risk associated with different substances (tobacco, alcohol, and non-specified substance use/multiple substance use).

Methods: A systematic literature search was conducted from inception to November 2022 using the Web of Science database (Clarivate Analytics), incorporating Web of Science Core Collection, the BIOSIS Citation Index, the KCI-Korean Journal Database, MEDLINE^®, the Russian Science Citation Index, the SciELO Citation Index, and the Cochrane Central Register of Reviews, and Ovid/PsycINFO databases. Inclusion criteria comprised original studies with pregnant women, using validated depression scales and substance use reporting.

Results: Among the 26 included studies, encompassing 514,441 women, the pooled prevalence of PPD among substance users during pregnancy was 29% (95% CI 25-33). Meta-analyzes revealed an overall odds ratio (OR) of 3.67 (95% CI 2.31-5.85, p < 0.01) indicating a significantly higher risk of PPD among substance users compared to non-users. Subgroup analyzes demonstrated a higher risk for women with non-specified or multiple substance use (OR 4.67, 95% CI 2.59-8.41; p < 0.01) and tobacco use (OR 4.01, 95% CI 2.23-7.20; p < 0.01). Alcohol use showed a trend toward higher risk that did not reach statistical significance (OR 1.88, 95% CI 1.00-3.55; p = 0.051).

Conclusion: This meta-analysis provides evidence of an increased risk of PPD among pregnant substance users, particularly those using multiple substances or tobacco. However, caution is needed in interpreting the association with alcohol use due to its non-significant result.

Systematic review registration: This study protocol was registered at PROSPERO (registration number: CCRD42022375500).

Keywords: alcohol use disorder; perinatal; postpartum; postpartum depression; substance use disorder; tobacco.

Publication types

Systematic Review

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This research received funding from the OSI Bilbao Basurto Research Commission for publication fees.