Pre-pregnancy obesity and mental disorders during pregnancy and postpartum: A systematic review and meta-analysis

To evaluate the prevalence and risk of antenatal and postnatal mental disorders among obese and overweight women.

Six databases (including MEDLINE, EMBASE, PsycINFO) were searched from inception to January 2013, in addition to citation tracking, hand-searches and expert recommendations. Studies were eligible if antenatal or postnatal mental disorders were assessed with diagnostic or screening tools among women who were obese or overweight at the start of pregnancy. Of the 4627 screened articles, 62 met the inclusion criteria for the review.

Unadjusted odds ratios were pooled using random-effects meta-analysis for studies examining antenatal depression (n=29), postnatal depression (n=16), antenatal anxiety (n=10) and postnatal anxiety (n=3). Obese and overweight women had significantly higher odds of elevated depression symptoms than normal weight women, both during pregnancy and postpartum . Obese women also had higher odds of antenatal anxiety. The few studies identified for eating disorders (n=2) or serious mental illness (n=2) also suggested increased risk among obese pregnant women.

Healthcare providers should be aware that women who are obese when they become pregnant are more likely to experience elevated antenatal and postpartum depression symptoms than normal weight women, with intermediate risks for overweight women. Further high quality studies are needed for other mental disorders, and to investigate the impact of co-morbid obesity and mental disorders on pregnancy outcomes. This review was carried out as part of a PhD studentship funded by the Medical Research Council and Tommy's Charity.