The effects of perinatal depression and anxiety on memory, attention, and cognitive flexibility: a systematic review...

Women in the perinatal period often report experiencing cognitive difficulties, such as forgetfulness, disorientation, and a reduced attention span. However, evidence from objective neuropsychological studies is inconsistent. Depressive and anxiety symptoms have been proposed as potential contributors to these cognitive challenges, with some studies suggesting a negative association between mood disturbances and cognitive performance during pregnancy and postpartum. This review aims to characterize the relationship between perinatal depressive and anxiety symptoms and cognitive functioning (memory, attention, and cognitive flexibility).

Following PRISMA guidelines, a systematic literature search was conducted in PubMed, Web of Science and PsycINFO electronic databases. Where at least three studies with comparable designs and outcomes were available, exploratory meta-analyses were conducted and are reported in supplementary material.

We included 42 studies in the present review. The most consistent finding was a significant positive association between depressive symptoms and self-reported cognitive complaints across six studies. Results for objective tasks were inconsistent for working memory (k = 11), attention (k = 24), and cognitive flexibility (k = 5). Autobiographical memory was associated with depressive symptoms, but evidence was based on few studies (k = 3). Verbal memory (k = 8) and recognition memory (k = 2) were not associated with depressive or anxiety symptoms. Across domains, most studies were cross-sectional, relied on self-report symptom measures, used heterogeneous non-ecological cognitive tasks and rarely assessed anxiety, limiting the strength and generalizability of conclusions.

Depressive symptoms are consistently associated with subjective cognitive complaints, but evidence for objective cognitive impairment in the perinatal period is inconclusive. The discrepancy between perceived and measured performance highlights the possible influence of mood, sleep, mental load, and sociocultural narratives on maternal cognition. More robust longitudinal and ecologically valid studies are needed to clarify these relationships and mechanisms, and to inform the development of targeted interventions.