Global analysis reveals high major depressive disorder rates among women during pregnancy and postpartum periods across diverse regions

BACKGROUND: For a meaningful global health response to major depressive disorder (MDD) during the peripartum period, its global distribution needs to be understood. The aim of this study was to conduct a systematic review of the prevalence of MDD during the peripartum period to assess sources of data heterogeneity and trends in prevalence during pregnancy and the postpartum period. METHODS: This systematic review and meta-regression quantified MDD during pregnancy and up to 12 months postpartum among women and girls aged 10-59 years, across world regions. We searched PubMed, Embase, PsycINFO, and grey literature sources for studies published between Jan 1, 1980, and Oct 23, 2025. We included data from cross-sectional or longitudinal surveys of women and girls assessing the prevalence of MDD during the peripartum period. MDD was defined with criteria from the DSM or ICD. Most studies included patients receiving perinatal care from hospitals with population-representative catchments. Preference was given to studies encompassing pregnancies of all gestational lengths; however, studies restricted to singleton or full-term births were included. Extracted prevalence data were non-identifiable and pre-aggregated from existing sources. Records generated in the electronic and grey literature searches were combined and titles, abstracts, and full texts were reviewed by AJF, PAM, JS, AMH, SMA, and PM. Their decisions and related disagreements were reviewed by senior authors (AJF and DFS). The meta-regression analysis quantified sources of measurement error within the available data and assessed the prevalence of MDD during the peripartum period and by location. We followed the PRISMA guidelines (PROSPERO ID CRD42022358108). Members of our authorship team have lived experience perspectives in mental disorders, but we did not consult individuals diagnosed with MDD during the peripartum period. FINDINGS: Of 31 812 potentially eligible studies, we screened the titles and abstracts of 25 616 studies, and included 1025 studies in the qualitative synthesis. We included 1505 prevalence datapoints from 780 studies eligible for stage two analysis, representing 2 018 198 women and girls from 90 countries and 19 world regions. Symptom scales identifying MDD symptoms overestimated its prevalence by between 71·3% (95% uncertainty interval [UI] 54·3-89·8) for the Edinburgh Postnatal Depression Scale in the postpartum period and 121·9% (91·7-156·8) for Patient Health Questionnaire during pregnancy, compared with diagnostic interview. MDD prevalence during the peripartum period was highest during the first 2 weeks postpartum (p<0·0001) and remained significantly elevated throughout the postpartum year (p<0·0001) compared with pregnancy. After adjusting for changes over the peripartum period and biases due to measurement error, the overall prevalence of MDD was 6·2% (95% UI 5·9-6·6) at any point in time during pregnancy and 6·8% (6·4-7·1) at any point in time during the postpartum year. Prevalence was highest in southern sub-Saharan Africa, ranging from 15·6% (12·7-19·1) during pregnancy to 16·6% (13·5-20·3) during the postpartum year; and south Asia, ranging from 13·7% (12·4-15·2) during pregnancy to 14·6% (13·1-16·1) during the postpartum year. The prevalence was lowest in high-income Asia Pacific, ranging from 3·1% (2·5-3·7) during pregnancy to 3·3% (2·8-3·9) during the postpartum year. INTERPRETATION: The prevalence of MDD was elevated during the entire peripartum period, and highest 2 weeks after giving birth. Our findings emphasise the need for increased integration of screening, prevention, and treatment of MDD during the peripartum period into existing models of care. FUNDING: Queensland Health, The University of Queensland, and Gates Foundation.