Prenatal exposure to nicotine and postpartum depression: a systematic review and meta-analysis

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Abstract
Purpose: Postpartum Depression (PPD) is the most common mental health complication of childbirth, and has short-term and long-term consequences for mother, child, and the entire family. PPD is a function of several factors. Prenatal exposure to nicotine (PEN) by Active Tobacco Smoking (ATS), Secondhand Smoking (SHS), or Electronic Nicotine Products (ENPs) is a major potential risk factor. This systematic review and meta-analysis aim to summarize and evaluate all evidence regarding the association between PEN and PPD. Methods: We searched the following databases, PubMed, Medline, Cochrane, EMBASE, and CINHAL, for studies published between Jan.1st ,2000&Sep.19th ,2024, with the outcome PPD. Studies quality was assessed using the Newcastle–Ottawa Scale. Pooled Prevalence (PP) was calculated using the Freeman-Tukey Double Arcsine Transformation method. Pooled Odds Ratio (pooled-OR) was estimated using a random-effects model. Sensitivity analysis was conducted using the leave-one-out technique. Results: Of 29 studies in the systematic review, 26 included in the meta-analysis. PP of PPD was 0.15,(95% CI[0.12–0.17]; I 2 = 99.80%, p < 0.001). Pooled-OR for ATS 1.96,(95%CI[1.59–2.41]; Z = 6.46, p < 0.001), 1.22,(95%CI[0.69–2.18], Z = 0.69, p = 0.49) for SHS, and 1.14,(95%CI[0.82–1.58,Z = 0.78, p = 0.43) for ENPs. While the overall Pooled-OR for all PEN was 1.74,(95%CI[1.44–2.12]; Z = 5.59, p < 0.001), funnel plots and Egger test showed no evidence of publication bias. Sensitivity analysis confirmed the robustness of the findings. Conclusion: This meta-analysis reveals that the accumulated evidence shows a significant association between prenatal PEN and PPD; though this final finding should be interpreted cautiously due to the high heterogeneity. Therefore, the exposure-stratified estimates represent the principal findings of this meta-analysis. The findings indicates a significant association between prenatal ATS and PPD, but no clear conclusion could be drawn about prenatal SHS or ENPs use due to the limited number of studies. There is a need for future studies that prospectively assess the impact of SHS and ENP on PPD.

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