Prenatal Exposure to Nicotine and Postpartum Depression: A Systematic Review and Meta-Analysis

Authors

• Reem Sharaf-Alddin, Macon & Joan Brock Virginia Health Sciences at Old Dominion UniversityFollow
• May Salama, Macon & Joan Brock Virginia Health Sciences at Old Dominion UniversityFollow
• Denise McKinney, Macon & Joan Brock Virginia Health Sciences at Old Dominion UniversityFollow
• George Saade, Macon & Joan Brock Virginia Health Sciences at Old Dominion UniversityFollow
• Qi Zhang, Macon & Joan Brock Virginia Health Sciences at Old Dominion UniversityFollow

ORCID

0000-0002-2297-9235 (Sharaf-Alddin), 0000-0002-1637-407X (Salama), 0000-0001-6324-9856 (McKinney)

Document Type

Article

Publication Date

2026

DOI

10.1007/s00737-026-01739-6

Publication Title

Archives of Women's Mental Health

Volume

29

Issue

4

Pages

102

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]; I² = 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.

Rights

© 2026 The Authors.

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Data Availability

Article states: "No datasets were generated or analysed during the current study."

Original Publication Citation

Sharaf-Alddin, R., Salama, M., McKinney, D., Saade, G., & Zhang, Q. (2026). Prenatal exposure to nicotine and postpartum depression: A systematic review and meta-analysis. Archives of Womens Mental Health, 29(4), Article 102. https://doi.org/10.1007/s00737-026-01739-6

Repository Citation

Sharaf-Alddin, R., Salama, M., McKinney, D., Saade, G., & Zhang, Q. (2026). Prenatal exposure to nicotine and postpartum depression: A systematic review and meta-analysis. Archives of Womens Mental Health, 29(4), Article 102. https://doi.org/10.1007/s00737-026-01739-6