Associations of physical activity during pregnancy with antenatal and postpartum depression: a systematic review and dose-response meta-analysis

OBJECTIVE: To explore the dose-response associations of physical activity (PA) during pregnancy with antenatal depression (AD) and postpartum depression (PPD). METHOD: Thirteen electronic databases were searched from inception to April 8, 2026 and additionally screened references manually. Interventional and longitudinal observational studies in pregnant populations were eligible if they reported dose-response associations for PA during pregnancy in relation to AD or PPD; cross-sectional studies were excluded. Linear and nonlinear dose-response meta-analyses were conducted. RESULTS: Twenty-three studies from 10 countries involving 122,847 participants were included, comprising 5 randomized clinical trials and 18 cohort studies. In the linear dose-response meta-analysis, each 300 MET-min/wk increase in PA was associated with a 6% lower risk of AD (RR, 0.94; 95% CI, 0.90-0.97), with substantial heterogeneity (I2 = 70.6%, P < 0.001). AD also showed a significant nonlinear dose-response relationship, with the lowest risk observed at approximately 1000-2000 MET-min/wk and no evident protective association above approximately 4000 MET-min/wk. PA during pregnancy was associated with a lower risk of depression in late pregnancy, whereas the overall associations with mid-pregnancy depression and PPD were not statistically significant. CONCLUSIONS: PA during pregnancy was associated with a lower risk of AD and showed a significant nonlinear dose-response relationship, with the lowest risk observed at approximately 1000 to 2000 MET-min/wk, whereas no significant overall association was observed with PPD.