Mental health outcomes after severe pregnancy complications: a scoping review

Postpartum mental health issues such as postpartum depression, anxiety and psychosis currently affect up to 17% of women globally. Pregnancy complications including severe maternal morbidity, hypertensive disorders of pregnancy and obstetric hemorrhage can be traumatic events that lead to increased risk of postpartum mental illness. This scoping review synthesizes evidence on associations between maternal pregnancy complications including severe maternal morbidity, hypertensive disorders of pregnancy and obstetric hemorrhage comorbidly with peripartum mental health outcomes. Following PRISMA-ScR guidelines, we searched MEDLINE, Embase, PsycInfo, and CINAHL (inception–August 2025) for studies comparing mental health outcomes (depression, post-traumatic stress disorder, anxiety, psychosis, suicidality, substance use) in individuals with vs. without pregnancy complications. Random-effects meta-analyses were conducted where feasible (I²<80%). Of 4,188 records initially identified, 79 studies (68.1 million participants) were included in this review. Meta-analyses of up to six studies showed greater odds of postpartum depression following hypertensive disorders of pregnancy (OR = 1.72, 95% confidence interval 1.27–2.32) and obstetric hemorrhage (OR = 1.73, 95% confidence interval 1.27–2.39). Associations between composite severe maternal morbidity and depression were inconsistent. Evidence suggested possible associations between composite severe maternal morbidity and post-traumatic stress disorder, but findings varied across studies. Significant statistical heterogeneity and insufficient studies prevented meta-analyses of studies examining anxiety disorders, substance abuse, suicidality or psychosis, as well as depression and PTSD, in some cases. Hypertensive disorders of pregnancy and obstetric hemorrhage are associated with increased odds of postpartum depression, while composite severe maternal morbidity shows variable associations with perinatal mental illness. Harmonized outcome definitions and further comprehensive research designs that include the consideration of severe psychiatric outcomes are needed to better understand mental health after severe pregnancy complications.