Association between suicidal behaviour in pregnant women and pregnancy and fetal outcomes: A systematic review and meta-analysis.

PURPOSE: Suicidal behavior during pregnancy, including ideation, planning, and attempts, represents a significant but under-researched public health concern linked to adverse maternal and fetal outcomes such as preterm labor, low birth weight, and stillbirth. This systematic review and meta-analysis (SRMA) aimed to synthesize evidence on the association between suicidal behavior during pregnancy and feto-maternal outcomes, addressing existing gaps in the literature.

MATERIALS AND

METHODS

The SRMA, following PRISMA 2020 guidelines, included observational studies that reported maternal and fetal outcomes among pregnant women exhibiting suicidal behaviour (suicidal ideation, planning, or attempts). Four databases (PubMed, Embase, Web of Science, and Cochrane) were searched up to April 30, 2025, and 18 studies were included. Risk of bias assessment was done using the Newcastle-Ottawa scale. Data were analysed using random-effects models to calculate pooled relative risks (RRs) and 95% confidence intervals (CIs).

RESULTS

From the 18 studies included for the SRMA, a total of 30749705 participants were analysed, with 6557 in the suicidal behaviour group. Suicidal behaviour significantly increased the risk of preterm labor (RR = 1.78, 95% CI: 1.7-1.86), preterm birth (RR = 1.40, 95% CI: 1.26-1.55), fetal anomaly (RR = 1.84, 95% CI: 1.22-2.77) and Low Birth Weight (RR = 1.83, 95% CI: 1.67-2.02), with no heterogeneity observed (I² = 0%). Stillbirth risk was markedly elevated (RR = 11.92, 95% CI: 10.32-13.77). Other outcomes, such as placental abruption and postpartum hemorrhage, also demonstrated increased risks. All the outcomes had a low to very low certainty of evidence.

CONCLUSION

Suicidal behaviour during pregnancy poses significant risks to maternal and fetal health, emphasizing the need for early identification and interventions. Addressing maternal mental health must be prioritized in prenatal care to improve outcomes for both mother and child. Others: The protocol was registered in the PROSPERO (ID: CRD42024539860).