The prevalence of depressive symptoms in surrogate mothers following child relinquishment: a systematic review and meta-analysis.

BACKGROUND

Surrogacy is a common assisted reproductive practice, yet its psychological impact on surrogate mothers remains a topic of concern. Understanding the prevalence of depressive symptoms among surrogate mothers is crucial for ensuring adequate mental health support. This systematic review and meta-analysis aimed to assess the prevalence of depressive symptoms among surrogate mothers.

METHODS

A comprehensive literature search was conducted across PubMed, Web of Science, Scopus, and Embase for studies published between 1 January 1990 and 31 December 2025. Reference lists of eligible articles were also screened. Studies examining rates of depressive symptoms in surrogate mothers within 1 year postpartum were included in the meta-analysis. A random-effects model was employed to estimate the pooled prevalence of depressive symptoms.

RESULTS

Eleven studies encompassing 637 surrogate mothers met the inclusion criteria, with six studies qualifying for meta-analysis. The pooled prevalence of depressive symptoms was 3% (95% CI: 0-16%). Subgroup analyses revealed a higher prevalence in India (27.3%) compared to studies from the UK and USA (0%). Additionally, studies with a low risk of bias reported a higher prevalence (9%) than those with a moderate risk (0%). No significant publication bias was detected.

CONCLUSIONS

The overall prevalence of depressive symptoms among surrogate mothers following child relinquishment appears low; however, these findings should be interpreted cautiously and considered exploratory in light of the limited underlying evidence. Further well-designed studies are needed to clarify contextual factors influencing mental health outcomes in surrogacy.