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

To explore the dose-response associations of physical activity (PA) during pregnancy with antenatal depression (AD) and postpartum depression (PPD).

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.

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.

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.