Researchers have reported anxiety, depression, hypertension, obsessive-compulsive disorder (OCD), and hemorrhage as the most frequent complications in the first year postpartum, publishing their findings in the American Journal of Obstetrics & Gynecology.1
Over half of pregnancy-related mortalities among US patients occur within the first year postpartum, and 15% of severe maternal morbidity cases occur after hospital discharge. These complications have been linked to significant adverse effects on quality of life.
Key takeaways:
- Over half of pregnancy-related deaths occur within the first year after birth, highlighting the need for ongoing postpartum care.
- Anxiety, depression, hypertension, OCD, and hemorrhage were the most common conditions identified.
- The review analyzed 117 studies covering more than 240 million patients across the United States and Canada.
- Postpartum depression was the most widely studied psychosocial complication, followed by anxiety.
- Researchers emphasized the need for consistent diagnostic criteria and long-term follow-up to better track and manage postpartum complications.
“Despite the major public health burden posed by postpartum complications, there is a lack of synthesis of contemporary data on their incidence and prevalence in the United States and Canada,” wrote investigators.
Study eligibility and screening criteria
The systematic review and meta-analysis was conducted to assess the frequency and timing of complications and mortality in the first year postpartum. Articles were identified through systematic searches of the Medline, PubMed, EBSCO CINAHL, Web of Science, and Cochrane databases.
Studies published in the United States or Canada between January 1, 2010, and December 31, 2024, about the frequency and timing of complications in adults from hospital delivery to 1 year postpartum were eligible. Those not meeting the minimum critical appraisal criteria, not reporting the timing of complications, or only examining patients with a specific medical condition were excluded.
Two independent reviewers screened full texts following title and abstract screening performed using the Covidence tool. Valid methods for identifying conditions and standard measurement of conditions were necessary for inclusion.
Data was extracted in a standardized Microsoft Excel document, with discrepancies resolved by discussion or by a third reviewer. Articles with patients aged under 18 years only had data about those aged 18 years and older extracted.
Types and frequency of postpartum complications
There were 117 studies included in the final analysis, 24 of which were reviews and 93 were original investigations. Of the latter, 75% were conducted in the United States and 25% were conducted in Canada. A total sample size of 246,521,464 patients was reported, with a median of 6030 per study.
Forty-one distinct complications were identified, 16 of which were medical, 13 procedural, and 12 psychosocial. Mortality was also reported, with categories including all-cause, drug-related or suicide, venous thromboembolism-related vs not, and intensive care transfer or death. Cardiovascular complications were the most common, including:
- Acute myocardial infarction
- Heart failure
- Pulmonary edema
- Hypertension
- Peripartum cardiomyopathy
- Maternal cardiac arrest
Other medical complications included infections, sepsis, overactive bladder, respiratory depression, severe anemia, acute cerebrovascular disease, puerperal cerebrovascular disorders, venous thromboembolism, and severe maternal morbidity. One study reported hypertension within 1 week of delivery in 8% of patients without a preexisting diagnosis.
Procedural and psychosocial complications
Postpartum hemorrhage was the most common procedural complication reported, in 14 systematic reviews and all retrospective cohort studies. Of psychosocial conditions, postpartum depression was examined in 31 studies, making it the most common. This was followed by anxiety in 11 studies.
Consistent methods of measurement were not reported for postpartum anxiety or posttraumatic stress disorder, but postpartum depression was frequently assessed using the Edinburgh Postnatal Depression Scale. Varying frequencies were reported for certain complications depending on timing, such as 35.8% for intimate partner violence at 1-month postpartum vs 21.6% at 12 months.
All-cause mortality rates of 6.3 and 8.4 per 100,000 live births were reported between labor and hospital discharge. For venous thromboembolism, this rate was 0.69 per 100,000 live births. Overall, anxiety, depression, OCD, hypertension, and hemorrhage were the most common conditions.
“This study underscores the need for standardized diagnostic criteria and longitudinal follow-up for research of postpartum complications,” wrote investigators.
Crisis pregnancy center attendance trends
Alongside these conditions, pregnant patients have begun to visit crisis pregnancy centers (CPCs) more often, as discussed by Maria Gallo, PhD, professor at the University of North Carolina at Chapel Hill, in a recent interview with Contemporary OB/GYN.2 In a study conducted by Gallo, CPC attendance among adult US women ranged from 9% to 17%.
Gallo also noted that the impact of abortion restrictions on future CPC attendance is unclear. Additionally, misinformation is often shared in CPCs, harming patient knowledge of reproductive health.
“As a society, we should… not be pushing people into attending CPCs,” said Gallo. “People who are pregnant and who need health care should be going to a place that is a legitimate source of health care.”
