Perinatal depression, maternal thyroid status and fetus/infant health and development: a systematic review

Background
Thyroid hormones are known to influence both maternal depression and child developmental outcomes, while maternal depression independently affects child outcomes. The potential interaction between thyroid dysfunction and depression in shaping child development remains insufficiently explored. The present study addresses such interplay.
Methods
Following PRISMA 2020 and JBI guidelines, three databases were searched through December 2025 for primary studies on maternal thyroid status, perinatal depression, and child development. Risk of bias (RoB) was assessed using validated tools. Due to clinical and methodological heterogeneity, data were synthesized narratively following SWiM guidelines.
Results
Eleven studies were included. Beyond independent risks for preterm birth and behavioral problems, limited evidence supports a synergistic model, while most studies likely reflect the simple co-occurrence of risks. Maternal thyroid peroxidase antibodies (TPO-Ab) were associated with child externalizing problems exclusively in the presence of clinical depression. High depressive symptoms also attenuated the cognitive benefits of prenatal iodine supplementation. Thyroid status appears to function as a risk moderator rather than a mediator. However, 50% of observational studies presented high RoB, primarily due to participant attrition.
Conclusion
Findings are still scarce to support a synergistic risk model where specific maternal thyroid parameters (i.e. thyroid autoimmunity and iodine status) may moderate the impact of depressive symptoms on child development. Despite the high RoB in half of the studies, results highlight the need for integrated screening protocols. Simultaneously assessing mental health and thyroid status may optimize risk stratification for high-risk mother-infant dyads.
This study was conducted at the Psychology Research Centre (CIPsi; PSI/01662), School of Psychology, University of Minho, and was supported by the Portuguese Foundation for Science and Technology (FCT; UID/01662/2025) through the Portuguese State Budget. The Centre is registered under the DOI: https://doi.org/10.54499/UID/01662/2025. C.S.C. was funded by a Doctoral research grant from the Portuguese Foundation for Science and Technology (FCT), grant number 2023.03367.BD.