Studies have reported conflicting findings on the association between maternal pre- and perinatal depression and autism spectrum disorder (ASD) in offspring.

To examine and consolidate the existing evidence on the association between maternal pre- and perinatal depression and the risk of ASD in children and adolescents.

In this systematic review and meta-analysis, we searched PubMed, Medline, EMBASE, Scopus, CINAHL and PsycINFO from the database inception to 21 February 2024. A meta-analysis was performed using random-effect models, and summary effect estimates were presented as odds ratios with 95% confidence intervals. Heterogeneity was assessed with Cochran’s Q and the I2-statistic test. Additionally, subgroup analysis was conducted to identify the source of potential heterogeneity within the included studies. A funnel plot and Egger’s regression test were employed to evaluate publication bias.

Twelve studies involving over 1.6 million mother–offspring pairs were included in the final analysis. A random-effects meta-analysis of these studies revealed a 52% increased risk (odds ratio 1.52, 95% CI 1.13–1.90) of ASD in the offspring of mothers experiencing pre-pregnancy depression, a 48% increased risk (odds ratio 1.48, 95% CI 1.32–1.64) in those experiencing antenatal depression and a 70% increased risk (odds ratio 1.70, 95% CI 1.41–1.99) in those with postnatal depression.

This systematic review and meta-analysis found that offspring born to mothers with depression before, during and after birth have a higher risk of developing ASD. Our findings underscore the need for early screening and targeted intervention programmes for at-risk children.