Exposure to Maternal Genitourinary Infections during Pregnancy and Risk for Offspring Mental Disorders: A Systematic Review

Abstract

Background: While genitourinary infections (GUI) are the most common infections during pregnancy, the evidence surrounding their association with mental disorders in offspring is inconsistent and limited. We aimed to systematically assess the results of previous studies that examined the associations between GUI exposure during pregnancy and risk of mental disorders in the offspring. Method: We conducted a systematic review following Preferred Reporting Items of Systematic Reviews and Meta-analyses (PRISMA) guideline for studies published by September 2025. The review included longitudinal observational studies published in English in peer-reviewed journals, with documented maternal GUI during pregnancy as exposure and mental disorders with standard diagnosis as an outcome. A comprehensive literature search was conducted in five electronic databases followed by a two-step screening process performed by two independent reviewers. Data was extracted and summarized as a narrative of grouped studies. Methodological quality of included studies was assessed using Joanna Briggs Institute’s (JBI) critical appraisal checklist for cohort and case control studies. Results: Of the 5662 studies from the literature search, 30 were included in the review. The studies had 11 types of infections and 6 different mental disorders. The most assessed mental disorder was autism spectrum disorder (ASD), and the most assessed infection was urinary tract infection (UTI). The findings showed significant association between GUI exposure during pregnancy and disorders such as ASD, attention deficit hyperactivity disorder (ADHD) or intellectual disability (ID). Majority of the studies reported lack of significant association with schizophrenia, mood disorders and other psychotic disorders. Findings regarding the effect of timing and severity of infections remain inconclusive. Conclusion: The results support existing evidence on the impact of prenatal infections on mental disorders, especially ASD, ADHD and ID. The review highlights the importance of routine screening, prevention and early treatment of GUI during pregnancy. Future studies should focus on identifying the relation with other mental disorders, and the impact of timing and severity of infections.