Objective To systematically review the intervention effect of cognitive-behavioral therapy on postpartum depression in pregnant and postpartum women. Methods The PubMed, Embase, Cochrane Library, Web of Science, CNKI, WanFang Data, and VIP databases were electronically searched to collect randomized controlled trials (RCTs) on the intervention effect of cognitive-behavioral therapy on postpartum depression in pregnant women from database inception to December 2024. Two reviewers independently screened the literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was then performed using RevMan 5.4 software. Results A total of 9 RCTs involving 7 154 participants were included. The meta-analysis results showed that cognitive-behavioral therapy can reduce postpartum depression (SMD=?0.57, 95%CI ?0.87 to ?0.27, P<0.001) and anxiety (MD=?2.04, 95%CI ?3.57 to ?0.52, P=0.008) in pregnant women with depression, but the preventive effect of prenatal intervention on postpartum depression symptoms was not significant. Conclusion Cognitive-behavioral therapy may help improve the negative emotions of pre depression and anxiety in pregnant women with depression, but the preventive effect of prenatal cognitive-behavioral therapy intervention on postpartum depression symptoms is not yet clear.