Journal Article Annotations
2019, 3rd Quarter

Women’s Mental Health

Annotations by Camille Tastenhoye, MD
September 2019

Preterm birth as a risk factor for postpartum depression: A systematic review and meta-analysis.

PUBLICATION #1 — Women’s Mental Health

Preterm birth as a risk factor for postpartum depression: A systematic review and meta-analysis.

de Paula Eduardo JAF, de Rezende MG, Menezes PR, Del-Ben CM.

Abstract: J Affect Disord. 2019 Aug 21;259:392-403. doi: 10.1016/j.jad.2019.08.069. (Epub ahead of print)

BACKGROUND:
This systematic review aimed to critically analyze the studies that explored preterm birth as risk factor for postpartum depression in the last 10 years.

METHODS:
Two independent researchers performed a systematic review of indexed studies in PubMed/Medline, Web of Science and PsycInfo database. The PRISMA for reporting systematic review model was used to conduct data extraction. A meta-analysis was performed including a sub-group of studies.

RESULTS:
The final sample consisted of 26 studies and 12 were included in the meta-analysis. Most of the studies supported the association between preterm birth (PTB) and postpartum depression (PPD). However, 8 studies did not find such association and, even among studies with positive findings, results were heterogeneous, given the methodological discrepancies among the studies. The meta-analysis provided evidence of higher risk for PPD among mothers of preterm infants in assessments performed up to 24 weeks after childbirth.

LIMITATIONS:
Most of the studies did not consider the role of important confounding variables, such as previous history of depression. Heterogeneity of assessment tools and cut-off scores were also considered a limitation.

CONCLUSIONS:
Further prospective population-based studies with an integrative approach of PPD are needed to provide consistent evidence of such association. Important confounding variables and biological measures implicated in PPD should be considered. Our findings highlight the importance of maternal mental health care in this target population, as preterm birth experience seem to affect both babies and mothers. We encourage PPD assessment for mothers of preterm infants, especially in the early postpartum period.

KEYWORDS:
Postpartum depression; Preterm birth; Risk factor

PMID: 31470184

DOI: 10.1016/j.jad.2019.08.069

Annotation

The finding:
This is a systematic review/meta-analysis aimed at determining whether there is an association between pre-term birth (<37 weeks) and the development of post-partum depression. 844 studies were originally located using their search terms; 26 studies met inclusion criteria and were included in the systematic review, with the 12 studies using the Edinburgh Postpartum Depression Scale as their assessment tool further included in the meta-analysis. These studies found some evidence of increased risk of post-partum depression in mothers who experience pre-term births, however among the 26 studies included in the systematic review there was significant heterogeneity in regards to both methods and results. Eighteen of the studies found increased risk of post-partum depression, with rates reported between 6.6%-42.9% (OR 1.20-18.4). The studies differed with regards to population studied (77.8% of studies using convenience samples found significant association), assessment time points (studies evaluating mother’s closer to child birth were more likely to report an association), and assessment tools (diagnostic interviews vs. self-report tools). Not all of the studies controlled for other confounding variables (13 of the 26), and among those that did, only five controlled for history of depression, and seven studies excluded women with a past or current history of depression. 12 studies were included in the meta-analysis (those that used EPDS as their assessment scale). The results of the meta-analysis largely reflected that of the systematic review, with highest risk of PPD found in the first six weeks after pre-term birth. Studies differed in cut-off values and assessment time-points.

Strength and weaknesses:
A large sample size (n=26 studies evaluating some 2,470,000 women overall) for the systematic review was off set by a smaller sample size for the meta-analysis (n=12). Many of the studies did not control for confounding variables (past history of depression). Heterogeneity of methods and assessment tools led to the limitation of studies included in the meta-analysis and made it difficult to obtain consistent data.

Relevance:
Pre-term birth is commonly presumed to be a risk factor for the development of post-partum depression and is often used by CL psychiatrists as part of their formulation when assessing new mothers. Many of the studies in this body of literature appear to corroborate this association, with the strongest association found in studies that screened mothers early. This effect existed even when controlling for personal history of depression and other confounding variables. The early post-natal period therefore remains a critical time in which to evaluate new mothers, particularly those who have a personal or family history of depression.

Type of study: Systematic review/ meta-analysis