Women’s Mental Health

Journal Article Annotations
2019, 3rd Quarter

Women’s Mental Health

Annotations by Camille Tastenhoye, MD
September 2019

  1. 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.


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.

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