Risk factors of postpartum depression and depressive symptoms: umbrella review of current evidence from systematic reviews and meta-analyses of observational studies
Br J Psychiatry. 2022 Jan 27;1-12. doi: 10.1192/bjp.2021.222 PDF costs $35
Chiara Gastaldon 1, Marco Solmi 2, Christoph U Correll 3, Corrado Barbui 4, Georgios Schoretsanitis 5
Background: Evidence on risk factors for postpartum depression (PPD) are fragmented and inconsistent.
Aims: To assess the strength and credibility of evidence on risk factors of PPD, ranking them based on the umbrella review methodology.
Method: Databases were searched until 1 December 2020, for systematic reviews and meta-analyses of observational studies. Two reviewers assessed quality, credibility of associations according to umbrella review criteria (URC) and evidence certainty according to Grading of Recommendations-Assessment-Development-Evaluations criteria.
Results: Including 185 observational studies (n = 3 272 093) from 11 systematic reviews, the association between premenstrual syndrome and PPD was the strongest (highly suggestive: odds ratio 2.20, 95%CI 1.81-2.68), followed by violent experiences (highly suggestive: odds ratio (OR) = 2.07, 95%CI 1.70-2.50) and unintended pregnancy (highly suggestive: OR=1.53, 95%CI 1.35-1.75).
Following URC, the association was suggestive for
- Caesarean section (OR = 1.29, 95%CI 1.17-1.43),
- gestational diabetes (OR = 1.60, 95%CI 1.25-2.06) and
- 5-HTTPRL polymorphism (OR = 0.70, 95%CI 0.57-0.86); and
- preterm delivery (OR = 2.12, 95%CI 1.43-3.14),
- anaemia during pregnancy (OR = 1.47, 95%CI 1.17-1.84),
- vitamin D deficiency (OR = 3.67, 95%CI 1.72-7.85) and
- postpartum anaemia (OR = 1.75, 95%CI 1.18-2.60).
No significant associations were found for medically assisted conception and intra-labour epidural analgesia. No association was rated as 'convincing evidence'. According to GRADE, the certainty of the evidence was low for Caesarean section, preterm delivery, 5-HTTLPR polymorphism and anaemia during pregnancy, and 'very low' for remaining factors.
Conclusions: The most robust risk factors of PDD were premenstrual syndrome, violent experiences and unintended pregnancy. These results should be integrated in clinical algorithms to assess the risk of PPD.
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- Postpartum Depression 3.3 X more likely if low vitamin D – Oct 2018
- Vitamin D prevents pregnancy depression (US Prevention Task Force say it cannot be prevented) - Feb 2019
- Depressed black pregnant women should take vitamin D – April 2018
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- Perinatal depression decreased 40 percent with just a few weeks of 2,000 IU of vitamin D – RCT Aug 2016
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- Depression in youths associated with low vitamin D during pregnancy – Oct 2014
- Postpartum depression 7X more likely if less than 10 ng of vitamin D – Sept 2014
- Depression after pregnancy and vitamin D – Nov 2013
- Depression and Vitamin D during Pregnancy – Dissertation Aug 2014
- Depression during pregnancy twice as likely if consume little vitamin D – July 2014
- Antidepressants might increase infertility and pregnancy problems – Nov 2012
- Association between season of birth and suicide – perhaps vitamin D – Sept 2012
- Depression 50 percent more likely if low vitamin D in early pregnancy – Aug 2012
- Pregnant blacks 50 pcnt more likely to be depressed if 3 ng less vitamin D – July 2012
- Depressed mothers more likely to have small babies – Aug 2010
- An Exploratory Study of Postpartum Depression and Vitamin D - May 2010