Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
College of Medicine and Public Health, Flinders University, Health Sciences Building, Sturt Road, Bedford Park, Adelaide, SA, 5001, Australia.
BMC Pregnancy Childbirth. 2020 Jul 22;20(1):416. doi: 10.1186/s12884-020-03092-7.
Postnatal Depression (PND) is a mood disorder that steals motherhood and affects the health and development of a newborn. While the impact of PND on motherhood and newborn in developed countries are well described, its epidemiology and health consequences in infant is not well known in middle-and low-income countries. The objective of this review was to determine the burden and association of PND with adverse infant health outcomes in low-and middle- income countries.
We searched observational studies written in the English language and conducted in middle-and low-income countries between December 1st, 2007, and December 31st, 2017. The CINHAL, MEDLINE, Emcare, PubMed, Psych Info, and Scopus databases were searched for the following search terms: PND, acute respiratory infection, pneumonia, diarrhea, exclusive breastfeeding, common infant illnesses, and malnutrition. We excluded studies in which the primary outcomes were not measured following a standardized approach. We have meta-analyzed the estimates from primary studies by adjusting for possible publication bias and heterogeneity. The analysis was conducted in Stata 14. The study was registered in PROSPERO protocol number CRD42017082624.
Fifty-eight studies on PND prevalence (among 63,293 women) and 17 studies (among 32,454 infants) on infant health outcomes were included. PND prevalence was higher in the low-income countries (Pooled prevalence (PP) = 25.8%; 95%CI: 17.9-33.8%) than in the middle-income countries (PP = 20.8%; 95%CI: 18.4-23.1%) and reached its peak in five to ten weeks after birth. Poor obstetric history and social support, low economic and educational status, and history of exposure to violence were associated with an increased risk of PND. The risk of having adverse infant health outcomes was 31% higher among depressed compared to non-depressed postnatal mothers (Pooled relative risk (PRR) = 1.31; 95%CI: 1.17-1.48). Malnutrition (1.39; 1.21-1.61), non-exclusive breastfeeding (1.55; 1.39-1.74), and common infant illnesses (2.55; 1.41-4.61) were the main adverse health outcomes identified.
One in four and one in five postnatal mothers were depressed in low and middle-income countries, respectively. Causes of depression could be explained by social, maternal, and psychological constructs. High risk of adverse infant health outcomes was associated with PND. Timely screening of PND and evidence-based interventions were a pressing need in low and middle-income countries.
产后抑郁症（PND）是一种偷走母亲身份并影响新生儿健康和发育的情绪障碍。尽管发达国家对 PND 对母亲和新生儿的影响已有详细描述，但中低收入国家对其在婴儿中的流行病学和健康后果尚不清楚。本综述的目的是确定中低收入国家 PND 与不良婴儿健康结果之间的负担和关联。
我们检索了 2007 年 12 月 1 日至 2017 年 12 月 31 日期间以英文发表并在中低收入国家进行的观察性研究。我们使用以下搜索词在 CINHAL、MEDLINE、Emcare、PubMed、Psych Info 和 Scopus 数据库中进行了检索：PND、急性呼吸道感染、肺炎、腹泻、纯母乳喂养、常见婴儿疾病和营养不良。我们排除了主要结局未采用标准化方法测量的研究。我们通过调整可能的发表偏倚和异质性，对主要研究的估计值进行了荟萃分析。分析在 Stata 14 中进行。该研究已在 PROSPERO 方案中注册，编号为 CRD42017082624。
共有 58 项关于 PND 患病率（63293 名妇女中）和 17 项关于婴儿健康结果（32454 名婴儿中）的研究被纳入。低收入国家的 PND 患病率较高（汇总患病率（PP）=25.8%；95%CI：17.9-33.8%），高于中等收入国家（PP=20.8%；95%CI：18.4-23.1%），并在产后 5 至 10 周达到峰值。不良产科史和社会支持、经济和教育地位低下以及遭受暴力的经历与 PND 风险增加有关。与非抑郁产后母亲相比，抑郁产后母亲发生不良婴儿健康结局的风险增加 31%（汇总相对风险（PRR）=1.31；95%CI：1.17-1.48）。营养不良（1.39；1.21-1.61）、非纯母乳喂养（1.55；1.39-1.74）和常见婴儿疾病（2.55；1.41-4.61）是确定的主要不良健康结局。
在中低收入国家，每四名和五名产后母亲中就有一名患有产后抑郁症。抑郁的原因可以用社会、产妇和心理结构来解释。PND 与不良婴儿健康结局的高风险相关。在中低收入国家，迫切需要及时筛查 PND 并实施基于证据的干预措施。
