WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Italy; and Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, New York, USA.
Department of Neuroscience, University of Padua, Italy; and Padua Neuroscience Center, University of Padua, Italy.
Br J Psychiatry. 2022 Oct;221(4):591-602. doi: 10.1192/bjp.2021.222.
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 ( = 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 weak for 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.
背景:产后抑郁症(PPD)的风险因素证据零散且不一致。
目的:根据伞式审查方法评估 PPD 风险因素的证据强度和可信度,并对其进行排名。
方法:截至 2020 年 12 月 1 日,检索数据库以获取观察性研究的系统评价和荟萃分析。两名审查员根据伞式审查标准(URC)评估质量和关联可信度,并根据推荐评估发展评估分级标准评估证据确定性。
结果:纳入 11 项系统评价中的 185 项观察性研究(=3272093 人),经分析显示经前期综合征与 PPD 之间的关联最强(高度提示:比值比 2.20,95%置信区间 1.81-2.68),其次是暴力经历(高度提示:比值比(OR)=2.07,95%置信区间 1.70-2.50)和意外怀孕(高度提示:OR=1.53,95%置信区间 1.35-1.75)。根据 URC,剖宫产(OR=1.29,95%置信区间 1.17-1.43)、妊娠糖尿病(OR=1.60,95%置信区间 1.25-2.06)和 5-羟色胺转运体启动子区多态性(OR=0.70,95%置信区间 0.57-0.86)的关联具有提示性;而早产(OR=2.12,95%置信区间 1.43-3.14)、妊娠期间贫血(OR=1.47,95%置信区间 1.17-1.84)、维生素 D 缺乏(OR=3.67,95%置信区间 1.72-7.85)和产后贫血(OR=1.75,95%置信区间 1.18-2.60)的关联较弱。未发现医源性受孕和分娩时硬膜外镇痛与 PPD 之间存在显著关联。没有关联被评为“令人信服的证据”。根据 GRADE,剖宫产、早产、5-羟色胺转运体启动子区多态性和妊娠期间贫血的证据确定性为低,其余因素的证据确定性为“非常低”。
结论:PPD 最有力的风险因素是经前期综合征、暴力经历和意外怀孕。这些结果应纳入临床算法以评估 PPD 的风险。
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