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.
Evidence on risk factors for postpartum depression (PPD) are fragmented and inconsistent.
To assess the strength and credibility of evidence on risk factors of PPD, ranking them based on the umbrella review methodology.
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.
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.
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.
产后抑郁症（PPD）的风险因素证据零散且不一致。
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。
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。
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”。
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。
