• Aust N Z J Psychiatry · Jun 2021

    Meta Analysis

    Association between mode of delivery and postpartum depression: A systematic review and network meta-analysis.

    Both elective (OR 1.47, 1.16-1.86) and emergency (OR 1.53, 1.22-1.91) caesarean section is associated with mild postpartum depression in this network meta-analysis.

    pearl
    • Lei Sun, Su Wang, and Xi-Qian Li.
    • Department of Psychology, School of Philosophy and Sociology, Jilin University, Jilin, China.
    • Aust N Z J Psychiatry. 2021 Jun 1; 55 (6): 588-601.

    BackgroundPostpartum depression is one of the most common postpartum diseases, which has an important impact on the interaction between mother, infant, partner and family, as well as the long-term emotional and cognitive development of infants. However, there are still great disagreements on whether the delivery mode will affect the risk of postpartum depression. The purpose of this study is to explore whether the mode of delivery will affect the risk of postpartum depression through the comprehensive network meta-analysis of elective cesarean section, emergency cesarean section, instrumental vaginal delivery and spontaneous vaginal delivery.MethodsWe searched in three electronic databases: PubMed, EMBASE and Cochrane Library.ResultsThis paper included 43 studies with a total sample size of 1,827,456 participants. Direct meta-analysis showed that the odds ratio of postpartum depression risk was 1.33 (95% confidence interval = [1.21, 1.46]) between cesarean section and vaginal delivery. The odds ratios of high Edinburgh Postpartum Depression Scale score between cesarean section and vaginal delivery in the three postpartum periods (within 2 weeks, within half a year and over half a year) were basically the same. There was no difference between cesarean section and vaginal delivery in the risk of severe postpartum depression at the Edinburgh Postpartum Depression Scale cut-off point ⩾13 (odds ratio = 1.07; 95% confidence interval = [0.99, 1.16]). Network meta-analysis showed that the risk of postpartum depression in the pairwise comparisons emergency cesarean section vs spontaneous vaginal delivery and elective cesarean section vs spontaneous vaginal delivery was odds ratio = 1.53 (95% confidence interval = [1.22, 1.91]) and 1.47 (95% confidence interval = [1.16, 1.86]).ConclusionThe mode of delivery has a significant effect on the occurrence of mild postpartum depression. Women who give birth by cesarean section, especially who give birth by emergency cesarean section, are at a higher risk of mild postpartum depression. We should carefully monitor the progress of postpartum mental disorders in women who delivered by cesarean section and make it possible for women to have a quick access to mental healthcare.

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    Notes

    pearl
    1

    Both elective (OR 1.47, 1.16-1.86) and emergency (OR 1.53, 1.22-1.91) caesarean section is associated with mild postpartum depression in this network meta-analysis.

    Daniel Jolley  Daniel Jolley
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    0

    Unfortunate wording in the conclusion here, implying causation where in fact there is no evidence of such. Delivery mode does not have a significant effect – it is rather significantly associated with PPD.

    The mode of delivery has a significant effect on the occurrence of mild postpartum depression.

    It's unfortunate that the authors and editors were not more careful with their wording in a very emotionally-charged and controversial area.

    Daniel Jolley  Daniel Jolley
     
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