Association of postpartum depression and cesarean section: A systematic review and meta-analysis

Abstract Objectives Postpartum depression (PPD) is a major depressive disorder. Its symptoms begin 4 weeks after delivery. Several studies have evaluated the association of the type of delivery with PPD; however, there are controversies regarding this association. Therefore, the aim of this systematic review was to estimate the overall association between cesarean section (CS) and PPD. Methods The international databases of Medline, Scopus, Web of Science, Science Direct, EMBASE and Ovid were searched until May 2017. Quality assessment was done using the Newcastle-Ottawa Scale. The pooled odds ratio in case-control and relative risk in cohort studies were used as the measures of association. A random-effects model was applied for the report of the results with 95% confidence intervals. Results Of 989 studies, 32 articles met the eligibility criteria and were included in the review. The adjusted OR of the association between CS and PPD was 1.15 (95% CI: 1.00, 1.34) and the crude odds ratio of this association was 1.36 (1.20, 1.55). The odds ratio of the association of elective and emergency CS and PPD was 1.29 (1.12, 1.49) and 1.36 (1.20, 1.55), respectively. In addition, the pooled relative risk of the association between CS and PPD was 1.22 (0.94, 1.58) in cohort studies. Conclusions Based on the results of this meta-analysis, it seems CS, regardless of the type of cesarean, is a risk factor for PPD.