Background
Methods
Overview of a systematic review of reviews
Search strategy and inclusion criteria for systematic reviews
Outcome measures
Example of search strategy for antenatal depression in PsycINFO via Ovid
Inclusion
Exclusion
Risk of bias and data extraction
Strategy for data synthesis
Results
Search
Antenatal depression prevalence and associated factors
Characteristics of included reviews
Review | Geographic coverage of the review | Prominent tools used | Data base searched | Number of primary studies | Number of participants | Quality assessment | Main findings relevant to the review | AMSTAR score | |
---|---|---|---|---|---|---|---|---|---|
Antenatal depression Prevalence | Risk factors | ||||||||
Biaggie, 2016 From 2003 to 2015 | Developed countries | Not reported | PubMed, Psych INFO, Cochrane Library | 97 | 1,541,303 | Not assessed | Not reported | - Lack of partner or social support (in 13 studies); - History of abuse or domestic violence (in 6 studies); - Personal history of mental illness (in 7 studies); - Un-planned or unwanted pregnancy (in 4 studies); - Adverse events in life and high perceived stress (in 3 studies); - Present or past pregnancy complications or loss (in 3 studies) | 5 |
Gelaye et al., 2016 From 1998 to 2015 | Low and middle-income countries | EPDS (22 studies) | PubMed, Embase, CINAHL, BIOSIS Online | 51 | 48,904 | Not assessed quality of the primary studies | 25.3% (95% CI 21.4–29.6%) | - Early life abuse (child maltreatment, a severe early life stressor, includes all forms of physical, sexual and psychological maltreatment that pose harm to a child’s health, development or dignity) in 2 studies - Adult abuse (intimate partner violence (IPV), encompassing physical, psychological and sexual abuse in five studies - Maternal low educational attainment in two studies - Maternal current low economic status in three studies - Lack of social support in one study - History of mental illness in one study | 7 |
Halim et al. 2017 From 1990 to 2017 | Low and Lower middle-income countries | EPDS in ten studies | PubMed, Web of Science, Scopus, Psyc Info, Applied Social Science Index and Abstracts (ASSIA) | 24 | 13,490 | Quality assessed but not used standard criteria | 15—65% | - Intimate partner violence during pregnancy in 24 studies | 7 |
Mitchel et al. 2017 From 1980 to 2015 | Developed countries | BDI in six studies | PubMed, MEDLINE, Embase and PsychINFO | 12 | 4751 | NOS criteria | Not reported | - Hyperemesis gravidarum in 12 studies | 7 |
Roomruangwong C et al. 2011 From 1968 to 2010 | Asian countries | BDI in six studies | MEDLINE (PubMed), PsychINFO and SCOPUS | 25 | 9126 | Not assessed the quality of primary studies | 20% | - Having a history of premenstrual symptoms (in 3 studies) - Poor marital relationship (in 3 studies) - Unplanned/unwanted pregnancy especially, during premarital period (in 8 studies) - Poor obstetric history (complication before or in current pregnancy) in five studies - Financial difficulties (in 4 studies) - Lack of support from husband or relatives (in 7 studies) | 4 |
Sparling et al. 2017 From 2008 to 2015 | All studies are included from developed countries except one from India | EPDS in 21 studies | PubMed, EMBASE and CINAHL | 35 | 88,051 | Quality in Prognostic Studies tool, Cochrane Collaboration tool | Not reported | - 173 studies, including three polyunsaturated fatty acids (PUFA) supplementation trials, found no evidence of an association between polyunsaturated fatty acid and depression) - 22 studies showed protective effects of healthy dietary patterns, multivitamin supplementation, fish and PUFA intake, calcium, vitamin D, zinc and possibly selenium from depression. - Given the methodological limitations of existing studies and inconsistencies in findings across studies, the evidence on whether nutritional factors influence the risk of perinatal depression is still inconclusive. | 7 |
Underwood et al. 2016 From 2000 to 2015 | Developed countries | EPDS in 13 studies | Embase, PsychINFO, MEDLINE and Cochrane Reviews | 16 | 35,419 | List of criteria’s that could resemble the standard quality assessment tool | 17% | - Previous depression history was found as a predictor of a current depression during pregnancy in five studies | 7 |
Wosu Ac et al. 2015 From 1999 to 2014 | Majority were from USA but the rest were from other developed countries | CES-D/ in three studies | PubMed, EMBASE, PyscINFO, CINAHL, Web of Science, BIOSIS, and Science Direct | 7 | 2161 | Newcastle-Ottawa Scale (NOS) | Not reported | - Childhood sexual abuse is strongly associated with prenatal depression (six studies) | 8 |
Lancaster CA et al. 2010 From 1980 to 2008 | Developed countries | CES- D in 49 studies | PubMed, CINAHL, SCOPUS, PsycINFO, Sociological Abstracts, ISI Proceedings, ProQuest | 57 | 36,257 | Quality assessment tool adapted from methods of the US Preventive Services Task Force | Not reported | - Life stress (in 18 studies), - lack of social support (in 24 studies), - Domestic violence (in seven studies) - Unwanted pregnancy (in six studies) - Lowe income (in 11 studies) - Unemployment (in 14 studies) - Lower education (in 20 studies) - Smoking (in 11 studies) - Alcohol use (in 10 studies) - Illicit drug use (in 8 studies) - Nulliparity (in 18 studies) - Poor obstetric history (in 10 studies) | 7 |
Howard LM et al. 2013 From 2000 to 2012 | From all continent except Africa | EPDS in 35 studies | Medline, Embase, and PsycINFO, and hand searches of Trauma Violence and Abuse, Journal of Traumatic Stress, and Violence Against Women | 67 | 171,465 | Yes, quality appraisal checklist | Not reported | - Life time domestic violence (in 11 studies) with a pooled odds ratio and 95%CI [3.04: 2.31,4.01, I2 = 51.1%] - Any past year partner violence in five studies, Pooled odds ratio with 95%CI [2.82: 1.52, 5.28, I2 = 75.3%] - Partner violence during pregnancy in seven studies, Pooled odds ratio with 95%CI [5.00: 4.94, 6.17, I2 = 23.7%] | 8 |
Risk factors | Number of reviews in which the risk factor was reported | Number of primary studies in which the factor was reported | Total participants |
---|---|---|---|
History of abuse (childhood or current sexual, physical or psychological) or domestic violence or intimate partner violence | 6 | 73 | 293,621 |
Lack of partner or of social support and poor marital relationship | 4 | 47 | 226,078 |
Personal or family history of any mental disorder or stress | 3 | 34 | 177,014 |
Un-planned or unwanted pregnancy specially during premarital condition or nullparity | 3 | 36 | 70,296 |
History of poor obstetric condition like current or past pregnancy complications such as hyperemesis gravidurum, adverse birth outcomes (low birth weight, preterm, still birth or infant lose after delivery), had cesarean section delivery | 4 | 33 | 56, 916 |
Maternal low economic status or unemployment condition or financial difficulties | 3 | 32 | 20,239 |
Maternal poor behavioral condition or practices like smoking, alcohol use, illicit drug use) | 1 | 29 | 18,444 |
Maternal low educational status | 2 | 22 | 14,638 |
10 reviews | 306 primary studies | 877,246 participants |
Findings
AMSTAR criteria | Name of the reviews | |||||||||
---|---|---|---|---|---|---|---|---|---|---|
Biaggie, 2016 | Gelaye, 2016 | Halim, 2017 | Mitchel,2017 | Roomruangwong, 2011 | Sparling, 2017 | Underwood, 2016 | Wosu, 2015 | Lancaster,2010 | Howard, 2013 | |
1. Was a-priori design provided? | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
2. Was there duplicate study selection and data extraction? | No | No | Yes | Yes | No | Yes | Yes | No | Yes | Yes |
3. Was a comprehensive literature search performed? | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
4. Was status of publication (e.g. grey literature) used as an inclusion criterion? | Yes | Yes | Yes | No | No | No | No | Yes | No | No |
5. Was a list of studies (included and excluded) provided? | Can’t answer | Can’t answer | Can’t answer | Can’t answer | Can’t answer | Can’t answer | Can’t answer | Can’t answer | Can’t answer | Can’t answer |
6. Were the characteristics of included studies provided? | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
7. Was the scientific quality of the included studies assessed and reported? | No | No | Can’t answer | Yes | No | Yes | Yes | Yes | Yes | Yes |
8. Was the scientific quality of the included studies used appropriately in formulating conclusions? | No | No | Can’t answer | No | No | No | No | No | Yes | No |
9. Were the methods used to combine the findings of studies appropriate? | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes | Yes |
10. Was the likelihood of publication bias assessed? | Not applicable | Yes | Not applicable | No | Not applicable | Not applicable | Not applicable | Yes | Not applicable | Yes |
11. Was the conflict of interest stated? | No | Yes | Yes | Yes | No | Yes | Yes | Yes | No | Yes |
Total AMSTAR score | 5 (middle) | 7(middle) | 7(middle) | 7(middle) | 4(middle) | 7(middle) | 7(middle) | 8(upper) | 7(middle) | 8 (upper) |
Association of antenatal depression with adverse birth outcomes
Characteristics of included reviews
Author, year | Geographic coverage of the review | Prominent tools used | Database searched | Number of studies and number of participants | Quality assessment tool used | Main findings relevant to our review | AMSTAR score | |
---|---|---|---|---|---|---|---|---|
PTB | LBW | |||||||
Ascort et al. 2014 Included studies conducted in the year from 1977 to 2013 | USA, Europe, Asia | CES-D (19 studies) | PubMed and PsycINFO | - PTB = 50 studies with Sample size of 286,043 - LBW = 33 studies with sample size of 43,534 | NOS | - Taking into account the methodological quality of studies, research on depression and PTB/GA is inconclusive at best - Is a systematic review as pooling was not conducted | - It was found that about more than half (53%) of published LBW findings reported statistically significant associations with prenatal depression and low birth weight - Was a systematic review as pooling was not conducted | 8 |
Araujo et al. 2010 Included studies conducted in the year from 1996 to 2007 | United States, Norway, Canada, Denmark, India, England, United Kingdom | Not found | PubMed, SciELO, and ISIWEB u | 10 studies with sample size of 231,201 | Downs & Black quality assessment check list | Depression during pregnancy was associated with low birth weight in seven studies - Was a systematic review as pooling was not conducted | 5 | |
Grigoriadis S et al. 2013 Included studies conducted in the year from 1992 to 2010 | most of the studies were in USA while few share Australia, China, Europe | CES-D at different cut of value in 11 studies | MEDLINE, EMBASE, CINAHL, Scopes and PsycINFO | - PTB = 15 studies with sample size of 23,754 - LBW = 6 studies with sample size of 14,090 | Systematic Assessment of Quality in Observational Research (SAQOR) and the Newcastle-Ottawa Scale | - Preterm birth (PAOR = 1.37; 95% CI, 1.04 to 1.81) - I2 = 61% - No evidence of publication bias | - Low - birth weight was not significantly associated with prenatal depression (POR = 1.21; 95% CI, 0.91 to 1.60) - I2 = 0.0% - No evidence of publication bias | 10 |
Grote K et al. 2010 Included studies conducted in the year from 1980 - 2009 | most of the studies were from USA while the rest are from Europe, Asia, Brazil | CES-D in 10 studies | MEDLINE, PsycINFO, CINAHL, social work abstracts, social services abstracts, and dissertation Abstracts international databases | - PTB = 20 studies with sample of 29,295 - LBW = 11 studies with sample size of 13,544 | Developed by modifying the instrument by Downs and Black | - Preterm birth is associated with depression during pregnancy PRR = 1.39 [1.19–1.61] - The association between antenatal depression and risk of PB was found to be higher in among women of lower socio-economic status in the United States. - I2 = 61% - Publication bias checked and corrected | - Low Birth Weight was associated with depression during pregnancy PRR = 1.49 [1.25–1.77] - The association between antenatal depression and risk of LBW was found to be higher in developing countries as compared to USA (RR = 2.05; 95% CI, 1.43–2.93) - I2 = 70% - Publication bias checked and corrected | 7 |
Jarde A et al. 2016 Included studies conducted in the year from 1992 to 2015 | most of the studies were from USA and other developed countries | DSM-IV (nine studies and CES-D (six studies) | MEDLINE, EMBASE, PsycINFO, cumulative index to nursing and allied health, Cochrane Central Register of Controlled Trials, and Web of Science. | - PTB = 14 studies - LBW = 8 studies with sample size of 25,663 | Newcastle-Ottawa Scale | Antenatal depression was associated with an increased risks of preterm birth (odds ratio [OR], 1.56; 95% CI, 1.25–1.94) - I2 = 39% | Antenatal depression was associated with an increased risk of low birth weight (OR, 1.96; 95% CI, 1.24–3.10) - I2 = 48% | 10 |
Staneva A et al. 2015 Included studies conducted in the year from 1992 to 2015 | The majority of studies (27) were from the USA, the remaining are from Europe, Brazil (2), Canada (1), UK (1), Norway (1), and China (1) | CES-D in six studies | MEDLINE, CINHAL, PsycInfo, and Cochrane databases and manual searches were performed through reference list of included studies | - 14 studies investigated the association between antenatal depression and PTB - Sample size not clear | checklist developed by a knowledge synthesis group for the specific purpose of review of the evidence relating to determinants of preterm birth and low birth weight | - Preterm birth was independently and significantly predicted by antenatal depression - Was a systematic review as pooling was not conducted | 7 |
Type of outcome | Number of primary studies | Sample size include | Estimates from review | Pooled estimates, I2 |
---|---|---|---|---|
Low birth weight | 6 | 14,090 | PAOR, (1.21; 95%CI: 0.91, 1.60) | PAOR = 1.49 (95%CI: 1.32, 1.68) I2 = 0.0%(P = 0.213) - No evidence of publication bias - No influential study found |
11 | 13,544 | PRR = 1.49(95%CI: 1.25, 1.77) | ||
8 | 25,663 | PAOR = 1.96(95%CI: 1.24, 3.10) | ||
Total | 25 | 53,297 | ||
Preterm birth | 15 | 23,754 | PAOR, (1.37; 95%CI: 1.04, 1.81) | PAOR = 1.40 (95%CI: 1.16, 1.69) I2 = 35.2%(P = 0.771) - No evidence of publication bias - No influential study found |
20 | 29,295 | PRR = 1.39(95%CI: 1.19, 1.61) | ||
14 | PAOR = 1.56(95%CI: 1.25, 1.94) | |||
Total | 39 | 75,451 |
Findings
AMSTAR criteria | Name of the reviews | |||||
---|---|---|---|---|---|---|
Accort, 2015 | Araujo, 2010 | Grigoriadis, 2013 | Grote, 2010 | Jarde, 2016 | Staneva, 2015 | |
1. Was a-priori design provided? | Yes | Yes | Yes | Yes | Yes | Yes |
2. Was there duplicate study selection and data extraction? | Yes | No | Yes | Yes | Yes | Yes |
3. Was a comprehensive literature search performed? | Yes | Yes | Yes | Yes | Yes | Yes |
4. Was status of publication (e.g. grey literature) used as an inclusion criterion? | No | No | Yes | No | Yes | No |
5. Was a list of studies (included and excluded) provided? | Can’t answer | Can’t answer | Can’t answer | Can’t answer | Can’t answer | Can’t answer |
6. Were the characteristics of included studies provided? | Yes | Yes | Yes | Yes | Yes | Yes |
7. Was the scientific quality of the included studies assessed and reported? | Yes | Yes | Yes | Yes | Yes | Yes |
8. Was the scientific quality of the included studies used appropriately in formulating conclusions? | Yes | No | Yes | No | Yes | No |
9. Were the methods used to combine the findings of studies appropriate? | Yes | Yes | Yes | Yes | Yes | Yes |
10. Was the likelihood of publication bias assessed? | Not applicable | Not applicable | Yes | Yes | Yes | Not applicable |
11. Was the conflict of interest stated? | Yes | No | Yes | No | Yes | Yes |
Total AMSTAR score | 8 (upper) | 5(middle) | 10 (upper) | 7(middle) | 10(upper) | 7(upper) |