History of premenstrual syndrome and development of postpartum depression: A systematic review and meta-analysis

BACKGROUND: Premenstrual syndrome (PMS) is thought to be a risk factor for postpartum depression (PPD), but results from studies examining the association have been mixed.

OBJECTIVES: To estimate the association between pre-pregnancy history of PMS and development of PPD and evaluate the risk of bias of included evidence.

SEARCH STRATEGY: PubMed, EMBASE, CINAHL, PsycINFO, Cochrane Library, CNKI, Wanfang Data, and reference lists of relevant papers were searched.

SELECTION CRITERIA: Observational studies that collected pre-pregnancy history of PMS and measured PPD status between one week and one year after delivery were included.

DATA COLLECTION AND ANALYSIS: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Random-effect models were used to calculate pooled odds ratios (ORs) with 95% confidence interval (CI). Small study effect was analysed by funnel plot. Risk of bias was assessed using the Risk of Bias Instrument for Non-Randomized Studies of Exposures (ROBINS-E).

MAIN RESULTS: Our meta-analysis included 19 studies. Overall, women with a pre-pregnancy history of PMS had more than double the odds of PPD compared to those without PMS (OR: 2.20, 95% CI: 1.81-2.68). However, the quality of evidence was low: five studies had moderate risk, eleven studies had serious risk, and three studies had critical risk of bias.

CONCLUSIONS: Current evidence supports a significant association between history of PMS and development of PPD. Well-designed prospective studies are needed to further investigate this relationship.