Antenatal Depressive Symptoms and the Risk of Preeclampsia or Operative Deliveries: A Meta-Analysis

<div><p>Background</p><p>The purpose of the study was to investigate the association between depression and/or depressive symptoms during pregnancy and the risk of an operative delivery or preeclampsia, and to quantify the strength of the association.</p><p>Methods</p><p>A search of the PubMed, SCI/SSCI, Proquest PsycARTICLES and CINAHL databases was supplemented by manual searches of bibliographies of key retrieved articles and review articles. We aimed to include case control or cohort studies that reported data on antenatal depression and /or depressive symptoms and the risk of an operative delivery and/or preeclampsia.</p><p>Results</p><p>Twelve studies with self-reported screening instruments were eligible for inclusion with a total of 8400 participants. Seven articles that contained 4421 total participants reported the risk for an operative delivery, and five articles that contained 3979 total participants reported the risk for preeclampsia. The pooled analyses showed that both operative delivery and preeclampsia had a statistically significant association with antenatal depressive symptoms (RR = 1.24; 95% CI, 1.14 to 1.35, and OR = 1.63, 95% CI, 1.32 to 2.02, respectively). When the pre-pregnancy body mass indices were controlled in their initial design, the risk for preeclampsia still existed (OR = 1.48, 95% CI, 1.04 to 2.01), while the risk for an operative delivery became uncertain (RR = 1.01, 95% CI, 0.85 to 1.22).</p><p>Conclusions</p><p>Antenatal depressive symptoms are associated with a moderately increased risk of an operative delivery and preeclampsia. An abnormal pre-pregnancy body mass index may modify this association.</p></div

Characteristics of the Included Studies.

<p>Abbreviations: SES = Socioeconomic Status, EPDS = Edinburgh Perinatal Depression Scale, BDI = Beck Depression Inventory, CES-D = Center for Epidemiological Studies Depression Scale</p><p>Characteristics of the Included Studies.</p

PRISMA 2009 Flow Diagram for Identification of Studies for Meta-analysis.

<p>PRISMA 2009 Flow Diagram for Identification of Studies for Meta-analysis.</p

Characteristics of the Included Studies.

<p>Abbreviations: SES = Socioeconomic Status, EPDS = Edinburgh Perinatal Depression Scale, CES-D = Center for Epidemiological Studies Depression Scale, PHQ-9 = Patient Health Questionnaire-9, PE = Preeclampsia</p><p>Characteristics of the Included Studies.</p

Characteristics of the Included Studies.

<p>Abbreviations: SES = Socioeconomic Status, EPDS = Edinburgh Perinatal Depression Scale, BDI = Beck Depression Inventory, CES-D = Center for Epidemiological Studies Depression Scale, PHQ-9 = Patient Health Questionnaire-9, PE = Preeclampsia</p><p>Characteristics of the Included Studies.</p

Risk of preeclampsia.

<p>Risk of preeclampsia.</p

Diagram of the layered structure of the vocal fold (Hoechst staining).

<p>The canine vocal fold includes the epithelium (E), lamina propria (LP) and muscle (M). Scale bar  =  100μm.</p

Cell immunofluorescence for the observation of surface protein expression.

<p>Both vocal fold fibroblasts (VFFs) (A) and differentiated adipose-derived mesenchymal stem cells (dADSCs) (B) can express vimentin and fibronectin. Scale bar  =  50μm.</p

Risk of operative deliveries

<p>Risk of operative deliveries</p

Quality Assessment of the Nine Included Studies.

<p>*1 indicates case definition or ascertainment of exposure; 2, representativeness of the cases or exposed cohort; 3, selection of controls or non-exposed cohort; 4, description of the control source or demonstration of outcome of interest in cohort; 5A, based on the most important factor to select and study controls; 5B, based on a second crucial factor to select and study controls; 6, assessment of exposure or outcome by blinded interview or record; 7, same method of ascertainment used for cases and controls or adequate follow-up period; 8, evenly distributed non-response rate or adequacy of follow-up of cohorts</p><p>Quality Assessment of the Nine Included Studies.</p