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Meta-Analysis
. 2008 Oct 8;2008(4):CD001690.
doi: 10.1002/14651858.CD001690.pub2.

Oestrogens and progestins for preventing and treating postpartum depression

Cindy-Lee Dennis  1 , Lori E Ross, Andrew Herxheimer
Affiliations
Meta-Analysis

Oestrogens and progestins for preventing and treating postpartum depression

Cindy-Lee Dennis et al. Cochrane Database Syst Rev. .

Abstract

Background: Postpartum depression is a common complication of childbirth, affecting approximately 13% of women. A hormonal aetiology has long been hypothesised due to the sudden and substantial fluctuations in concentrations of steroid hormones associated with pregnancy and the immediate postpartum period. There is also convincing evidence that oestrogens, progestins, and related compounds have important central nervous system activity at physiological concentrations.

Objectives: The primary objective of this review was to assess the effects of oestrogens and progestins, including natural progesterone and synthetic progestogens, compared with placebo or usual antepartum, intrapartum, or postpartum care in the prevention and treatment of postpartum depression.

Search strategy: We searched The Cochrane Pregnancy and Childbirth Group trials register (June 2004), the Cochrane Depression Anxiety and Neurosis Group trials register (July 2004), the Cochrane Central Register of Controlled Trials (July 2004), MEDLINE (1966 to 2004), EMBASE (1980 to 2004), and CINAHL (1982 to 2004). We scanned secondary references and contacted experts in the field.

Selection criteria: All published and unpublished randomised controlled trials comparing an oestrogen and progestin intervention with a placebo or usual antepartum, intrapartum, or postpartum care among pregnant women or new mothers recruited within the first year postpartum.

Data collection and analysis: Two review authors participated in the evaluation of methodological quality, data extraction, and data analysis. Results are presented using relative risk for categorical data and weighted mean difference for continuous data.

Main results: Two trials, involving 229 women, met the selection criteria. Norethisterone enanthate, a synthetic progestogen, administered within 48 hours of delivery was associated with a significantly higher risk of developing postpartum depression. Oestrogen therapy was associated with a greater improvement in depression scores than placebo among women with severe depression.

Authors' conclusions: Synthetic progestogens should be used with significant caution in the postpartum period. The role of natural progesterone in the prevention and treatment of postpartum depression has yet to be evaluated in a randomised, placebo-controlled trial. Oestrogen therapy may be of modest value for the treatment of severe postpartum depression. Its role in the prevention of recurrent postpartum depression has not been rigorously evaluated. Further research is warranted.

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Conflict of interest statement

Lori Ross is currently a co‐investigator of an ongoing trial that is evaluating the effect of transdermal estradiol patches in women with postpartum depression.

Figures

1.1
1.1. Analysis
Comparison 1 Progestins versus placebo for prevention of postpartum depression, Outcome 1 Identified with major depressive symptoms at 6 weeks postpartum.
1.2
1.2. Analysis
Comparison 1 Progestins versus placebo for prevention of postpartum depression, Outcome 2 Identified with minor/major depressive symptoms at 6 weeks postpartum.
1.3
1.3. Analysis
Comparison 1 Progestins versus placebo for prevention of postpartum depression, Outcome 3 Mean depression scores at 6 weeks postpartum.
1.4
1.4. Analysis
Comparison 1 Progestins versus placebo for prevention of postpartum depression, Outcome 4 Identified with major depressive symptoms at 12 weeks postpartum.
1.5
1.5. Analysis
Comparison 1 Progestins versus placebo for prevention of postpartum depression, Outcome 5 Identified with minor/major depressive symptoms at 12 weeks postpartum.
1.6
1.6. Analysis
Comparison 1 Progestins versus placebo for prevention of postpartum depression, Outcome 6 Mean depression scores at 12 weeks postpartum.
1.7
1.7. Analysis
Comparison 1 Progestins versus placebo for prevention of postpartum depression, Outcome 7 Mean days of vaginal bleeding.
1.8
1.8. Analysis
Comparison 1 Progestins versus placebo for prevention of postpartum depression, Outcome 8 Identified as breastfeeding.
2.1
2.1. Analysis
Comparison 2 Oestrogens versus placebo for treatment of postpartum depression, Outcome 1 Identified with depressive symptoms ‐ 4 weeks post‐treatment.
2.2
2.2. Analysis
Comparison 2 Oestrogens versus placebo for treatment of postpartum depression, Outcome 2 Mean depression scores ‐ 4 weeks post‐treatment.
2.3
2.3. Analysis
Comparison 2 Oestrogens versus placebo for treatment of postpartum depression, Outcome 3 Identified with depressive symptoms ‐ 12 weeks post‐treatment.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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