Perinatal depression and adverse child growth outcomes in low-income and middle-income countries (LMICs): A systematic review and meta-analysis

Abstract

Perinatal depression (PND), which encompasses the antepartum and postpartum depression (APD and PPD), is a neglected crisis in low-income and middle-income countries (LMICs). We aimed to systematically search and meta-analyze existing evidence to determine whether a mother's PND affects adverse growth outcomes in children in LMICs (PROSPERO protocol: CRD42021246803). We conducted searches, including nine databases (PubMed, EMBASE, Web of Science, CINAHL Plus, Global Health Database, Google Scholar, WHO Regional Databases, PsycINFO, and LILACS) from January 2000 to September 2023. We restricted studies that assessed PND using validated screening tools or clinical interviews during pregnancy or within 12 months postpartum. We included studies that reported four types of adverse child growth outcomes (stunting, wasting, underweight, and overweight/obesity) in children younger than 5 years. We assessed the quality using the Newcastle Ottawa Scale and pooled risk ratios (RRs) and odds ratios (ORs) between PND and each adverse growth outcome using random-effects models. In total, 27 studies met the inclusion criteria for systematic review, with 24 eligible for meta-analysis, spanning data from 15 countries and 26,261 mother-baby pairs. Based on the studies that reported ORs, children below the age of 3 years with mothers experiencing PND had higher odds for stunting (OR 1.63, 95% CI 1.32, 2.02, I2 = 56.0%) and underweight (OR 2.65, 95% CI 1.90, 3.68, I2 = 34.5%) compared to children of mothers without PND. The pooled RRs for stunting and underweight did not show significant differences between mothers with and without PND. Studies on wasting (n = 5) and overweight/obesity (n = 2) were limited, demonstrating inconsistent results across studies. The association between PND and adverse growth outcomes varied according to the measure of association, region, country, PND type, outcome timepoint, and study design. There were limited studies in diverse LMICs, particularly on wasting, or overweight/obesity as an outcome.

Fig 1. PRISMA flowchart.

From: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. doi: 10.1136/bmj.n71. For more information, visit: http://www.prisma-statement.org/. Note: LMICs = low-income and middle-income countries. *A total of 24 sub-studies included since Bennett et al. (2016) conducted in 4 different countries and reported the findings in each country. *A total of 27 sub-studies included since Bennett et al. (2016) conducted in 4 different countries and reported the findings in each country.

Fig 2. Meta-analysis of odds ratio between perinatal depression and stunting (n = 14)–subgroup analysis according to type of perinatal depression (antepartum vs. postpartum) and region.

A. Subgroup analysis according to type of perinatal depression. B. Subgroup analysis according to region.

Fig 3. Meta-analysis of the risk ratio between perinatal depression and stunting of children.

A. Subgroup analysis according to type of perinatal depression ^a. B. Subgroup analysis according to region.

Fig 4. Meta-analysis of odds ratio between perinatal depression and underweight (n = 10)–subgroup analysis according to region and type of perinatal depression (antepartum vs.

postpartum). A. Subgroup analysis according to type of perinatal depression. B. Subgroup analysis according to region.

Fig 5. Meta-analysis of the risk ratio between perinatal depression and underweight of children.

A. Subgroup analysis according to type of perinatal depression ^a. B. Subgroup analysis according to region.

Fig 6. Subgroup analysis of the risk ratio between perinatal depression and wasting according to type of perinatal depression ^a.