Elsevier

Journal of Psychiatric Research

Volume 121, February 2020, Pages 82-90
Journal of Psychiatric Research

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

https://doi.org/10.1016/j.jpsychires.2019.11.010Get rights and content

Highlights

  • PMS may be a risk factor for postpartum depression, but with mixed findings to date.

  • This study synthesised evidence from papers published in English and Chinese.

  • From meta-analysis a positive association between the two conditions was identified.

  • Women with a history of PMS had double the odds of developing postpartum depression.

  • Good-quality prospective studies are needed to confirm this finding.

Abstract

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.

Introduction

Postpartum depression (PPD) is one of the most common complications of childbearing (Stewart and Vigod, 2016) that occurs within one year after childbirth, and affects about 13–19% of women worldwide (O'Hara and McCabe, 2013). It has deleterious effects on both mothers and children if left untreated (Da Costa et al., 2006; Murray et al., 2003). Suicide and infanticide are the most severe consequences (Esscher et al., 2016; Lindahl et al., 2005; Wisner et al., 2013) and several other negative outcomes are also related to PPD, such as impairment of both mother-infant attachment and emotional development in children (Stein et al., 2014). It is important, therefore, to identify women at risk of PPD as early as possible.

Psychosocial factors, previous history of depression and lack of social support are the strongest known predictors for PPD (Ghaedrahmati et al., 2017; O'Hara and Swain, 1996). Premenstrual syndrome (PMS) has been recently recognised as a potential risk factor of PPD (Buttner et al., 2013; Maliszewska et al., 2017; Turkcapar et al., 2015), however whether having a history of PMS increases the risk for PPD remains unclear and inconsistent findings have been reported. For example, Sylvén and colleagues reported that women with a history of PMS before pregnancy had three times higher odds of PPD at six weeks postpartum, compared to those without such a history (odds ratio (OR), 95% confidence interval (CI): 3.35, 1.72–6.51) (Sylvén et al., 2013); while, Martini et al. found that pre-pregnancy PMS was not associated with PPD (OR, 95%CI: 1.74, 0.55–5.47) (Martini et al., 2015). This lack of evidence for an association reported in the latter study may reflect insufficient statistical power, a limitation that could be addressed by conducting an appropriate meta-analysis of available results.

In their recently-published systematic review, Amiel Castro et al. (Amiel Castro et al., 2018) concluded that the evidence supports an association of PMS with increased risk of PPD; however they did not consider the temporal relationship between PMS and PPD when selecting studies for inclusion. As a result, studies that examined the effect of PPD on PMS development after delivery (Haywood et al., 2007; Warner et al., 1991) and studies examining the comorbidity between PMS and PPD (Kim et al., 2016; Yang et al., 2015) were included along with studies investigating the association between history of PMS and development of PPD. Moreover, their review did not include a meta-analysis to estimate the overall magnitude of the association to compare with previous findings in the literature (Bloch et al., 2005; Kara et al., 2008). A synthesis of evidence is still lacking, therefore, that specifically focuses on the history of PMS and the development of PPD and that provides an analysis of pooled results from different studies (Dwyer et al., 2001; Thompson, 1994).

The classification of PMS is a potential issue that could lead to inconsistent findings in studies assessing prevalence or associations. PMS has multiple definitions that differ in terms of timing, type, and severity of symptoms (Yonkers and Simoni, 2018). For example, the World Health Organization (WHO)'s International Statistical Classification of Diseases and Related Health Problems Tenth edition (ICD-10) includes “premenstrual tension syndrome”, which refers to any premenstrual symptoms such as tension or migraine without consideration of the type or severity of the symptoms (Pearlstein, 2007a). This definition serves as the most relaxed criteria of PMS, corresponding to a prevalence up to 80–90% (Pal et al., 2011; Raval et al., 2016; Tolossa and Bekele, 2014). In contrast, the American College of Obstetricians and Gynecologists (ACOG) definition of PMS (American College of Obstetricians and Gynecologists, 2000) and the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) definition for a severe form of PMS – premenstrual dysphoric disorder (PMDD) (American Psychiatric Association, 1994) – both specify the physical and psychological symptoms that must be present and require that symptoms are sufficiently severe to impair a woman's daily life. These two definitions across the degree of PMS have a prevalence of 40% and 3–8%, respectively (Pearlstein, 2007b). More recently, the International Society for Premenstrual Disorders (ISPMD) used core premenstrual disorders (PMDs) to define the most commonly encountered and widely recognised type of PMS, which is distinguished from physiological premenstrual symptoms. Core PMDs refer to premenstrual symptoms that significantly affect an individual's daily functioning irrespective of the type or number of symptoms (Ismaili et al., 2016; Nevatte et al., 2013; O'Brien et al., 2011). This concept has been incorporated in the 2017 version of the Royal College of Obstetricians and Gynaecologists (RCOG) PMS guideline (Royal College of Obstetricians and Gynaecologists, 2017). Similarly, the various measurements of PPD, the confounding factors, and different methods used for participants selection, may all contribute to mixed findings on the association between history of PMS and development of PPD reported across studies.

This systematic review aims to: (1) summarise current evidence for the association between a pre-pregnancy history of PMS and PPD development; (2) evaluate the risk of bias of the included studies; (3) perform a meta-analysis to estimate the magnitude of this association; and (4) provide recommendations for future studies examining the association of interest.

Section snippets

Protocol and registration

This review was registered with PROSPERO and the protocol ID is CRD42018080685.

Data sources and searches

In accordance with PRISMA guidelines (Moher et al., 2009), we conducted a comprehensive literature search for articles published in both English and Chinese up to 1 April 2019. The English databases searched were PubMed, EMBASE, CINAHL, PsycINFO and Cochrane library, and the Chinese databases searched were CNKI and Wanfang Data. We combined the data-specific search terms on exposure (PMS/PMDD) and outcomes (PPD) (see

Identification of relevant studies

An electronic search identified 904 records from the various databases. An additional 14 citations were retrieved from reference lists of relevant papers. Abstracts of 642 records were screened after duplicates were removed. The full texts of 106 records closely relevant to the research topic were assessed. Of these, 19 studies meeting all inclusion criteria were synthesised in the meta-analysis, two of which were published in Chinese (Wang, 2008; Zhang, 2011) and the rest in English (Aydin et

Principal findings

To our knowledge, this is the first systematic review and meta-analysis that specifically summarises evidence on the association between history of PMS prior to pregnancy and PPD with regards to the same pregnancy. Our results showed that compared to women without a history of PMS, those with a history of PMS before pregnancy had more than twice the odds of developing PPD within the first 12 months after childbirth. This association did not differ by study design, definition of PMS, or

Conclusion

In summary, the findings from this systematic review and meta-analysis support a significant association between history of PMS before pregnancy and PPD development following pregnancy. This conclusion suggests the potential benefit of collecting women's PMS history during antenatal check-ups and/or postpartum visits in reducing the risk of PPD. However, well-designed prospective studies considering the limitations of the current evidence are needed to further articulate the relationship

Funding source

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. S.C. is supported by the UQ Research Training Scholarship. G.D.M is supported by a National Health and Medical Research Council Principal Research Fellowship (Application ID 1121844).

Declaration of competing interest

None.

The authors report no conflicts of interest.

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