Thyroid autoimmunity and risk of post-partum depression: a systematic review and meta-analysis of longitudinal studies
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The aim of this study was to systematically investigate whether, and to what extent, the detection of thyroid autoimmunity during pregnancy and in the weeks after childbirth is associated with an increased risk of developing post-partum depression (PPD), a condition associated with possible adverse outcomes for both mother and offspring. We performed a systematic review and meta-analysis of longitudinal studies, assessing the incidence of PPD in women with and without anti-thyroperoxidase antibody (TPOAb) positivity.
We searched MEDLINE, EMBASE, Web of Science, Cochrane Library, and CINAHL. Methodological quality of the studies was assessed by the Newcastle–Ottawa Scale. In the presence of even modest between-studies heterogeneity, assessed by Cochrane Q and I2 tests, risk ratios (RRs) for PPD were combined using a random effects model. Funnel plot and trim-and-fill analysis were used to assess publication bias.
Five included studies provided information on 449 women with TPOAb-positive and 2483 TPOAb-negative women. Pooled RR indicated a significantly increased risk to develop PPD in TPOAb-positive group (RR 1.49, 95% CI 1.11–2.00; P = 0.008; I2 = 47%, Pfor heterogeneity = 0.11). Consistent with a possible publication bias, the trim-and-fill test detected two putative missing studies in the funnel plot. Nevertheless, the adjustment for publication bias produced a negligible effect on the pooled estimate (adjusted RR 1.41, 95% CI 1.18–1.68, P = 0.0002).
Thyroid autoimmunity during pregnancy and in the weeks after childbirth is associated with an increased risk of developing PPD. Further well-designed studies are warranted to confirm this association and elucidate underlying pathophysiological mechanisms.
KeywordsPost-partum depression Thyroiditis Anti-thyroperoxidase antibodies Hypothyroidism Cohort studies
EM: acquisition of data, analysis and interpretation of data, and drafting the article; SD: analysis and interpretation of data, and drafting the article; CC: acquisition of data; AM: acquisition of data; FF: critical revision for important intellectual content; SF: statistical analysis and interpretation of data; AB: conception and design, analysis and interpretation of data, critical revision for important intellectual content, drafting the article, and final approval of the version to be published. All the authors read and approved the final manuscript.
This work was supported by Ministero dell’Università e della Ricerca Scientifica, Italy.
Compliance with ethical standards
Conflict of interest
The authors have no potential conflicts of interest to disclosure.
Ethics approval is not required as this study is a meta-analysis based on published studies.
Patient consent is not required as this study is a meta-analysis based on published studies.
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