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Meta-analysis of association between caesarean section and postpartum depression risk

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Ning, Jiajie, Deng, Jing, Li, Shanshan, Lu, Caina, Zeng, Pingping·2024·Frontiers in Psychiatry
DOI 10.3389/fpsyt.2024.1361604PMC PMC11006970
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Abstract

Background: The association of caesarean section (CS) for postpartum depression (PPD) remains controversial. This study aims to explore the relationship between CS and the risk of PPD, in order to provide a basis for preventing PPD. Material and methods: We searched PubMed, Web of Science, Cochrane Library, and EMBASE databases for literature about the correlation between CS and PPD published as of February 2024. The combined odds ratios (ORs) and 95% confidence intervals (Cls) were obtained by flexible use of fixed-effects models or random-effects models. Results: A total of 18 publications were ultimately included in the analysis. Among these, 14 were cohort studies and 4 were case-control reports, encompassing 844,328 total cases. All of the included studies were deemed to be of moderate or higher quality. The meta-analysis indicated that the prevalence of PPD among parturients undergoing CS was 13.4% (95% CI: 6.5%-25.5%).The adjusted odds ratio (OR) for the association between CS and PPD was 1.12 (95% CI: 1.04-1.20) compared to the natural vaginal delivery (NVD) group. Specifically, the adjusted OR for the association between CS and PPD was 1.29 (95% CI: 1.18-1.40) during the first 1-6 months postpartum, and 1.23 (95% CI: 1.14-1.33) after 6 months postpartum. Furthermore, in comparison to the NVD group, the adjusted OR for elective caesarean section (ELCS) and emergency caesarean section (EMCS) were 0.96 (0.83, 1.10) and 1.20 (1.08, 1.34), respectively. Conclusion: Our findings suggest that PPD risk may rise in the presence of CS. In particular, the risk was increased by 20% in the EMCS group, and the risk of PPD within one to six months postpartum after CS increases by 6% compared to that at six months postpartum. In the future, more rational designs and in-depth studies are needed to obtain more accurate information. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/#recordDetails , identifier CRD42023389265.

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  • Cesarean delivery is linked to a threefold higher risk of experiencing chronic pain, affecting 22% of women at one year postpartum, which may directly correlate with more severe depressive symptoms.

    “Furthermore, another study demonstrate that this delivery mode is linked to a threefold higher risk of experiencing chronic pain, affecting 22% of women at one year postpartum, which may directly correlate with more severe depressive symptoms.65,66”

    From Influence of Neuraxial Anesthesia Technique During Vaginal and Cesarean Delivery and Association with Postpartum Depression: A Narrative Review of Literature (2026) · cites this paper as [66]

    The Discussions (page unavailable) link pain after repeat cesarean delivery with increased postpartum depression risk. They do not report a threefold higher risk of chronic pain or that chronic pain affects 22% of women at one year postpartum; the pain discussion concerns repeat cesareans and the early postpartum period. (LLM, conf=0.86)

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  • Women undergoing emergency cesarean delivery are associated with a 20% higher risk for postpartum depression.

    “Additionally, women undergoing emergency cesarean delivery are associated with a 20% higher risk for PPD and should receive increased postpartum psychiatric screening with the Edinburgh Postnatal Depression Scale.66”

    From Influence of Neuraxial Anesthesia Technique During Vaginal and Cesarean Delivery and Association with Postpartum Depression: A Narrative Review of Literature (2026) · cites this paper as [66]

    The Abstract Results report an adjusted odds ratio of 1.20 (95% CI 1.08–1.34) for postpartum depression after emergency caesarean section compared with vaginal delivery. That supports the direction and approximate magnitude of the association, although it is 20% higher odds rather than necessarily 20% higher risk. The Discussions describe use of the Edinburgh Postnatal Depression Scale in included studies but do not recommend increased screening with it for these women. (LLM, conf=0.88)

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Cited by

Sorted by citations

Authors
Ning, J., Deng, J., Li, S., Lu, C., & Zeng, P.
Affiliations
Guangxi Medical University (CN)
Corresponding author
Zeng, Pingping
ORCID
Venue
Frontiers in Psychiatry
Publisher
Frontiers Media SA
Published
2024-03-28
Volume
15
Pages
1361604-1361604
ISSN
1664-0640 (ISSN-L)
DOI
10.3389/fpsyt.2024.1361604
PMC
PMC11006970
OpenAlex
W4393274149
Cited by
42
References
4
Citations by year
2026: 28 · 2025: 11 · 2024: 3
FWCI
3.31
Type
journal article
Language
en
Open access
Licence
Locations
  • Frontiers in Psychiatry (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Division of Graduate Education
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
  • Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
Keywords
cesarean section, postpartum depression, elective cesarean section, emergency cesarean section, vaginal delivery, postpartum period, maternal mental health, risk factors for postpartum depression, maternal morbidity, maternal mortality risk, maternal mortality

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