Cesarean section and risk of postpartum depression: A meta-analysis

•The association of CS with the risk of PPD remains controversial.•We conducted a meta-analysis of CS, ElCS and EmCS for risk of PPD.•CS and EmCS might be associated with an increased risk of PPD.•Further studies about the specific types of CS and PPD risk are needed.

ObjectiveThe association of cesarean section (CS) with the risk of postpartum depression (PPD) remains controversial. Therefore, we conducted a meta-analysis to explore the association between CS and the risk of PPD.MethodsA systematic literature search was performed in PubMed, Web of Science and Embase databases for relevant articles up to November 2016. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated with fixed-effects model or random-effects model.ResultsA total of 28 studies from 27 articles involving 532,630 participants were included in this meta-analysis. The pooled OR of the association between CS and PPD risk was 1.26 (95% CI: 1.16-1.36). In subgroup analyses stratified by study design [cohort studies: (1.25, 95% CI: 1.10-1.41); case-control studies: (1.25, 95% CI: 1.00-1.56); cross-sectional studies: (1.44, 95% CI: 1.14-1.82)] and adjustment status of complications during pregnancy [adjusted for: (1.29, 95% CI: 1.12-1.48); not-adjusted for: (1.24, 95% CI: 1.13-1.36)], the above-mentioned associations remained consistent. The pooled ORs of PPD were 1.15 (95% CI: 0.92-1.43) for elective cesarean section (ElCS) and 1.47 (95% CI: 1.33-1.62) for emergency cesarean section (EmCS).ConclusionThis meta-analysis suggests that CS and EmCS increase the risk of PPD. Further evidence is needed to explore the associations between the specific types of CS and the risk of PPD.