Postpartum pain and the risk of postpartum depression: A meta‐analysis of observational studies

Objective: This meta‐analysis of observational studies aimed to derive a more precise estimation of the relationship between postpartum pain and postpartum depression (PPD). Methods: A systematic literature search was completed in the following databases from inception to September 26, 2022: PubMed, Embase, and Web of Science. Quality evaluation of each study was achieved through Newcastle‐Ottawa scale (NOS) assessment. Heterogeneity across studies was evaluated by Cochran's Q test and I 2 test. Pooled estimates of odds ratios (ORs) and corresponding 95% confidence intervals (CIs) were analyzed using fixed‐effects model or random‐effects model, according to heterogeneity. Subgroup analysis, sensitivity analysis, and Egger's test were also performed. Results: From the identified 1884 articles, a total of 8 studies involving 3973 participants were included in the final meta‐analysis. Seven of the 8 studies were evaluated as high‐quality, with NOS scores ≥7. A significant heterogeneity was observed ( I 2 = 66.5%, p = 0.004) among eight studies. Therefore, the performed random‐effect model suggested a significant association between postpartum pain and PPD risk (OR 1.29, 95% CI 1.10–1.52, p = 0.002). However, the subgroup analyses did not define the source of heterogeneity. Moreover, the sensitivity analysis showed the stability of the pooled results, but the significant publication bias was identified ( p = 0.009). The trim and fill method was performed and resulted in an OR of 1.14 (95% CI 0.95–1.37, p = 0.162). Conclusions: This meta‐analysis found a potential association between postpartum pain and PPD. Further researches are needed to provide more robust evidences.