Prevalence and risk factors for postpartum depression among women with preterm and low-birth-weight infants: a systematic review SN Vigod, a L Villegas, b C-L Dennis, c LE Ross d a Women’s College Hospital and Women’s College Research Institute, Toronto, ON, Canada b Reproductive Life Stages Program, Women’s College Hospital, Toronto, ON, Canada c Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, ON, Canada d Social Equity and Health Research Section, Centre for Addiction and Mental Health, Toronto, ON, Canada Correspondence: Dr SN Vigod, Reproductive Life Stages Program, Women’s College Hospital, 76 Grenville St., 9th Floor, Toronto, ON, Canada M5S 1B2. Email simone.vigod@wchospital.ca Accepted 14 December 2009. Published Online 29 January 2010. Background Although much is known about the risk factors for postpartum depression (PPD), the role of giving birth to a preterm or low-birth-weight infant has not been reviewed systematically. Objective To review systematically the prevalence and risk factors for PPD among women with preterm infants. Search strategy Medline, CINAHL, EMBASE, PsycINFO and the Cochrane Library were searched from their start dates to August 2008 using keywords relevant to depression and prematurity. Selection criteria Peer-reviewed articles were eligible for inclusion if a standardised assessment of depression was administered between delivery and 52 weeks postpartum to mothers of preterm infants. Data collection and analysis Data on either the prevalence of PPD or mean depression score in the target population and available comparison groups were extracted from the 26 articles included in the review. Risk factors for PPD were also extracted where reported. Main results The rates of PPD were as high as 40% in the early postpartum period among women with premature infants. Sustained depression was associated with earlier gestational age, lower birth weight, ongoing infant illness/disability and perceived lack of social support. The main limitation was that most studies failed to consider depression in pregnancy as a confounding variable. Author’s conclusions Mothers of preterm infants are at higher risk of depression than mothers of term infants in the immediate postpartum period, with continued risk throughout the first postpartum year for mothers of very-low-birth-weight infants. Targeted clinical interventions to identify and prevent PPD in this vulnerable obstetric population are warranted. Keywords Depression, low birth weight, postpartum, prematurity. Please cite this paper as: Vigod S, Villegas L, Dennis C-L, Ross L. Prevalence and risk factors for postpartum depression among women with preterm and low-birth-weight infants: a systematic review. BJOG 2010;117:540–550. Introduction Postpartum depression (PPD) affects approximately 10–15% of women and is one of the most common com- plications of child-bearing. 1 The consequences of PPD for both mother and infant are well established: women who suffer from PPD are twice as likely to experience future episodes of depression over a 5-year period. 1 PPD can also impair maternal–infant interactions, leading to attachment insecurity, developmental delay and social interaction diffi- culties in affected children. 2–6 Risk factors for PPD have been examined in three meta- analyses, indicating that the strongest predictors of PPD include depression or anxiety during pregnancy, personal and family history of depression, lack of social support and stressful life events. 1,7,8 However, as most women who become depressed do not necessarily have personal and family histories of depression, it is important to focus on variables that occur more commonly, such as stressful events. Few infant-related variables have been considered in the above-mentioned meta-analyses, yet childcare stress has been identified as having a moderate impact on PPD in 540 ª 2010 The Authors Journal compilation ª RCOG 2010 BJOG An International Journal of Obstetrics and Gynaecology DOI: 10.1111/j.1471-0528.2009.02493.x www.bjog.org Systematic review