Oestrogens and progestins for preventing and treating postpartum depression

 

Abstract

Background

Postpartum depression is a common complication of childbirth, affecting approximately 13% of women. A hormonal aetiology has long been hypothesised due to the sudden and substantial fluctuations in concentrations of steroid hormones associated with pregnancy and the immediate postpartum period. There is also convincing evidence that oestrogens, progestins, and related compounds have important central nervous system activity at physiological concentrations.

Objectives

The primary objective of this review was to assess the effects of oestrogens and progestins, including natural progesterone and synthetic progestogens, compared with placebo or usual antepartum, intrapartum, or postpartum care in the prevention and treatment of postpartum depression.

Search methods

We searched The Cochrane Pregnancy and Childbirth Group's Trials Register (March 2010), scanned secondary references and contacted experts in the field.

Selection criteria

All published and unpublished randomised controlled trials comparing an oestrogen and progestin intervention with a placebo or usual antepartum, intrapartum, or postpartum care among pregnant women or new mothers recruited within the first year postpartum.

Data collection and analysis

Two review authors participated in the evaluation of methodological quality, data extraction, and data analysis. Results are presented using relative risk for categorical data and weighted mean difference for continuous data.

Main results

Two trials, involving 229 women, met the selection criteria. Norethisterone enanthate, a synthetic progestogen, administered within 48 hours of delivery was associated with a significantly higher risk of developing postpartum depression. Oestrogen therapy was associated with a greater improvement in depression scores than placebo among women with severe depression.

Authors' conclusions

Synthetic progestogens should be used with significant caution in the postpartum period. The role of natural progesterone in the prevention and treatment of postpartum depression has yet to be evaluated in a randomised, placebo-controlled trial. Oestrogen therapy may be of modest value for the treatment of severe postpartum depression. Its role in the prevention of recurrent postpartum depression has not been rigorously evaluated. Further research is warranted.

 

Plain language summary

Oestrogens and progestins for preventing and treating postpartum depression

Additional research needed to evaluate the effect of oestrogens for the prevention and treatment of postpartum depression but synthetic progesterones should not be administered.

Postpartum depression is a common complication of childbirth, affecting approximately 13% of women. A hormonal aetiology has long been hypothesised due to the sudden and substantial fluctuations in concentrations of steroid hormones associated with pregnancy and the immediate postpartum period. This review of two trials, involving 229 women, found synthetic progestogens do not prevent the development of postpartum depression and, due to their significant negative effect on maternal mood, their administration in the postpartum period for other clinical indications (e.g., contraception) is questionable. The prophylactic effect of natural progesterone remains unknown. Despite the promising preliminary findings, additional research is also needed before oestrogens can be recommended for the routine treatment of postpartum depression. Its role in the prevention of recurrent postpartum depression has not been rigorously evaluated. Further research is warranted.

 

摘要

背景

使用雌激素(oestrogens)與黃體激素(progestin)以預防和治療產後憂鬱症

產後憂鬱症是一種常見的生產併發症，它影響大約13% 的婦女。它的病因長期被假定為懷孕期和產後時期突發且大量類固醇荷爾蒙的濃度變動所造成，另有具有說服力的證據指出雌激素、黃體素以及相關的化合物在生理濃度時具有重要的中樞神經系統活性。

目標

本文獻回顧的主要目的是評估雌激素與黃體素(包括天然的黃體酮(progesterone)與合成的黃體素(progestogens))，在預防及治療產後憂鬱症的效果，並與安慰劑或常用的產前、生產中或產後照護作比較。

搜尋策略

我們搜尋了The Cochrane Pregnancy and Childbirth Group trials register(2004年6月)、the Cochrane Depression Anxiety and Neurosis Group trials register(2004年7月)、the Cochrane Central Register of Controlled Trials(2004年7月)、MEDLIN (1966年到2004年)、EMBASE(1980年到2004年)以及CINAHL(1982年到2004年)，我們也參考文獻並聯絡了該領域的專家。

選擇標準

所有比較使用雌激素和黃體素與安慰劑或常用的產前、生產中或產後照護的已發表和未發表之隨機對照試驗，對象則是懷孕的婦女或是在產後第1年內的新手媽媽。

資料收集與分析

2位回顧作者參與了方法品質評估、資料選用以及資料分析。若為類別型的資料，結果以相對風險(RR)呈現；若為連續性資料，結果以加權平均差(weighted mean difference)呈現。

主要結論

有2個試驗共229名婦女符合選擇的標準。產後48小時內服用炔諾酮庚酸酯(norethisterone enanthate)(一種合成的黃體素)很明顯地具有較高的風險引發產後憂鬱症，而患有嚴重憂鬱症的婦女接受雌激素療法在憂鬱量表分數方面比安慰劑帶來更多的進步。

作者結論

產後使用合成的黃體素應該要更加注意。在預防與治療產後憂鬱症方面，天然黃體酮的角色還需要隨機的安慰劑對照試驗來加以評估。雌激素療法在治療嚴重產後憂鬱方面可能價值不大，它在預防產後憂鬱症復發方面的角色也還沒有被嚴格地評估過，因此還需要有更深入的研究。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

雖然還需要有更多的研究來評估雌激素用於預防與治療產後憂鬱症的效果，但是仍不應該給予合成的黃體酮。產後憂鬱症是一種常見的生產併發症，它影響約13% 的婦女。它的病因長期被假定為懷孕期和產後時期突發且大量類固醇荷爾蒙的濃度變動所造成。此文獻回顧發現合成的黃體素不能預防產後憂鬱症的發生，而且因為它對於母親的心情有明顯的負面影響，所以在產後的期間因其他臨床適應症(例如避孕)而給予這個藥物，仍值得商榷的。此外，天然的黃體酮的預防效果還是未知的。儘管有一些有利的初步發現，在雌激素被建議作為產後憂鬱症的例行性治療前還需要有更多的研究來評估。它在預防產後憂鬱症復發方面的角色也還沒有被嚴格地評估過，因此還需要有更深入的研究。