Risk for postpartum depression associated with assisted reproductive technologies and multiple births: a systematic review.
BACKGROUND
It has been hypothesized that certain obstetrical populations, including women who conceive using assisted reproductive technologies (ART) and women with multiple births, may be at increased risk for postpartum depression. In this systematic literature review, we examine the published evidence for this hypothesis.


METHODS
The databases Medline, CINAHL, EMBASE, PsycINFO and the Cochrane Library were searched from their start dates through to April 1, 2009 using relevant keywords. All published, peer-reviewed articles in English, Spanish or French including a standardized assessment of depression administered between 2 and 52 weeks postpartum were considered for inclusion. Two independent reviewers abstracted and critically appraised a total of 13 eligible articles.


RESULTS
The data indicate little or no increased risk for postpartum depression among women who use ART to conceive. In contrast, most studies of adequate quality indicate that mothers of multiples may be at elevated risk for symptoms of depression. However, existing data do not permit differentiation between transient maternal distress and clinically significant postpartum depression.


CONCLUSIONS
Studies included in this review were often limited by small samples and lack of appropriate comparison groups, making further research in this area essential. In particular, lack of control for maternal psychiatric history and other important sociodemographic predictors of depression is a serious limitation of existing research on this topic. Further, the use of reproductive technologies and multiple births often co-occur, and few study designs enabled separation of the effects of these two variables. However, evidence of increased risk for symptoms of postpartum depression among women with multiple births, if confirmed, may warrant targeted interventions for this population.
Ross
Lori E
LE
Social Equity & Health Research Section, Centre for Addiction & Mental Health, Toronto, Canada. l.ross@utoronto.ca
McQueen
Karen
K
Vigod
Simone
S
Dennis
Cindy-Lee
CL
D019052:Depression, Postpartum / Q000209:etiology*; D005260:Female; D006801:Humans; D011247:Pregnancy; D011272:Pregnancy, Multiple / Q000523:psychology*; D027724:Reproductive Techniques, Assisted / Q000009:adverse effects*; D012307:Risk Factors