A systematic review and meta-analysis found that urinary incontinence was associated with a 45% increased risk of postpartum depression.

The study, published in the American Journal of Obstetrics & Gynecology, synthesized data from 11 published studies involving 92,974 participants.

Key findings included:

• An overall odds ratio (OR) for the association between urinary incontinence and postpartum depression of 1.45 (95% confidence interval [CI] = 1.11–1.79; 95% prediction interval = 0.49–2.40; I²=65.9%; P = .001)
• An OR for cohort studies (n=7,91,544 participants) of 1.63 (95% CI, 1.35–1.91; 95% prediction interval, 1.14–2.13; I²=11.1%; P = .345)
• An OR for cross-sectional studies (n=4, 1430 participants) of 1.05 (95% CI, 1.04–1.05; 95% prediction interval, 1.04–1.06; I²=0.0%; P = .413).

Subgroup analyses based on time after delivery showed:

• < 6 months postpartum (4 studies, 4,573 participants): OR = 1.44 (95% CI = 1.07–1.81; I²=0.0%; P = .603)
• ≥ 6 months postpartum (5 studies, 89,502 participants): OR = 1.53 (95% CI = 1.16–1.89; prediction interval, 0.41–2.65; I²=50.7%; P = .087).

Analysis Details

The researchers searched MEDLINE, Embase, Cochrane Library, Web of Science, and PsycINFO databases from inception to December 26, 2023. They included cross-sectional and cohort studies addressing the association between urinary incontinence and postpartum depression.

A DerSimonian and Laird random-effects model was used to estimate pooled odds ratios, 95% CIs, and 95% prediction intervals. The risk of bias was assessed using the National Institutes of Health Quality Assessment Tool for Observational Cohort Studies.

The included studies were published between 2000 and 2023, with cohort sizes ranging from 204 to 83,066 participants. Maternal age ranged from 15 to 40 years, and the postpartum period examined spanned from 25 days to 1 year after delivery.

Additional Findings

In the total study population, spontaneous vaginal delivery was the most common delivery type; the number of deliveries for the participants ranged from one to five; between 4.5% and 16.4% of women were single, divorced, or widowed; and 18.6% to 97.5% had attained university or professional school education.

Most studies used the Edinburgh Postnatal Depression Scale (EPDS) to measure postpartum depression, with varying cutoff scores: six studies used a cutoff of 9–10, while four studies used a cutoff of 12–13.

One study used diagnostic codes for depressive episodes associated with the puerperium.

The researchers noted heterogeneity among adjustment variables, but most studies accounted for maternal age, marital status, delivery type, number of deliveries, and depression history.

Sensitivity analyses revealed:

• A significant modification of pooled OR for cross-sectional studies when removing data from Doering et al and Ganann et al
• A significant modification of pooled OR for studies with postpartum periods <6 months when removing data from Sword et al and Fritel et al
• No significant modification of pooled OR for cohort studies overall or for those with postpartum periods ≥6 months.

Meta-regression models found:

• No significant results for maternal age (β = 0.02, 95% CI = –0.22 to 0.26, P = .875)
• No significant results for percentage of vaginal deliveries (β = 1.20, 95% CI = –2.20 to 4.60, P = .407)
• Significant results for percentage of primiparous women (β = 1.67, 95% CI = 0.17–3.18, P = .034).

The study had several limitations, including temporal ambiguity in study designs, insufficient data on potential confounding factors, limited reporting of adjusted data, lack of information on specific types of urinary incontinence, and variability in EPDS cutoff scores across studies.

The study authors concluded, "This systematic review and meta-analysis suggests that urinary incontinence may be a potential predictor of postpartum depression. Thus, it is important that health care professionals offer support and treatment options to women who experience these conditions."

The authors reported no conflict of interest.