Management of major depressive disorders in pregnant or breastfeeding women in primary care: a systematic meta-review

Background Major depressive disorders (MDDs) are common during the perinatal period, with a prevalence around 12%. General practitioners are increasingly involved in the management of these disorders, but no specific recommendations have been developed for primary care. The objective was to review the literature on the detection, treatment and follow-up of MDD in pregnant and breastfeeding women in primary care. Methods A systematic meta-review was carried out to synthesize the findings of systematic reviews, meta-analyses, and Good Practice Guidelines published between 2002 and 2021. PubMed, Cochrane and ISI Web of Science databases were searched. Methodological and quality assessment was done using the AGREE II, PRISMA and R-AMSTAR grids. A narrative synthesis was elaborated. Results In total, 34 articles were included. The use of psychotherapy alone by cognitive-behavioral therapy (CBT) or interpersonal psychotherapy (ITP) was recommended as first-line therapy in mild and moderate MDD in 7 guidelines included in our review. The 14 systematic reviews, meta-analyses included confirm their efficacy with a slight superiority of CBT as compared to IPT (OR, 2.00; 95% CI, 1.61 to 2.48); Standardized mean differences (SMD) between -2.86 (95% CI from -4.41 to -1.31) and -0.61 (95% CI from 0.73 to -0.49), depending on the study) (OR, 0.68; 95% CI, 0.55 to 0.84); SMD between 0.39 (95% CI 0.18 to 0.61) and 1.41 (95% CI % from 0.96 to 1.86)). All of the Good Practice Guidelines included recommend pharmacotherapy in second intention, if it represents the most suitable therapeutic option. Selective serotonin reuptake inhibitors (in particular sertraline) are preferred, because there are suitable during pregnancy and breastfeeding in 6 of the systematic reviews included, nevertheless, they all mention the lack of high-quality clinical trial in their limits. The same limitation was highlighted in the 8 studies that focused on complementary medicine. Conclusion This study provides a synthesis on the management of MDD in pregnant and breastfeeding women in primary care. Further high-quality studies are needed on antidepressants drugs use and complementary medicines to elicit their respective role during the perinatal period.