The effect of skin-to-skin care on postpartum depression among mothers of preterm or low birthweight infants: A systematic review and meta-analysis

Abstract

Background: Mothers of preterm or low birthweight (LBW) infants are at two to three times greater risk of postpartum depression (PPD) than mothers of healthy infants, which may be partially due to mother-infant separation during hospitalization. Skin-to-skin care could protect against PPD among these vulnerable mothers. We examined the effect of skin-to-skin care on PPD among mothers of preterm or LBW infants through a systematic review and meta-analysis.

Methods: We searched six peer-reviewed databases for prospective studies of skin-to-skin interventions that took place in neonatal intensive care units (NICUs), used a validated PPD tool, and were published in English between 1979 and 2017. Data were standardized and pooled using Hedges method in a quality-weighted meta-analysis.

Results: Eight studies detailing seven interventions met inclusion criteria. Intervention characteristics varied with duration ranging from one week to over two months, skin-to-skin sessions ranging from 15 min to 1 h, and frequency ranging from thrice daily to thrice weekly. Five PPD tools were used predominantly as continuous measures. Meta-analysis demonstrated that skin-to-skin interventions were associated with a 1.04% reduction in standardized depression scores versus standard care (p < 0.001), though high heterogeneity was evident (I² = 82.4%, p < 0.001).

Limitations: Studies differed markedly with respect to design and intervention features, and were methodologically limited by using continuous depressive scores (not dichotomous PPD diagnoses) as the outcome.

Conclusions: Skin-to-skin care has a small protective effect on maternal depressive scores, however the clinical relevance of this finding is arguably minimal. Additional well-designed studies are warranted to conclusively assess the effects of skin-to-skin on PPD.

Keywords: Abbreviations: PPD, postpartum depression; LBW, low birthweight; Low birth weight infant; NICU, neonatal intensive care unit; Neonatal intensive care unit; Postpartum depression; Preterm infant; Skin-to-skin care.