Prophylactic Effect Of Probiotics On Perinatal Depression:A Systematic Review And Meta-analysis

Background:Perinatal depression is a psychiatric disease which can cause serious harm to both maternal and child health and family relationship.Recent studies have found that gut microbiota can regulate brain function through metabolic,immune and neuroendocrine pathways.Previous clinical studies have shown that probiotics have a certain therapeutic effect on patients with severe depression,so people expect to use probiotics to treat perinatal depression,but the evidence to support it is limited.Objective:To evaluate the prophylactic effect of probiotics on perinatal depression and provide evidence-based reference for further clinical application.Method:PubMed、Embase、Medline、Cochrane、Web of Science、ProQuest、CNKI,VIP database and Wanfang database were searched to collect randomized controlled trials(RCTs)comparing the use of probiotics versus placebo for the treatment of perinatal depression.Two researchers screened and extracted data,and assessed the risk of bias of included trials.Review Manager(RevMan)5.3 was used for Meta analysis,sensitivity test and publication bias test.Results:Two review authors independently retrieved the database using the designed search strategy,and three randomized controlled studies(n=585)were finally included in qualitative synthesis.Heterogeneity was detected between the studies and the random effect model was used to analyze.There is no difference in the improvement of the EPDS score between the probiotics group and the placebo group.Further subgroup analyze showed that the beneficial effect of probiotics on EPDS score was significant in postnatal,but not in antenatal.GRADE evidence quality was rate as extremely low.Conclusion:The certainty of evidence is very low and we are uncertain if probiotics have any therapeutic effect on perinatal depression,thus offering limited implication for clinical practice.In the future,more high-quality studies on healthy pregnant women are needed,and further research is needed on the optimal options of probiotic strains,doses,intervention initiation weeks and intervention duration.