Reliability of Evidence to Guide Decision-Making in the Use of Acupuncture for Postpartum Depression

Hu, Xiu-Wu; Fan, Quli; Ma, Li; Jin, Rui; Gong, Rui; Zhao, Xiaoying; Qiu, Fenfen; Zhou, Liang

doi:10.3389/fpubh.2022.942595

Cited by 3 publications

(4 citation statements)

References 29 publications

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“…Acupuncture may mediate complex processes involving interactions between physical and physiological factors [ 62 ]. Acupuncture seems effective in treating postpartum depression [ 63 ], which may be a contributing factor to PH [ 64 ]. However, no study has measured the emotional status of women with PH.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of acupuncture for postpartum hypogalactia: A systematic review and meta-analysis of randomized controlled trials

Bao,

Yin,

Zhou

et al. 2024

PLoS ONE

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Background Postpartum hypogalactia (PH) is prominent during lactation and may negatively impact the mother’s or infant’s health. Acupuncture is widely used to increase maternal breast milk production. However, the effects of acupuncture on PH remain unclear. Therefore, this review aimed to evaluate the efficacy and safety of acupuncture in individuals with PH. Materials and methods Articles on potentially eligible randomized controlled trials (RCTs) on acupuncture for PH published from database inception to October 2023 were retrieved from the PubMed, Web of Science, Cochrane Library, EMBASE, EBSCO, Scopus, China National Knowledge Infrastructure, Chinese Biomedical Literature Database, WanFang, and VIP databases. Two reviewers independently screened the records, extracted essential information, and evaluated the methodological quality of the RCTs using the revised Cochrane risk-of-bias (RoB) tool. The primary outcome was a change in serum prolactin (PRL) levels before and after treatment. Secondary outcomes included milk secretion volume (MSV), total effective rate (TER), mammary fullness degree (MFD), and exclusive breastfeeding rate (EBR). Meta-analyses were performed using RevMan v5.4. Finally, the quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation tool. Results This study included 19 RCTs involving 2,400 participants. The included studies were classified as having an unclear to high RoB. Our findings indicated that, overall, acupuncture showed a significant effect in increasing serum PRL levels (standardized mean differences [SMDs] = 1.09, 95% confidence interval [CI]: 0.50, 1.68), MSV (SMD = 1.69, 95% CI: 0.53, 2.86), TER (relative risk [RR] = 1.25, 95% CI: 1.10, 1.42), and EBR (RR = 2.01, 95% CI: 1.07, 3.78) compared to that in the control group; however, no difference in MFD (SMD = 1.17, 95% CI: –0.09, 2.42) was observed. In the subgroup analysis, acupuncture combined with Chinese herbs or conventional treatment was significantly more effective in increasing serum PRL levels, MSV, and TER than did Chinese herbs or conventional treatment alone. Moreover, acupuncture alone resulted in significantly higher serum PRL levels compared to Chinese herbs; however, this benefit was not observed for TER and MFD. The quality of evidence was critically low. Conclusion Acupuncture may effectively increase milk secretion in women with PH. However, owing to the low quality of evidence, further rigorously designed studies are warranted to confirm our findings.

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Section: Discussionmentioning

confidence: 99%

Efficacy and safety of acupuncture for postpartum hypogalactia: A systematic review and meta-analysis of randomized controlled trials

Bao,

Yin,

Zhou

et al. 2024

PLoS ONE

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“…Previous meta-analyses ( 42 , 43 ) have shown the potential benefits of acupuncture, including manual acupuncture, moxibustion and other techniques for PPD ( 44 – 46 ), but did not specifically discuss the efficacy and safety of EA in PPD treatment. Therefore, this meta-analysis aims to further explore the efficacy and safety of EA in treating PPD.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of electroacupuncture in patients with postpartum depression: a meta-analysis

Fang,

Wang,

Zheng

et al. 2024

Front. Psychiatry

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ObjectiveThis study aimed to assess the clinical effectiveness and safety of electroacupuncture (EA) for the treatment of postpartum depression (PPD).MethodsWe systematically retrieved relevant randomized controlled trials (RCTs) from electronic databases, including PubMed, Cochrane Library, China National Knowledge Infrastructure, EMBASE, China Science and Technology Journal Database, Chinese Biological Medical Database, and the Wanfang database from their inception to November 2023. The outcomes measured were the Hamilton Depression Rating Scale (HAMD) scores, Edinburgh Postnatal Depression Scale (EPDS) scores, adverse events (AEs), and the total response rate. The study aimed to estimate heterogeneity, publication bias, mean difference (MD), and risk ratios (RR) with 95% confidence intervals (CIs).ResultsThis study included 12 RCTs with a total of 1364 participants (571 in the treatment group and 793 in the control group) for analysis. The results of the meta-analysis indicated that EA did not significantly reduce HAMD (MD = 1.49, 95% CI = [−0.30, 3.27], P = 0.1, I2 = 0%) and EPDS (MD = 1.12, 95% CI = [−1.62, 3.85], P = 0.42, I2 = 32%) scores compared to sham EA among patients with PPD, resulting in low heterogeneity. In terms of the total response rate, the EA group exhibited superior results compared to the placebo group (RR = 1.77, 95% CI = [1.15, 2.74], P = 0.01, I2 = 0%) and the sham EA group (RR = 1.2, 95% CI = [1.02, 4.4], P = 0.02, I2 = 0%), with statistical significance and low heterogeneity. The incidence of AEs was lower, also with low heterogeneity (RR = 0.9, 95% CI = [0.57, 1.43], P = 0.66, I2 = 12%).ConclusionThe current evidence indicates that the effectiveness and safety of EA in the treatment of PPD warrant affirmation. However, EA does not demonstrate superiority over sham EA in reducing HAMD and EPDS scores in patients with PPD. Due to the limited quantity and quality of curent research, the above conclusion should be further validated through high-quality studies to confirm the efectiveness of EA in PPD management.Systematic review registrationhttps://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=318917, identifier CRD42023318917.

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“…A recent meta-analysis included six systematic reviews/meta-analyses of acupuncture for PPD to assess its effectiveness. Three of them reported that acupuncture was more effective than controls, and three found no difference, making it difficult to draw consistent conclusions (Hu et al, 2022 ). In summary, the current study confirms that acupuncture has some efficacy in the treatment of PPD, but the mechanism is unclear, and the evidence is insufficient.…”

Section: Discussionmentioning

confidence: 99%

“…It can play a role in alleviating depressive symptoms by toning down emotions and harmonizing qi and blood (Yan et al, 2021 ). Nevertheless, the mechanisms of action behind the beneficial effects of acupuncture for PPD are controversial, and there is still a lack of strong evidence for its effectiveness and safety (Yang et al, 2018 ; Hu et al, 2022 ).…”

Section: Introductionmentioning

confidence: 99%

Structural and functional improvement of amygdala sub-regions in postpartum depression after acupuncture

Huang

Zhuo

Wang

et al. 2023

Front. Hum. Neurosci.

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ObjectiveThis study aimed to analyze the changes in structure and function in amygdala sub-regions in patients with postpartum depression (PPD) before and after acupuncture.MethodsA total of 52 patients with PPD (All-PPD group) were included in this trial, 22 of which completed 8 weeks of acupuncture treatment (Acu-PPD group). An age-matched control group of 24 healthy postpartum women (HPW) from the hospital and community were also included. Results from the 17-Hamilton Depression Scale (17-HAMD) and the Edinburgh Postnatal Depression Scale (EPDS) were evaluated, and resting-state functional magnetic resonance imaging (rs-fMRI) scans were performed at baseline and after the acupuncture treatment. Sub-regions of the amygdala were used as seed regions to measure gray matter volume (GMV) and analyzed for resting-state functional connectivity (RSFC) values separately. Finally, correlation analyses were performed on all patients with PPD to evaluate association values between the clinical scale scores, GMV, and RSFC values, while controlling for age and education. Pearson's correlation analyses were conducted to investigate the relevance between GMV and RSFC values of brain regions that differed before and after acupuncture treatment and clinical scale scores in Acu-PPD patients.ResultsThe HAMD scores for Acu-PPD were reduced after acupuncture treatment (P < 0.05), suggesting the positive effects of acupuncture on depression symptoms. Structurally, the All-PPD group showed significantly decreased GMV in the left lateral part of the amygdala (lAMG.L) and the right lateral part of the amygdala (lAMG.R) compared to the HPW group (P < 0.05). In addition, the GMV of lAMG.R was marginally increased in the Acu-PPD group after acupuncture (P < 0.05). Functionally, the Acu-PPD group showed a significantly enhanced RSFC between the left medial part of the amygdala (mAMG.L) and the left vermis_6, an increased RSFC between the right medial part of the amygdala (mAMG.R) and left vermis_6, and an increased RSFC between the lAMG.R and left cerebelum_crus1 (P < 0.05). Moreover, correlation studies revealed that the GMV in the lAMG.R was significantly related to the EPDS scores in the All-PPD group (P < 0.05).ConclusionOur findings demonstrated that the structure of amygdala sub-regions is impaired in patients with PPD. Acupuncture may improve depressive symptoms in patients with PPD, and the mechanism may be attributed to changes in the amygdala sub-region structure and the functional connections of brain areas linked to the processing of negative emotions. The fMRI-based technique can provide comprehensive neuroimaging evidence to visualize the central mechanism of action of acupuncture in PPD.

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Reliability of Evidence to Guide Decision-Making in the Use of Acupuncture for Postpartum Depression

Cited by 3 publications

References 29 publications

Efficacy and safety of acupuncture for postpartum hypogalactia: A systematic review and meta-analysis of randomized controlled trials

Efficacy and safety of acupuncture for postpartum hypogalactia: A systematic review and meta-analysis of randomized controlled trials

Efficacy and safety of electroacupuncture in patients with postpartum depression: a meta-analysis

Structural and functional improvement of amygdala sub-regions in postpartum depression after acupuncture

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