Maryam Zamani - Instructor, Department of Midwifery, School of Nursing and Midwifery, Neyshabur University of Medical Sciences, Neyshabur, Iran
Elham Azmoude - Instructor, Department of Midwifery, Neyshabur University of Medical Sciences, Neyshabur, Iran ORCID
Rasoul Alimi - PhD in biostatistics, Department of Public Health, School of Health, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Iran
Nahid Marvi - PhD student of Reproductive Health, Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
Sedigheh Abdollahpour - PhD of Reproductive Health, Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran

Background: Postpartum depression is a serious mood disorder that affects the physical and mental health of mothers and infants. Some studies have reported the relationship between postpartum depression and breastfeeding. This study aimed to assess the effect of postnatal depression on exclusive breastfeeding.Design: A systematic review and meta-analysisMethods: A systematic literature search in English was conducted using PubMed, Google Scholar, Scopus, Web of Science, and Cochrane Library Databases from their start dates until February ۲۰۲۱. Outcome estimates were pooled by odds ratios (ORs). Forest plots were used to express the results of each study and the heterogeneity among studies, and a potential source of heterogeneity was investigated using subgroup analysis. Statistical analyses were implemented using Stata version ۱۷.۰.Result: Women with postpartum depression significantly had ۲.۱۷ times (۹۵% CI, ۱.۵۰-۳.۱۶; P < .۰۰۱) higher odds of nonexclusive breastfeeding than those without postpartum depression. Also, the random effect meta-analysis showed that non-exclusive breastfeeding was ۷۵ percent (OR ۱.۷۵, ۹۵% CI ۱.۴۶-۲.۰۹) greater in depressed mothers than in their non-depressed counterparts in studies using cut point ≥۱۲ as a standard symptom of depression for the EPDS scale. There was no heterogeneity in estimating this pooled effect size. Conclusion: Women with postpartum depressive symptoms are vulnerable to discontinuation of exclusive breastfeeding

Postpartum depression, postnatal depression, breastfeeding, lactation, exclusive breastfeeding