ABSTRACT
OBJECTIVE: To perform a meta-analysis and comparison between high-income, and low- and middle-income countries postpartum depression symptoms prevalences. METHODS: PubMed, Embase, Virtual Health Library, Scopus, Web of Science, PsycINFO and CINAHL databases were searched until October 2022 for studies that collected data from pandemic. The metaprop command was used in the Stata statistical software v.12.0 to run a random-effects meta-analysis. RESULTS: A total of 15 studies with 4,788 postpartum women were included. The overall prevalence of postpartum depression symptoms was 31% (95% CI: 21.85-40.99). The pooled prevalence of postpartum depression symptoms among women from high-income countries [30.5% (95% CI: 16.95-46.02)] did not differ significantly from that among women from low- and middle-income countries [31.5% (95% CI: 19.26-45.15)]. However, studies that analyzed women up to one month after childbirth had a lower prevalence of postpartum depression symptoms [17.5% (95% CI: 9.85-26.62)] compared to those that observed them up to one year after childbirth [38.3% (95% CI: 33.96-42.83)]. CONCLUSIONS: The prevalence of postpartum depression symptoms was high regardless of the country's human development index and it must be regularly tracked around the world to assess, discuss, and recommend more assertive steps that may be implemented based on the particular characteristics of each country.
ABSTRACT
Introdução: Alguns estudos verificaram que a vacinação contra o coronavírus SARS COV-2 induz resposta efetiva de titulação de anticorpos neutralizantes no sangue e leite materno. No entanto, a maioria dos artigos publicados considerou a transferência de imunidade mãe-feto em mulheres recuperadas da COVID-19 e não vacinadas e/ou analisaram leite e/ou sangue isoladamente. Objetivo: Comparar o quantitativo de anticorpos neutralizantes contra o SARS-CoV-2 no leite e no sangue das lactantes vacinadas em relação àquelas não vacinadas. Métodos: Revisão sistemática nas bases de dados Biblioteca Virtual em Saúde, Pubmed, Embase, Web of Science e Scopus de acordo com as diretrizes do PRISMA e registrada no PROSPERO sob o n° CRD42021287554. Foram elegíveis estudos de coorte, caso-controle e transversal que avaliaram a presença de anticorpos neutralizantes contra o SARS-CoV-2 no leite e no sangue de lactantes vacinadas e que tiveram como grupo controle lactantes não vacinadas. Por sua vez, foram excluídos relatos de casos, revisão sistemática com ou sem meta-análise, artigos que analisaram os anticorpos em mulheres infectadas ou não lactantes, e ainda aqueles que não trouxeram nos seus resultados os dados de comparação entre os grupos que receberam ou não a vacina. Foi avaliado o risco de viés de todos os artigos incluídos através da ferramenta de avaliação Newcastle-Ottawa Scale. Resultados: As buscas nas bases de dados identificaram 233 registros. Após a remoção de 128 que estavam duplicados, foram lidos os títulos e resumos de 105 e excluídos 94 destes. Com a leitura na íntegra de 11 artigos, 4 estudos de coorte foram considerados elegíveis e, incluídos nesta revisão sistemática. Os resultados destes estudos apontaram que, após a vacinação com os imunizantes Pfizer-BioNTech e Moderna, as lactantes apresentaram níveis elevados de anticorpos neutralizantes IgG e IgA anti-SARS-CoV-2 tanto no sangue quanto no leite materno, sendo o nível sanguíneo consideravelmente maior. Conclusão: Como ainda não existem vacinas disponíveis para uso em menores de seis meses e as lactantes vacinadas contra o vírus SARS-CoV-2 apresentam maior expressão de anticorpos em relação àquelas não vacinadas, é provável que, além da proteção materna contra COVID-19, a imunização também forneça imunidade neonatal através da amamentação.
Introduction: Some studies have found that vaccination against the SARS-COV-2 coronavirus induces an effective titration response of neutralizing antibodies in blood and breast milk. However, most published articles considered the transfer of mother fetus immunity in women recovered from COVID-19 and not vaccinated and/or analyzed milk and/or blood alone. Objective: To compare the amount of neutralizing antibodies in the milk and blood of vaccinated infants for SARS-CoV-2. Methods: Systematic review in the Virtual Health Library, Pubmed, Embase, Web of Science and Scopus databases in accordance with PRISMA guidelines and registered in PROSPERO under number CRD42021287554. Cohort, case-control and cross-sectional studies that evaluated the presence of neutralizing antibodies against SARS-CoV-2 in the milk and blood of vaccinated infants and that had unvaccinated infants as a control group were eligible. In turn, case reports, systematic review with or without meta-analysis, articles that analyzed antibodies in infected or non-lactating women, and even those that did not bring in their results data for comparison between the groups that received or not the vaccine. The risk of bias of all included articles was assessed using the Newcastle Ottawa Scale assessment tool. Results: Database searches identified 233 records. After removing 128 that were duplicates, the titles and abstracts of 105 were read and 94 were excluded. With the full reading of 11 articles, 4 cohort studies were considered eligible and included in this systematic review. The results of these studies showed that, after vaccination with the immunizers Pfizer-BioNTech and Moderna, the nursing mothers had high levels of anti-SARS-CoV-2 IgG and IgA neutralizing antibodies both in the blood and in breast milk, with the blood level considerably bigger. Conclusion: As there are still no vaccines available for use in infants under six months of age and lactating women vaccinated against the SARS-CoV-2 virus have a higher expression of antibodies compared to those not vaccinated, it is likely that, in addition to maternal protection against COVID-19, immunization also provides neonatal immunity through breastfeeding.
