産後うつ病予防における補完代替医療の有効性評価：ターゲットトライアル模倣研究

Subject: This study aims to evaluate the effectiveness of Complementary and Integrative Health (CIH) therapies in reducing the incidence and severity of Postpartum Depression (PPD) using real-world data and target trial emulation. Methods: Using electronic health records (EHR) from a large healthcare system, we emulated target trials for CIH approaches including acupuncture, chiropractic, aromatherapy, and omega-3 fatty acids. CIH usage was identified and extracted from clinical notes using natural language processing (NLP) techniques. Logistic regression-based propensity score matching was employed to address confounding factors. The primary outcome was the incidence of PPD within 12 months postpartum, defined by diagnostic codes or antidepressant initiation. Secondary outcomes included changes in PHQ-9 scores and subgroup analyses by treatment type. Results: For the primary outcome, none of the treatments significantly reduced PPD risk intervals (CIs). However, omega-3 fatty acids and chiropractic care significantly reduced PHQ-9 scores in the treatment groups (omega-3 fatty acids: p<0.001, chiropractic care: p = 0.021), with no comparable improvements in controls. Aromatherapy showed mixed results, with reduced severe depression in the treatment group but increased severity in controls. Acupuncture had no significant effect (p > 0.05). These findings suggest that omega-3 fatty acids and chiropractic care may alleviate PPD symptoms, while the effects of aromatherapy, acupuncture and chiropractic remain inconclusive and warrant further investigation. Conclusion: This study provides approach to evaluating CIH interventions in real-world settings. These findings underscore the importance of integrating non-traditional treatment options into clinical practice to improve outcomes for individuals affected by PPD.