Revi ewer’s report  
 
Title: The Association Between Labor Epidural Analgesia and Postpartum Depression A  
Systematic Review and Meta -Analysis  
 
Version: 1 Date: 27 Dec 2019  
 
Reviewer: Vahideh Moghaddam Hosseini  
 
Reviewer's report:  
 
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I am thankful for authors' attention to this important and challenging issue. Hopefully, The result 
of this study leads to reconsidering the current belief regarding the positive effect of LEA on 
improving PPD.  
 
There are just some minor recommendations:  
 
-Inclusion and exclusion criteria, line 38: the designs of all included studies are observational - 
prospective cohort that it is not equal to non -randomized (observational) trials. There was not 
conducted any exp erimental trials.   
 
- There has not been pointed to the parity (primipara vs multipara) of participants. You should 
assess heterogeneity in this regard or even, addition to the presented results, make two groups of 
primi and multipara and then, run the an alysis for each group, separately.  
 
Are the methods appropriate and well described?  
If not, please specify what is required in your comments to the authors.  
 
Yes 
 
Does the work include the necessary controls?  
If not, please specify which controls are required in your comments to the authors.  
 
Unable to assess  
 
Are the conclusions drawn adequately supported by the data shown?  
If not, please explain in your comments to the authors.  
 
Yes 
 
 
Are you able to assess any statistics in the manuscript or would you recommend an  
additional statistical review?  
If an additional statistical review is recommended, please specify what aspects require further  
assessment in  your comments to the editors.  
 
I recommend additional statistical review  
 
Quality of written English  
Please indicate the quality of language in the manuscript:  
 
Acceptable  
 
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