Labor Analgesia as a Predictor for Reduced Postpartum Depression Scores: A Retrospective Observational Study

Lim, Grace; Farrell, Lia M.; Facco, Francesca; Gold, Michael; Wasan, Ajay D.

doi:10.1213/ane.0000000000002720

Cited by 73 publications

(93 citation statements)

References 22 publications

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“…6,7 In recent years, the association between pain during childbirth and postpartum psychiatric disorders has been investigated. [8][9][10][11] The pain of childbirth has been correlated with postpartum blues, which is characterized as transient mood changes within the first few days after delivery and is rarely associated with complications. [12][13][14] Also, the severity of acute postpartum pain may be an independent risk factor for the development of persistent pain and PPD.…”

Section: Résumémentioning

confidence: 99%

“…Three studies described the LEA technique as a manual bolus of low concentration local anesthetic, with or without opioid, followed by a continuous infusion of local anesthetic solution, with or without opioid. 8,10,21 One study described manually administered boluses of a local anesthetic and opioid solution to maintain labour analgesia. 22 Only one study specified that the labour analgesia may have included a combined spinal-epidural, but the details of the technique were not provided.…”

Section: Search and Screeningmentioning

confidence: 99%

“…22 Only one study specified that the labour analgesia may have included a combined spinal-epidural, but the details of the technique were not provided. 23 Types of postpartum psychiatric disorders The primary objective of most studies (11/17) [8][9][10][11]14,[21][22][23][24][25][26][27][28][29] focused on identifying depressed mood and a positive PPD screen. Five of the 17 studies 25,26,28,30, postpartum PTSD symptoms, and one study 32 focused on postpartum anxiety (Table 1).…”

Section: Search and Screeningmentioning

confidence: 99%

“…Ten of the studies that evaluated PPD symptoms used the Edinburgh Postnatal Depression Scale (EPDS) screening tool. [8][9][10][11]14,21,22,24,27,29 The EPDS is a ten-item self-rating scale used to screen for symptoms that are common in women with PPD. 33 Responses to items are scored from 0 to 3, with a maximum score of 30.…”

Section: Measures Of Psychiatric Disordersmentioning

confidence: 99%

“…The time at which the EPDS was evaluated ranged between two days and six months postpartum. More than half of screening evaluations (6/10) 8,10,11,21,24,25,[27][28][29]31 were completed between four and six weeks postpartum.…”

Section: Measures Of Psychiatric Disordersmentioning

confidence: 99%

See 4 more Smart Citations

Pharmacologic labour analgesia and its relationship to postpartum psychiatric disorders: a scoping review

Munro

MacCormick

Sabharwal

et al. 2020

Can J Anesth/J Can Anesth

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Section: Résumémentioning

confidence: 99%

Section: Search and Screeningmentioning

confidence: 99%

Section: Search and Screeningmentioning

confidence: 99%

Section: Measures Of Psychiatric Disordersmentioning

confidence: 99%

Section: Measures Of Psychiatric Disordersmentioning

confidence: 99%

See 3 more Smart Citations

Pharmacologic labour analgesia and its relationship to postpartum psychiatric disorders: a scoping review

Munro

MacCormick

Sabharwal

et al. 2020

Can J Anesth/J Can Anesth

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Perioperative Adjunctive Esketamine for Postpartum Depression Among Women Undergoing Elective Cesarean Delivery

Chen,

Guo,

et al. 2024

JAMA Netw Open

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ImportancePostpartum depression (PPD) is one of the most common mental health conditions during the perinatal and postpartum periods, which can have adverse effects on both mother and infant.ObjectiveTo investigate the efficacy of perioperative adjunctive esketamine administration after cesarean deliveries in the prevention of PPD.Design, Setting, and ParticipantsA single-center, double-blind, placebo-controlled, randomized clinical trial was conducted from January 1, 2022, to January 1, 2023, at Fujian Provincial Hospital among 298 women aged 18 to 40 years, with an American Society of Anesthesiologists grade I to III classification and singleton full-term pregnancies who were scheduled for elective cesarean deliveries. Primary analyses were performed on a modified intention-to-treat basis.InterventionsPatients were randomly assigned to the esketamine (n = 148) and control (n = 150) groups. Those in the esketamine group received a single intravenous injection of 0.25 mg/kg of esketamine immediately after fetal delivery, followed by 50 mg of esketamine as an adjuvant in patient-controlled intravenous analgesia for 48 hours after surgery. Saline was given to the control group of patients.Main Outcomes and MeasuresThe primary outcome was assessments of PPD symptoms by using the Edinburgh Postnatal Depression Scale (EPDS) at postpartum day 7. Positive screening for PPD was defined as a score of 10 or more points on the EPDS. In addition, the EPDS was analyzed as a continuous variable to evaluate depressive symptoms. Secondary outcomes included the Numeric Rating Scale (NRS) of postoperative pain, along with safety evaluations including adverse events and clinical assessments at postpartum days 14, 28, and 42.ResultsA total of 298 pregnant women were included, with 150 in the control group (median age, 31.0 years [IQR, 29.0-34.0 years]) and 148 in the esketamine group (median age, 31.0 years [IQR, 28.0-34.0 years]). The prevalence of depression symptoms was significantly lower among patients given esketamine compared with controls (23.0% [34 of 148] vs 35.3% [53 of 150]; odds ratio, 0.55; 95% CI, 0.33-0.91; P = .02) on postpartum day 7. In addition, the esketamine group also showed a significantly lower change in EPDS scores (difference of least-squares means [SE], −1.17 [0.44]; 95% CI, −2.04 to −0.31; effect size, 0.74; P = .008). However, there were no differences between the groups in the incidence of positive screening results for PPD or in changes from the baseline EPDS scores at postpartum days 14, 28, and 42. There were no differences in NRS scores at rest and on movement except on movement at 72 hours postoperatively, when scores were significantly lower in the esketamine group (median, 3.0 [IQR, 2.0-3.0] vs 3.0 [IQR, 3.0-3.5]; median difference, 0 [95% CI, 0-0]; P = .03).Conclusions and RelevanceThese results suggest that intravenous administration of esketamine during the perioperative period of elective cesarean delivery can improve depression symptoms during the early postpartum period. However, this antidepression effect may not be universally applicable to patients with low EPDS scores.Trial RegistrationChinese Clinical Trial Registry Identifier: ChiCTR2100054199

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Association between labor and delivery pain and postpartum pain with symptoms and clinical diagnosis of postpartum depression in patients with overweight and obesity

Rajabaliev

LaSorda

Ibarra

et al. 2022

Arch Gynecol Obstet

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Purpose Childbirth pain has been associated with the risk for postpartum depression. However, existing studies have been limited by the use of depression screening tools as outcomes, and none to date have used a structured clinical interview for DSM-V (SCID), which is considered the gold standard for psychiatric diagnoses. This study aimed to quantify the relationships between labor and postpartum pain and postpartum depression diagnosis detected by SCID, as well as depression symptoms detected by the Center for Epidemiological Studies Depression Scale (CESD) screening tool, among a high-risk cohort. Methods The study was a secondary analysis of a prospective observational study of a cohort of women enriched for high risk for depression, i.e., pregnant women originally enrolled in a prospective study investigating factors leading to excessive gestational weight gain. Subjects were assessed prospectively for depression using both SCID and CESD at the third trimester and at 6 months postpartum. Overweight and obesity were defined as pre-gravid body mass index (BMI) ≥ 25 kg/m2. Both vaginal and cesarean deliveries were included in the cohort. Pain scores (0–10 numeric rating scale) during childbirth and after delivery were correlated with CESD and SCID. Propensity score matching was performed with propensity groups defined as those with low–moderate postpartum pain and those with high postpartum pain. The relationships between pain measures and 6-month postpartum depression diagnosis by SCID, and between pain measures and 6-month postpartum depression symptoms by CESD, were assessed by unweighted logistic regression and by logistic regression weighted by propensity score derived by average treatment effect (ATE) adjusted for baseline covariates. Results There were 237 subjects in the cohort for analysis. Labor and postpartum pain were not associated with depression diagnosis by SCID at 6 months postpartum. However, postpartum pain, but not labor pain, was associated with depressive symptoms on the CESD at 6 months postpartum. Women with higher maximum postpartum pain scores had significantly higher odds of developing clinically significant postpartum depressive symptoms at 6 months, compared to those with lower pain scores in the unweighted model (OR: 1.3, 95% CI 1.0, 1.5; P = 0.005) and ATE-weighted models (OR: 1.2, 95% CI 1.0, 1.5; P = 0.03). Consistent with prior work, SCID and CESD were strongly associated, and 92.9% (13/14) of participants with postpartum depression diagnosis by 6-month SCID also showed high CESD symptomology, P < 0.0001). Conclusions Although labor and postpartum pain were not associated with clinical diagnosis of depression (SCID) at 6 months postpartum, postpartum pain was linked to 6-month postpartum depression symptoms. Depressive symptoms are more likely to be exhibited in women with higher postpartum pain, potentially reflecting poorer birth recovery. The contribution of postpartum pain and depressive symptoms to overall patterns of poor recovery after childbirth should be assessed further.

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Labor Analgesia as a Predictor for Reduced Postpartum Depression Scores: A Retrospective Observational Study

Cited by 73 publications

References 22 publications

Pharmacologic labour analgesia and its relationship to postpartum psychiatric disorders: a scoping review

Pharmacologic labour analgesia and its relationship to postpartum psychiatric disorders: a scoping review

Perioperative Adjunctive Esketamine for Postpartum Depression Among Women Undergoing Elective Cesarean Delivery

Association between labor and delivery pain and postpartum pain with symptoms and clinical diagnosis of postpartum depression in patients with overweight and obesity

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