Neuraxial analgesia during labor and postpartum depression: Systematic review and meta-analysis

Abstract

Background: Severe pain has been linked to depression, which raises the question of whether neuraxial analgesia during childbirth is associated with a reduced risk of postpartum depression. This association has been explored, but previous studies did not control or analyze relevant confounders. We conducted a systematic review and meta-analysis to determine the association between neuraxial analgesia and postpartum depression. Methods: A systematic review was conducted using PubMed, Embase, and the Cochrane Central Register of Controlled Trials. Studies that tested the effect of neuraxial analgesia during labor on depression or depressive symptoms in the first year postpartum were included. Relevant articles were extracted independently by 2 authors. Results: In total, 14 studies (86,231 women) were included. The association between neuraxial analgesia and the long-term incidence of postpartum depression after childbirth was the risk ratio = 0.75, 95% confidence interval (CI): 0.56–1.00, P = .05; I2 = 79%, P < .00001. There was a significant association (pooled risk ratio = 0.55, 95% CI: 0.34–0.90, P = .02; I2 = 55%, P = .06) between neuraxial analgesia and the incidence of postpartum depression in the first week after delivery. The subgroup analysis showed a trend suggesting that in Asian populations, those who received neuraxial analgesia had lower postpartum depression rates than those who received non-neuraxial analgesia (risk ratio = 0.57, 95% CI: 0.38–0.86; P = .008; I2 = 82%) at ≥4 weeks after delivery. Conclusion: Neuraxial analgesia may be beneficial for the short-term and long-term mental effects of parturient women, especially for short term after delivery. High-quality studies addressing the role of neuraxial analgesia during labor and its impact on postpartum depression remain necessary.

Long-term effects of neuraxial analgesia

“…As peripartum pain may www.co-anesthesiology.com be associated with postnatal depression, epidural analgesia has been proposed as a potential intervention to reduce this risk. Data from meta-analyses examining the relationship between labour epidural and postnatal depression are conflicting with some studies finding a reduction in risk [25,26], and others finding no such association [27]. This relationship is difficult to define given the conflicting evidence, limitations of the mainly observational studies and high likelihood of confounding.…”