Obstetric pain correlates with postpartum depression symptoms: a pilot prospective observational study

Abstract

Background: Data linking labor pain and postpartum depression are emerging. Robust, prospective evaluations of this relationship while factoring other important variables are lacking. We assessed perinatal pain and other factors predicting postpartum depression (PPD) symptoms. Methods: Third trimester women, stratified by a priori plan to receive or avoid labor epidural analgesia, were longitudinally followed from the prenatal period through labor and delivery, until 6 weeks and 3 months postpartum. Electronic pain data was collected hourly during labor in real time, capturing pain unpleasantness, intensity, pain management satisfaction, and expectations. Prenatal and postpartum data included anxiety, depression, the Brief Pain Inventory (BPI), pain catastrophizing, resiliency, and perceived social support and stress. The primary outcome was Edinburgh Postnatal Depression Score (EPDS) as a marker of PPD symptoms. The primary pain variable of interest was labor pain emotional valence (unpleasantness burden, area under the curve for entire labor duration). Single and multivariable linear regressions examined perinatal pain variables in relation to EPDS. Results: Of 72 subjects included, 55 planned/received labor epidural analgesia and 17 planned avoidance/avoided it. In the planned epidural group, the emotional valence of labor pain independently predicted six-week EPDS (labor pain unpleasantness burden, R 2 = 0.42, P = 0.002). In addition to labor pain, prenatal and postpartum pain variables from the BPI independently predicted six-week EPDS. Three-month depression scores were linked to labor and acute pain (6 weeks postpartum), but not to chronic (3 months postpartum) pain variables. Intrapartum pain management satisfaction and expectations were largely met or exceeded and did not differ between analgesia groups. Conclusion: For susceptible women, pain at all perinatal time points-prenatal, labor, and postpartum-appear to be independently linked to depression scores at 6 weeks postpartum. The relationships are true, even though satisfaction and expectations regarding labor pain management were met or exceeded. These data support the concept that labor and acute postpartum pain influences both acute and long-term PPD symptoms, although additional data are needed to assess how analgesia preference interacts with these relationships.

Genetic associations of perinatal pain and depression

“…The present study identifies a relationship between this noncoding RNA SNP (rs11135349) and labor pain unpleasantness; our own data have similarly found that labor pain unpleasantness is significantly associated with depression scores at six weeks postpartum, in women planning/receiving labor epidural analgesia (R 2 ¼ 0.41; P ¼ 0.001). 55 Together, these findings suggest that this noncoding RNA species may contribute to disease etiology not only for depression phenotypes but also for labor pain.…”

Childbirth Pain and Post-Partum Depression: Does Labor Epidural Analgesia Decrease This Risk?

“…More recently, Lim et al revealed perinatal pain during multiple time points including prenatal, intrapartum, and postpartum independently predicts six-week EPDS scores. 16 Eisenach et al demonstrated that acute postpartum pain severity predicted a 3-fold increased risk for PPD at 8 weeks. 5 A large Canadian cohort of 5,614 women assessed for PPD using a cut-off score of 13 on the EPDS (Edinburgh Postnatal Depression Scale) found an increased risk of PPD at 3 months in women reporting prolonged perinatal pain.…”

Association of Childbirth Pain with Postnatal Depressive and Anxiety Disorders in Nulliparous Parturients: A Prospective Study

“…However, whether the pain syndrome is of neuropathic nature is unknown. 27 The SF-MPQ-2 was used in Cesarean delivery to evaluate for post-delivery chronic neuropathic pain; however, there is limited information on its use in those undergoing labor process. 28 We demonstrated that pre-delivery neuropathic pain, as measured by SF-MPQ-2, was associated with postnatal anxiety and/or depressive disorders.…”

“…25 During labor, neuropathic pain may arise from direct pressure on the lumbosacral plexus, which is left exposed to the pelvic area, and the pain may usually be resolved after the childbirth process. 25 Previous studies have suggested an association between the intensity of labor pain and PND development; 26,27 a prospective observational study in 72 women showed that increased pain at each perinatal time point (pre-delivery, labor, postdelivery) was independently associated with increased EPDS scores at 6 weeks after delivery. However, whether the pain syndrome is of neuropathic nature is unknown.…”