Relationship between painless delivery and postpartum depression: The Japan Environment and Children’s Study (JECS)

Abstract

Background Postpartum depression is one of the most commonly experienced psychological disorders for women after childbirth, usually occurring within one year. This study aimed to clarify whether women with painless delivery, including epidural analgesia, spinal-epidural analgesia, and paracervical block, had a decreased risk of postpartum depression after giving birth in Japan. Methods The Japan Environment and Children’s Study (JECS) was a prospective cohort study that enrolled registered fetal records (n = 104,065) in 15 regions nationwide in Japan. Binomial logistic regression analyses were performed to calculate the adjusted odd ratios (aORs) for the association between mode of delivery with or without analgesia and postpartum depression at one-, six- and twelve-months after childbirth. Results At six months after childbirth, painless vaginal delivery was associated with a higher risk of postpartum depression (aOR: 1.218, 95% confidence interval: 1.067–1.391), compared with vaginal delivery without analgesia or cesarean section. Nevertheless, the risk disappeared one year after delivery. Among the pregnant women who requested painless delivery, 5.1% had a positive Kessler-6 scale (K6) score for depression before the first trimester (p < 0.0001), which was significantly higher than the proportions in the vaginal delivery without analgesia (3.5%) and cesarean delivery (3.5%) groups. Conclusions Our data suggested that the risk of postpartum depression at six months after childbirth tended to be increased after painless vaginal delivery, compared with vaginal delivery without analgesia or cesarean section. Requests for painless delivery continue to be relatively uncommon in Japan, and women who make such requests might be more likely to experience postpartum depressive symptoms because of underlying personality characteristics, including a tendency to worry.

Association Between Mode of Delivery and Postpartum Depression: The Japan Environment and Children’s Study (JECS)

“…1.02 (95% CI, 0.97-1.08)], 35 partly due to different outcome settings. On the other hand, the null association between CS and risk of PPD at 6 months from childbirth found in our A c c e p t e d V e r s i o n study was similar to the findings from previous studies with 55,814 Norwegian women, 36 1,379 Qatari women, 37 and 99,202 Japanese women.…”

“…On the other hand, the null association between CS and risk of PPD at 6 months from childbirth found in our A c c e p t e d V e r s i o n study was similar to the findings from previous studies with 55,814 Norwegian women, 36 1,379 Qatari women, 37 and 99,202 Japanese women. 35 The mechanism by which CS may influence risk of PPD is not clear. 1,3 Biological mechanisms such as hormonal change may play a role in the development of PPD.…”