Use of Labor Neuraxial Analgesia for Vaginal Delivery and Severe Maternal Morbidity

Guglielminotti, Jean; Landau, Ruth; Daw, Jamie R.; Friedman, Alexander M.; Chihuri, Stanford; Li, Guohua

doi:10.1001/jamanetworkopen.2022.0137

Cited by 34 publications

(41 citation statements)

References 46 publications

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“…For scheduled CS, Abe et al performed a nationwide population-based study to determine the association between the anesthesia method and SMM in a Japanese population and reported that GA was associated with increased SMM compared with NA (OR, 2.68; 95% CI, 1.97–3.64) [ 35 ]. Another population-based cross-sectional study including 575, 524 women demonstrated that NA for vaginal delivery was associated with a 14% decrease in the risk of SMM [ 36 ] and hence a lower risk of PPD.…”

Section: Discussionmentioning

confidence: 99%

Association of General Anesthesia and Neuraxial Anesthesia in Caesarean Section with Maternal Postpartum Depression: A Retrospective Nationwide Population-Based Cohort Study

Hung

Tsao

Yang

et al. 2022

JPM

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Although cesarean section (CS) has become a common method of child delivery in recent decades, the choice between general anesthesia (GA) and neuraxial anesthesia (NA) for CS must be carefully considered. Depending on the type of anesthesia used in CS, a major outcome observed is the occurrence of postpartum depression (PPD). This study investigated the association between PPD risk and the anesthesia method used in CS by using data from three linked nationwide databases in Taiwan, namely, the National Health Insurance Research Database, the National Birth Reporting Database, and the National Death Index Database. After propensity score matching by baseline depressive disorders, maternal demographics, status at delivery, infant’s health, maternal diseases during pregnancy, and age of partner, we included women who had natural births (n = 15,706), cesarean sections with GA (n = 15,706), and cesarean sections with NA (n = 15,706). A conditional logistic regression was used to estimate the odds ratios and 95% confidence intervals (CIs) of PPDs, including depression, sleep disorder, and medication with hypnotics or antidepressants, under anesthesia during CS. The prevalence rates of combined PPDs were 26.66%, 43.87%, and 36.30% in natural births, CS with GA, and CS with NA, respectively. In particular, the proportions of postpartum use of hypnotic drugs or antidepressants were 21.70%, 39.77%, and 31.84%, which were significantly different. The aORs (95% CIs) were 2.15 (2.05–2.25) for the included depressive disorders, 1.10 (1.00–1.21) for depression, 1.03 (0.96–1.11) for sleep disorder, and 2.38 (2.27–2.50) for medication with hypnotics or antidepressants in CS with GA compared with natural births. Women who underwent CS with GA had a significantly higher risk of depressive disorders and a higher need for antidepressants for sleep problems than those who underwent CS with NA. The risks of PPD were significantly associated with the anesthesia method, especially GA. Our results can assist physicians in carefully considering the appropriate anesthesia method for CS delivery, particularly with regard to postpartum drug abuse and drug safety.

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Section: Discussionmentioning

confidence: 99%

Association of General Anesthesia and Neuraxial Anesthesia in Caesarean Section with Maternal Postpartum Depression: A Retrospective Nationwide Population-Based Cohort Study

Hung

Tsao

Yang

et al. 2022

JPM

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“…In the context of health care research, mediator variables interact with the association between the treatment and the outcome, explaining all or part of the association of the treatment with the outcome. Guglielminotti et al 3 found that that greater than one fifth of the association of neuraxial labor analgesia with SMM was mediated by the reduced risk of PPH. 3 The incidence of SMM has been increasing with time in the US.…”

Section: Openmentioning

confidence: 99%

“…Guglielminotti et al 3 found that that greater than one fifth of the association of neuraxial labor analgesia with SMM was mediated by the reduced risk of PPH. 3 The incidence of SMM has been increasing with time in the US. 1 However, a real-world problem is the disparity in maternal morbidity and mortality rates observed across the world 7 and also access to neuraxial labor analgesia for vaginal delivery, as Guglielminotti and colleagues alluded to, which may preclude our ability to generalize their findings to populations outside of the US.…”

Section: Openmentioning

confidence: 99%

“…Guglielminotti et al 3 conducted a US population-based observational study including 575 524 women who experienced vaginal delivery and found that neuraxial labor analgesia for vaginal delivery was associated with a 14% reduction in SMM compared with no neuraxial labor analgesia, which was mediated by more than 21% through reduction of postpartum hemorrhage (PPH). 3 The study took the due diligence to delineate the outcomes associated with neuraxial labor analgesia in vaginal delivery for the propensity weighted cohort using the inverse probability treatment weighting (IPTW) method by further stratifying the baseline risk factors associated with SMM, such as race and ethnicity (ie, non-Hispanic White vs other, including Asian or Pacific Islander, Black, Hispanic, Native American, and other) and maternal comorbidities. 3 Moreover, Guglielminotti et al 3 conducted robust sensitivity analyses using the stabilized weights (SWs) and the propensity score matching as part of the cohort creation and multiple imputations for missing information.…”

mentioning

confidence: 99%

“…3 The study took the due diligence to delineate the outcomes associated with neuraxial labor analgesia in vaginal delivery for the propensity weighted cohort using the inverse probability treatment weighting (IPTW) method by further stratifying the baseline risk factors associated with SMM, such as race and ethnicity (ie, non-Hispanic White vs other, including Asian or Pacific Islander, Black, Hispanic, Native American, and other) and maternal comorbidities. 3 Moreover, Guglielminotti et al 3 conducted robust sensitivity analyses using the stabilized weights (SWs) and the propensity score matching as part of the cohort creation and multiple imputations for missing information.…”

mentioning

confidence: 99%

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Neuraxial Labor Analgesia for Vaginal Delivery and Severe Maternal Morbidity

2022

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The Centers for Disease Control and Prevention (CDC) defines severe maternal morbidity (SMM) as an array of 16 diseases and 5 procedures denoting an acutely life-threatening pregnancy-related condition, 1 which also serve as excellent surrogates for adverse maternal and perinatal outcomes, including maternal and perinatal death. 2 SMM also has higher risk of an adverse effect on maternal functioning and well-being after the birth. Neuraxial labor analgesia for vaginal delivery is a procedure of neuraxial anesthesia and the most effective method to manage labor pain. In North America, more than 70% of women receive neuraxial labor analgesia for vaginal delivery.Guglielminotti et al 3 conducted a US population-based observational study including 575 524 women who experienced vaginal delivery and found that neuraxial labor analgesia for vaginal delivery was associated with a 14% reduction in SMM compared with no neuraxial labor analgesia, which was mediated by more than 21% through reduction of postpartum hemorrhage (PPH). 3

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Racial and Ethnic Disparities in Receipt of General Anesthesia for Cesarean Delivery

Thomas,

Lange,

Banayan

et al. 2024

JAMA Netw Open

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ImportanceGeneral anesthesia for cesarean delivery is associated with increased maternal morbidity, and Black and Hispanic pregnant patients have higher rates of general anesthesia use compared with their non-Hispanic White counterparts. It is unknown whether risk factors and indications for general anesthesia differ among patients of differing race and ethnicity.ObjectiveTo evaluate differences in general anesthesia use for cesarean delivery and the indication for the general anesthetic by race and ethnicity.Design, Setting, and ParticipantsIn this retrospective, cross-sectional, single-center study, electronic medical records for all 35 117 patients who underwent cesarean delivery at Northwestern Medicine’s Prentice Women’s Hospital from January 1, 2007, to March 2, 2018, were queried for maternal demographics, clinical characteristics, obstetric and anesthetic data, the indication for cesarean delivery, and the indication for general anesthesia when used. Data analysis occurred in August 2023.ExposureCesarean delivery.Main Outcomes and MeasuresThe rate of general anesthesia for cesarean delivery by race and ethnicity.ResultsOf the 35 117 patients (median age, 33 years [IQR, 30-36 years]) who underwent cesarean delivery, 1147 (3.3%) received general anesthesia; the rates of general anesthesia were 2.5% for Asian patients (61 of 2422), 5.0% for Black patients (194 of 3895), 3.7% for Hispanic patients (197 of 5305), 2.8% for non-Hispanic White patients (542 of 19 479), and 3.8% (153 of 4016) for all other groups (including those who declined to provide race and ethnicity information) (P &lt; .001). A total of 19 933 pregnant patients (56.8%) were in labor at the time of their cesarean delivery. Of those, 16 363 (82.1%) had neuraxial labor analgesia in situ. Among those who had an epidural catheter in situ, there were no racial or ethnic differences in the rates of general anesthesia use vs neuraxial analgesia use (Asian patients, 34 of 503 [6.8%] vs 1289 of 15 860 [8.1%]; Black patients, 78 of 503 [15.5%] vs 1925 of 15 860 [12.1%]; Hispanic patients, 80 of 503 [15.9%] vs 2415 of 15 860 [15.2%]; non-Hispanic White patients, 255 of 503 [50.7%] vs 8285 of 15 860 [52.2%]; and patients of other race or ethnicity, 56 of 503 [11.1%] vs 1946 of 15 860 [12.3%]; P = .16). Indications for cesarean delivery and for general anesthesia were not different when stratified by race and ethnicity.Conclusions and RelevanceRacial disparities in rates of general anesthesia continue to exist; however, this study suggests that, for laboring patients who had labor epidural catheters in situ, no disparity by race or ethnicity existed. Future studies should address whether disparities in care that occur prior to neuraxial catheter placement are associated with higher rates of general anesthesia among patients from ethnic and racial minority groups.

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Use of Labor Neuraxial Analgesia for Vaginal Delivery and Severe Maternal Morbidity

Cited by 34 publications

References 46 publications

Association of General Anesthesia and Neuraxial Anesthesia in Caesarean Section with Maternal Postpartum Depression: A Retrospective Nationwide Population-Based Cohort Study

Association of General Anesthesia and Neuraxial Anesthesia in Caesarean Section with Maternal Postpartum Depression: A Retrospective Nationwide Population-Based Cohort Study

Neuraxial Labor Analgesia for Vaginal Delivery and Severe Maternal Morbidity

Racial and Ethnic Disparities in Receipt of General Anesthesia for Cesarean Delivery

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