Administration of epidural labor analgesia is not associated with a decreased risk of postpartum depression in an urban Canadian population of mothers: a secondary analysis of prospective cohort data

Abstract

BackgroundPostpartum depression (PPD) is a common complication of pregnancy, affecting approximately 13% of mothers internationally. Previous research has examined whether epidural analgesia used for pain control during labor and birth is associated with a lower risk of PPD, but reports conflicting results and may have suffered from methodological shortcomings. Our study aimed to prospectively assess whether epidural analgesia is associated with a lower risk of PPD (at either 6 weeks or 6 months postpartum) after attempting to adequately adjust for selection bias and confounding variables.MethodsWe conducted a secondary analysis of a prospective cohort of urban Canadian mothers who were recruited at birth in Calgary, Canada, in 2010, for a primary study on predictors of PPD. Mothers with full-term, singleton infants who did not require neonatal intensive care unit admission of >24 hours were included, and filled out questionnaires at birth, 6 weeks and 6 months postpartum including demographics, birth data, maternal and infant physical health, lifestyle, breastfeeding and maternal mental health. Descriptive statistics were calculated for participant characteristics and to identify potential confounder variables. Multivariable logistic regression analysis was conducted to assess whether epidural analgesia is associated with PPD after controlling for available confounding variables.ResultsOur study included 206 mothers who had vaginal deliveries and were free of depression at delivery. We found an incidence of PPD of 13.3% (n=27) and no statistically significant association between epidural use and PPD, regardless of adjustment for potential confounding variables (unadjusted odds ratio [OR] 0.86, 95% confidence interval [CI] 0.69–1.22; adjusted OR (for body mass index 1.04, 95% CI 0.40–2.77).ConclusionWe did not observe a significant association between epidural use and PPD. While the CIs are wide, we do not believe that this masks a clinically relevant association, and as such, the risks and benefits of epidural analgesia communicated to women during labor and delivery should not be modified.

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

“…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.…”

“…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).…”

“…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.…”

“…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.…”

“…Nine studies [8][9][10][11][21][22][23]27,29 had a primary objective of evaluating the association of pharmacologic labour analgesia with postpartum psychiatric disorders. Of the six studies with the primary objective of linking LEA and PPD, [8][9][10][11]27,29 two studies found that fewer patients screened positive for PPD with LEA compared with patients who chose non-epidural labour analgesia. 8,29 In one study, all patients received LEA, and the extent of 123 labour pain relief by LEA predicted lower PPD scores.…”