Effect of epidural labor analgesia on postpartum depression and maternal and infant outcomes in parturients with gestational diabetes mellitus---A prospective cohort study

Abstract

BackgroundPostpartum depression (PPD) negatively affects the health of new mothers and can impair infant development. Both labor pain and gestational diabetes mellitus (GDM) are potential risk factors for PPD. However, the effects of epidural labor analgesia in parturients with GDM on PPD and maternal and infant outcomes have not been characterized.MethodsParturients with GDM in our hospital were assigned to the epidural group (n = 133) and no epidural (control) group (n = 130) according to their choice to receive epidural labor analgesia. The Edinburgh Postnatal Depression Scale (EPDS) was used to evaluate maternal mental status at 24 h and 42 days postpartum. Data for relative variables in the perinatal period were collected, and the potential associations of epidural analgesia with PPD and maternal and infant outcomes were analyzed by univariate analysis and multivariate logistic regression analyses.ResultsEpidural analgesia was a protective factor for PPD at 24 h postpartum (odds ratio [OR], 0.301, 95% confidence interval [CI]: 0.104–0.867, p < 0.05), and the EPDS score at 24 h post-delivery showed significant correlation with that at 42 days post-delivery (Pearson correlation coefficient = 0.527, p < 0.001). The rate of neonatal admission to the neonatal intensive care unit (NICU) for hypoglycemia was higher in the epidural group (6.92%) than in the control group (1.50%; p < 0.05). Epidural analgesia and drug-based diabetes control were independent predictors of the rate of neonate transfer to the NICU for hypoglycemia.ConclusionEpidural analgesia was a protective factor for PPD at 24 h postpartum, but associated with an increased risk of neonatal transfer to the NICU for hypoglycemia. Thus, monitoring of neonatal blood glucose levels after administration of epidural analgesia in parturients with GDM may be beneficial.Clinical Trial Registrationthe study was registered in the China Clinical Registration Center (URL: http://www.chictr.org.cn/listbycreater.aspx, Registration No. ChiCTR-OOC-17013164)

A Brief Review on Postpartum Depression

“…Depression screening program of meta-analysis generally concludes that depression screening and systemic paths must be combined for well-defined and referral of cases and pre-implemented self-care plans to achieve various possible positive benefits. Postpartum depression unfortunately remains undertreated and underdiagnosed [8].…”