Epidural Labor Analgesia Is Associated with a Decreased Risk of the Edinburgh Postnatal Depression Scale in Trial of Labor after Cesarean: A Multicenter, Prospective Cohort Study

Abstract

Postpartum depression is a disabling mental disorder commonly seen in parturients under trial of labor after cesarean, which causes serious harm to the parturients. The etiology is unclear. We hypothesized that epidural labor analgesia can reduce the incidence rate of postpartum depression. Enrolled multiparas were divided into the epidural labor analgesia group (n = 263) or nonanalgesia group (n = 160) according to their own request. Edinburgh Postnatal Depression Scale was used to assess their mental status at 48 hours and 42 days after delivery. Relative perinatal variables were collected and further analyzed using univariate analysis and multivariate logistic regression analysis to assess the relation of epidural analgesia with the occurrence of postpartum depression under trial of labor after cesarean. The Edinburgh Postnatal Depression Scale score 48 hours ≥ 10 in the no epidural analgesia group was 26.42% while the epidural analgesia group was 8.49% (OR, 0.209; 95% CI, 0.096–0.429; P<0.001). The Edinburgh Postnatal Depression Scale score 42 day ≥ 10 in the no epidural analgesia group was 25.16% while the epidural analgesia group was 6.59% (OR, 0.235; 95% CI, 0.113–0.469; P<0.001). The incidence of postpartum depression was significantly lower in the epidural labor analgesia group at 48 hours and 42 days. There was also a significant relation between the Edinburgh Postnatal Depression Scale scores at 48 hours and 42 days after delivery. Epidural analgesia, discomfort within 42 days, and self-rating anxiety scale are independent predictors of postpartum depression for trial of labor after cesarean in 42 days. Epidural labor analgesia is associated with a decreased risk of postpartum depression. Further study with a large sample size and more centers is needed to evaluate the impact of epidural analgesia on the occurrence of postpartum depression. Chinese Clinical Trial Register, ChiCTR-ONC-17010654.

Peripartum Predictors of the Risk of Postpartum Depressive Disorder: Results of a Case-Control Study

“…A study by Sun et al, also showed no influence of episiotomy on the increased prevalence of PPD [ 23 ]. In Poland, episiotomy was performed during about 57% deliveries [ 24 ].…”

Perinatal Predictors of Postpartum Depression: Results of a Retrospective Comparative Study

“…According to Sun et al, a higher prevalence of postpartum depression was noted in primiparas (20.3–29%) compared to multiparas 13.5% [ 29 ]. Similar results were obtained by Ly Do who demonstrated a twofold increase in the risk in primiparas [ 30 ].…”

Labor Analgesia Reduces the Risk of Postpartum Depression in Women with Single-Term Pregnancy: A Prospective Cohort Clinical Study

“…The identi ed relationship between pain and depression has already been reported in the general population [22]Naturally, it was logical to speculate that labor pain experienced by obstetric patients would contribute to PPD. The intensity of labor pain has been related to a mood disorder in the early postpartum period [23]Lim et al also reported that improvement in labor pain was a signi cant predictor of PPD [24]Therefore, accumulative evidence suggests that patients who used labor analgesia for pain control had a lower incidence of PPD than those who did not [14,24,25]In the present study, we found that labor analgesia was associated with a decreased risk of PPD when compared with the cesarean section, although no signi cant association was revealed between perinatal pain and PPD. A reasonable explanation is that the birth modes, i.e., vaginal birth, possibly make a difference in PPD.…”