The association between labour epidural analgesia and postpartum depression in primiparous patients: a historical cohort study
Open accessAbstract
Purpose Peripartum pain has been associated with postpartum depression (PPD), and labour epidural analgesia (LEA) may be able to modify this risk. The objective of this historical cohort study was to examine the association between LEA and PPD among primiparous patients. Methods With institutional research ethics board approval, a provincial perinatal database was searched for primiparous patients who delivered a liveborn singleton infant between 2004 and 2018. Those patients who experienced PPD following their first delivery were identified by a history of PPD in the perinatal records of their second pregnancy. We used logistic regression to compute odds ratios (ORs) for the association between LEA and PPD and performed an adjusted analysis to control for confounding variables. Results A total of 35,437 primiparous patients were identified, 67% (n = 23,599) of whom received LEA. In the cohort, 3.7% (n = 1,296) of patients developed PPD. Patients who received LEA had increased odds of developing PPD compared with patients who did not receive LEA (adjusted OR, 1.29; 95% confidence interval [CI], 1.12 to 1.48). In a multivariable regression model, LEA remained a significant predictor for PPD, as did body mass index, pre-existing anxiety, and maternal antidepressant use. Conclusion This historical cohort study found an association between LEA and PPD among primiparous patients who subsequently had a second pregnancy in the same province. The findings call into question the hypothesis that LEA decreases the risk for PPD and further illustrates the complexities of PPD.
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One historical cohort found an increased risk of postpartum depression associated with neuraxial analgesia during labor.
“Notably, one historical cohort found an increased risk of PPD associated with neuraxial analgesia during labor”
The finding of increased postpartum depression risk among epidural recipients has not been shown repeatedly by current research at the time.
“Additionally, one large historical cohort study reported an increased risk of PPD among epidural recipients, though these findings have not been shown repeatedly by current research at the time.54”
One large historical cohort study reported an increased risk of postpartum depression among epidural recipients.
“Additionally, one large historical cohort study reported an increased risk of PPD among epidural recipients, though these findings have not been shown repeatedly by current research at the time.54”
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Cites
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Fagan, J., Dufour, S., Duet, S., Downs, E., Siddaiah, H., Viswanath, O., Shekoohi, S., & Kaye, A. (2026) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s579920
- Authors
- Jin, S., Munro, A., & George, R. B.
- Affiliations
- Izaak Walton Killam Health Centre (CA)
- Dalhousie University (CA)
- University of Toronto (CA)
- Venue
- Canadian Journal of Anesthesia/Journal canadien d'anesthésie
- Published
- 2023-09-19
- Volume
- 70
- Issue
- 12
- Pages
- 1909-1916
- ISSN
- 0832-610X (ISSN-L)
- 1496-8975
- OpenAlex
- W4386857513
- Cited by
- 3
- References
- 2
- Citations by year
- 2026: 1 · 2024: 2
- FWCI
- 0.76
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Canadian Journal of Anesthesia/Journal canadien d anesthésie (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Canadian Anesthesiologists' Society
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Health Sciences › Medicine › Surgery › Anesthesia and Pain Management
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Keywords
- labor epidural analgesia, postpartum depression, primiparous women, second pregnancy, body mass index, maternal anxiety, maternal antidepressant use, risk factors for postpartum depression
- MeSH terms
- Anxiety, Female, Humans, Labor, Obstetric, Pregnancy, Cohort Studies, Analgesia, Epidural, Depression, Postpartum
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