A systematic review of the association between postpartum depression and neuraxial labor analgesia
Abstract
Background Postpartum depression (PPD) is the most common complication after childbirth, affecting 10-15% of women. It is associated with serious long-term consequences for the mother and family. Whether or not neuraxial labor analgesia mitigates the risk is uncertain and controversial. The purpose of this review was to summarize studies investigating the association between neuraxial labor analgesia and the incidence of PPD. Methods A systematic literature search for randomized controlled trials and cohort studies reporting the incidence of PPD among parturients who received neuraxial analgesia compared with non-neuraxial or no analgesia. The primary outcome was the incidence of PPD between 5 and 12 weeks' postpartum. Depression was diagnosed using a cutoff score of ≥10 on the Edinburgh Postnatal Depression scale, a validated screening tool. The risk of bias of each study was evaluated, and odds ratios and 95% confidence intervals calculated from raw data or reported as adjusted odds ratios. Results Eleven observational studies involving 5717 patients were included. Three studies had a critical risk, three a serious risk, and five a moderate risk of bias. Two studies reported significantly lower odds for PPD associated with neuraxial analgesia compared with non-neuraxial or no analgesia, whereas the odds ratios in the remaining nine studies were not significantly different. Conclusions Our systematic review did not find compelling evidence for an association between PPD and…
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Some studies demonstrate no significant association between neuraxial anesthesia and postpartum depression, suggesting that analgesia alone may not independently influence postpartum mood when broader psychosocial factors dominate.
“Some studies demonstrate no significant association between neuraxial anesthesia and PPD, suggesting that analgesia alone may not independently influence postpartum mood when broader psychosocial factors dominate.46,53”
Cites
ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions
Sterne, J. A., Hernán, M. A., Reeves, B. C., Savović, J., Berkman, N. D., Viswanathan, M., Henry, D., Altman, D. G., Ansari, M. T., Boutron, I., et al. (2016) · BMJ · doi:10.1136/bmj.i4919 · Cited by 20,329 · see citing works
Effects of perinatal mental disorders on the fetus and child
Stein, A., Pearson, R. M., Goodman, S. H., Rapa, E., Rahman, A., McCallum, M., Howard, L. M., & Pariante, C. M. (2014) · The Lancet · doi:10.1016/s0140-6736(14)61277-0 · Cited by 2,166 · see citing works
Consequences of maternal postpartum depression: A systematic review of maternal and infant outcomes
Slomian, J., Honvo, G., Emonts, P., Reginster, J.-Y., & Bruyère, O. (2019) · Women's Health · doi:10.1177/1745506519844044 · Cited by 1,496 · see citing works
Stewart, D. E., & Vigod, S. (2016) · New England Journal of Medicine · doi:10.1056/nejmcp1607649 · Cited by 500 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
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
- Orbach-Zinger, S., Heesen, M., Grigoriadis, S., Heesen, P., & Halpern, S.
- Affiliations
- Kantonsspital Baden (CH)
- Sunnybrook Health Science Centre (CA)
- University of Zurich (CH)
- Venue
- International Journal of Obstetric Anesthesia
- Publisher
- Elsevier BV
- Published
- 2021-02
- Volume
- 45
- Pages
- 142-149
- ISSN
- 0959-289X (ISSN-L)
- OpenAlex
- W3093887698
- Cited by
- 20
- References
- 4
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 4 · 2023: 4 · 2022: 7
- FWCI
- 0.46
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- International Journal of Obstetric Anesthesia (publishedVersion)
- PubMed (publishedVersion)
- 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
- postpartum depression, neuraxial labor analgesia, epidural analgesia, labor analgesia, Edinburgh Postnatal Depression Scale, childbirth complications
- MeSH terms
- Analgesics, Female, Humans, Pregnancy, Analgesia, Epidural, Analgesia, Obstetrical, Depression, Postpartum, Parturition, Pain Management
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
