Labor epidural analgesia and the risk of postpartum depression: A meta-analysis of observational studies
Open accessAbstract
Study objective This study aims to systematically review the literature to evaluate the association between labor epidural analgesia (LEA) and postpartum depression (PPD). Design Meta-analysis. Setting Obstetric patients delivering vaginally with or without LEA in a hospital. Interventions This study aimed to investigate the effects of providing LEA on developing PPD. Measurements Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated using the random effects model. Results A total of 356 full text articles were reviewed. Eleven articles studying 85,928 patients met inclusion criteria. The pooled unadjusted OR 1.03 and 95% CI (0.77, 1.37) suggest that LEA is not associated with a decreased risk of developing PPD. Conclusions Labor epidural analgesia was not shown to confer protection against developing PPD according to this meta-analysis. Future studies are needed to explore whether other aspects of LEA, beyond its presence or absence, influence the onset of PPD.
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Some current evidence, including meta-analysis and prospective studies, does not support a direct relationship between neuraxial anesthesia and protection against postpartum depression.
“Importantly, some current evidence, including meta-analysis and prospective studies, does not support a direct relationship between neuraxial anesthesia and protection against postpartum depression.46–49”
Many studies demonstrate a neutral association between neuraxial anesthesia and postpartum depression.
“Many studies demonstrate a neutral association”
Several recent studies demonstrate no independent association between epidural use and postpartum depression after adjustment for psychosocial confounding variables.
“However, several recent studies demonstrate no independent association between epidural use and PPD after adjustment for psychosocial confounding variables.45–51”
Most studies regarding neuraxial anesthesia and postpartum depression are observational, increasing susceptibility to confounding variables.
“Most studies regarding neuraxial anesthesia and PPD are observational, increasing susceptibility to confounding variables.43,47”
Cites
Antenatal risk factors for postpartum depression: a synthesis of recent literature
Robertson, E., Grace, S., Wallington, T., & Stewart, D. E. (2004) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2004.02.006 · Cited by 1,886 · see citing works
Trends in postpartum depressive symptoms- 27 States, 2004, 2008, and 2012
Ko, J. Y., Rockhill, K. M., Tong, V. T., Morrow, B., & Farr, S. L. (2017) · MMWR. Morbidity and Mortality Weekly Report · doi:10.15585/mmwr.mm6606a1 · Cited by 334 · see citing works
Muzik, M., Bocknek, E. L., Broderick, A., Richardson, P., Rosenblum, K. L., Thelen, K., & Seng, J. S. (2013) · Archives of Women's Mental Health · doi:10.1007/s00737-012-0312-0 · Cited by 293 · see citing works
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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
- Kountanis, J. A., Vahabzadeh, C., Bauer, S., Muzik, M., Cassidy, R., Aman, C., MacEachern, M., & Bauer, M. E.
- Affiliations
- Michigan Medicine (US)
- Oakland University (US)
- University of Michigan (US)
- Corresponding author
- Kountanis, Joanna A
- ORCID
- Venue
- Journal of Clinical Anesthesia
- Publisher
- Elsevier BV
- Published
- 2020-05
- Volume
- 61
- Pages
- 109658
- ISSN
- 0952-8180 (ISSN-L)
- OpenAlex
- W2990322083
- Cited by
- 45
- References
- 3
- Citations by year
- 2026: 5 · 2025: 10 · 2024: 6 · 2023: 6 · 2022: 9 · 2021: 6 · 2020: 3
- FWCI
- 0.74
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- Locations
- Journal of Clinical Anesthesia (publishedVersion)
- PubMed (publishedVersion)
- Deep Blue (University of Michigan) (submittedVersion, cc-by-nc)
- 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, obstetric analgesia, vaginal delivery, maternal mental health, risk factors
- MeSH terms
- Female, Humans, Labor, Obstetric, Pregnancy, Analgesia, Epidural, Odds Ratio, Analgesia, Obstetrical, Depression, Postpartum, Observational Studies as Topic
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