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Cited by 45Maternal Mental Health During Pregnancy and PostpartumAnesthesia and Pain ManagementMaternal and Perinatal Health Interventions

Neuraxial labour analgesia is associated with a reduced risk of maternal depression at 2 years after childbirth: A multicentre, prospective, longitudinal study

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Liu, Zhi-Hua, He, Shu-Ting, Deng, Chun-Mei, Ding, Ting, Xu, Ming-Jun, Wang, Lei, Li, Xue-Ying, Wang, Dong-Xin·2019·European Journal of Anaesthesiology
DOI 10.1097/eja.0000000000001058PMC PMC6738542
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Abstract

BACKGROUND: Severe labour pain is an important risk factor of postpartum depression, and early depression is associated with an increased risk of long-term depression; whereas the use of epidural analgesia during labour decreases the risk of postpartum depression. OBJECTIVE: To investigate whether neuraxial labour analgesia was associated with a decreased risk of 2-year depression. DESIGN: This was a multicentre, prospective, longitudinal study. SETTING: The study was performed in Peking University First Hospital, Beijing Obstetrics and Gynecology Hospital and Haidian Maternal and Child Health Hospital in Beijing, China, between 1 August 2014 and 25 April 2017. PATIENTS: Five hundred ninety-nine nulliparous women with single-term cephalic pregnancy preparing for vaginal delivery were enrolled. MAIN OUTCOME MEASURE: Depressive symptoms were screened with the Edinburgh Postnatal Depression Scale at delivery-room admission, 6-week postpartum and 2 years after childbirth. A score of 10 or higher was used as the threshold of depression. The primary endpoint was the presence of depression at 2 years after childbirth. The association between the use of neuraxial labour analgesia and the development of 2-year depression was analysed with a multivariable logistic regression model. RESULTS: Five hundred and eight parturients completed 2-year follow-up. Of these, 368 (72.4%) received neuraxial analgesia during labour and 140 (27.6%) did not. The percentage with 2-year depression was lower in those with neuraxial labour analgesia than in those without (7.3 [27/368] vs. 13.6% [19/140]; P = 0.029). After correction for confounding factors, the use of neuraxial analgesia during labour was associated with a significantly decreased risk of 2-year depression (odds ratio 0.455, 95% confidence interval 0.230 to 0.898; P = 0.023). CONCLUSION: For nulliparous women with single-term cephalic pregnancy planning for vaginal delivery, the use of neuraxial analgesia during labour was associated with a reduced risk of maternal depression at 2 years after childbirth. TRIAL REGISTRATION: www.chictr.org.cn: ChiCTR-OCH-14004888 and ClinicalTrials.gov: NCT02823418.

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  • Across delivery modes, the relationship between neuraxial anesthesia and postpartum depression is best characterized as neutral at the population level, with potential protective effects in select clinical contexts.

    “Across delivery modes, the relationship between neuraxial anesthesia and postpartum depression (PPD) appears complex but is best characterized as neutral at the population level, with potential protective effects in select clinical contexts has been described as either protective or neutral at various amounts of time postpartum across many studies.37–51”

    From Influence of Neuraxial Anesthesia Technique During Vaginal and Cesarean Delivery and Association with Postpartum Depression: A Narrative Review of Literature (2026) · cites this paper as [42]

    The Discussion reports a significant association between neuraxial labour analgesia and reduced depression at two years in nulliparous women planning vaginal delivery. It also says the study’s eligibility criteria limit generalisability. This supports a potential protective association in a specific clinical context, but not the claim of neutrality at the population level or a conclusion across delivery modes. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Across observational studies, cohort analyses, systematic reviews, and meta-analyses, neuraxial anesthesia does not appear to increase the risk of postpartum depression at the population level.

    “Across observational studies, cohort analyses, systematic reviews, and meta-analyses, neuraxial anesthesia does not appear to increase the risk of PPD at the population level.”

    From Influence of Neuraxial Anesthesia Technique During Vaginal and Cesarean Delivery and Association with Postpartum Depression: A Narrative Review of Literature (2026) · cites this paper as [42]

    The Discussion reports lower depression at 6 weeks and 2 years among women who received neuraxial labour analgesia, supporting the narrower conclusion that it was not associated with increased risk in this cohort. But the paper limits its findings to nulliparous women with single cephalic term pregnancies planning vaginal delivery and explicitly cautions that generalisability is limited. It does not establish the claim across systematic reviews and meta-analyses or at the population level. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Select analyses suggest modest protective effects of neuraxial anesthesia on postpartum depression, particularly among women experiencing severe labor pain or high intrapartum stress.

    “select analyses suggest modest protective effects, particularly among women experiencing severe labor pain or high intrapartum stress.”

    From Influence of Neuraxial Anesthesia Technique During Vaginal and Cesarean Delivery and Association with Postpartum Depression: A Narrative Review of Literature (2026) · cites this paper as [42]

    The Discussion (page unavailable) reports an association between neuraxial labour analgesia and lower postpartum depression, and the Results report 2-year depression in 7.3% of the analgesia group versus 13.6% of the comparison group. The paper discusses intense labour pain as a possible risk factor, but the passages do not show a stronger protective association specifically among women with severe labour pain or high intrapartum stress. That subgroup qualification is unsupported. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • Neuraxial anesthesia is not associated with increased risk of postpartum depression and may have neutral or protective effects, particularly compared with general anesthesia for cesarean delivery.

    “Collectively, available evidence indicates that neuraxial anesthesia likely does not increase the risk of postpartum depression and may exhibit either neutral or modest protective effects in labor.37–51”

    From Influence of Neuraxial Anesthesia Technique During Vaginal and Cesarean Delivery and Association with Postpartum Depression: A Narrative Review of Literature (2026) · cites this paper as [42]

    The Discussion reports lower postpartum depression at 6 weeks and a significantly decreased risk of depression at 2 years among women who received neuraxial labour analgesia. The study included women planning vaginal delivery and compared neuraxial analgesia with no neuraxial analgesia; it does not support the claim’s comparison with general anesthesia for cesarean delivery. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Postpartum depression assessment timing varies widely across studies, ranging from days postpartum to two years after delivery, leading to variability in reported prevalence.

    “Additionally, PPD assessment timing varies widely across studies, ranging from days of postpartum to two years after delivery, leading to variability in reported prevalence.41,42”

    From Influence of Neuraxial Anesthesia Technique During Vaginal and Cesarean Delivery and Association with Postpartum Depression: A Narrative Review of Literature (2026) · cites this paper as [42]

    The Methods (Collection of perinatal data; Follow-up at 2 years after childbirth) assess depression at 6 weeks and again at 2 years, and the Results report different proportions at those times. The paper does not establish that assessments across studies begin within days postpartum or that differences in assessment timing cause variability in reported prevalence. Page numbers are unavailable in our copy. (LLM, conf=0.84)

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Cited by

Sorted by citations

Authors
Liu, Z.-H., He, S.-T., Deng, C.-M., Ding, T., Xu, M.-J., Wang, L., Li, X.-Y., & Wang, D.-X.
Affiliations
Peking University First Hospital (CN)
Corresponding author
  • Wang, Lei
  • Wang, Dong-Xin
ORCID
Venue
European Journal of Anaesthesiology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2019-10
Volume
36
Issue
10
Pages
745-754
ISSN
0265-0215 (ISSN-L)
DOI
10.1097/eja.0000000000001058
PMC
PMC6738542
OpenAlex
W2982711867
Cited by
45
References
9
Citations by year
2026: 3 · 2025: 4 · 2024: 7 · 2023: 5 · 2022: 16 · 2021: 7 · 2020: 3
FWCI
5.99
Type
journal article
Language
en
Open access
Licence
cc-by-nc-nd
Locations
  • European Journal of Anaesthesiology (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
Funders
  • Peking University First Hospital
  • Capital Medical University
  • Peking University
  • Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medicine
  • Beijing Obstetrics and Gynecology Hospital, Capital Medical University
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
epidural analgesia, maternal depression, postpartum depression, long-term depression, labor pain, nulliparous women, vaginal delivery, Edinburgh Postnatal Depression Scale, risk factors for depression, postpartum mental health, Beijing, China, North America, Europe
MeSH terms
Adult, Female, Follow-Up Studies, Humans, Labor, Obstetric, Longitudinal Studies, Pregnancy, Prospective Studies, Surveys and Questionnaires, Severity of Illness Index, Analgesia, Epidural, Multivariate Analysis, Odds Ratio, Analgesia, Obstetrical, Depression, Postpartum, Parturition, Delivery, Obstetric, Postpartum Period, Young Adult, Pain Management

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