Neuraxial analgesia during labor and postpartum depression: Systematic review and meta-analysis
Open accessAbstract
Background: Severe pain has been linked to depression, which raises the question of whether neuraxial analgesia during childbirth is associated with a reduced risk of postpartum depression. This association has been explored, but previous studies did not control or analyze relevant confounders. We conducted a systematic review and meta-analysis to determine the association between neuraxial analgesia and postpartum depression. Methods: A systematic review was conducted using PubMed, Embase, and the Cochrane Central Register of Controlled Trials. Studies that tested the effect of neuraxial analgesia during labor on depression or depressive symptoms in the first year postpartum were included. Relevant articles were extracted independently by 2 authors. Results: In total, 14 studies (86,231 women) were included. The association between neuraxial analgesia and the long-term incidence of postpartum depression after childbirth was the risk ratio = 0.75, 95% confidence interval (CI): 0.56–1.00, P = .05; I 2 = 79%, P < .00001. There was a significant association (pooled risk ratio = 0.55, 95% CI: 0.34–0.90, P = .02; I 2 = 55%, P = .06) between neuraxial analgesia and the incidence of postpartum depression in the first week after delivery. The subgroup analysis showed a trend suggesting that in Asian populations, those who received neuraxial analgesia had lower postpartum depression rates than those who received non-neuraxial analgesia (risk ratio = 0.57, 95% CI: 0.38–0.86; P = .008; I 2 = 82%) at ≥4 weeks after delivery. Conclusion: Neuraxial analgesia may be beneficial for the short-term and long-term mental effects of parturient women, especially for short term after delivery. High-quality studies addressing the role of neuraxial analgesia during labor and its impact on postpartum depression remain necessary.
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A meta-analysis including over 86,000 participants, as well as multiple prospective cohort studies, observed significantly decreased rates of postpartum depression in patients who underwent neuraxial labor analgesia compared with patients who did not, with a difference seen as long as 2 years postpartum.
“A meta-analysis including over 86,000 participants, as well as multiple prospective cohort studies have observed significantly decreased rates of PPD in patients who underwent neuraxial labor analgesia compared to patients who did not, with difference seen as long as 2 years postpartum.37,42,43”
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 [43]
The Abstract Results report 14 studies involving 86,231 women and a significant association with lower postpartum depression rates in the first week after neuraxial analgesia. The longer-term result was borderline (P = .05), and the Methods limit included outcomes to the first year postpartum; this paper does not support a difference persisting to two years. (LLM, conf=0.88)
Experimental — accuracy not yet measuredAcross 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 [43]
The Results (§3.4; page not provided) report a pooled risk ratio of 0.75 (95% CI 0.56–1.00) for postpartum depression at four or more weeks, supporting the cautious claim that neuraxial labor analgesia does not appear to increase risk in the studies analyzed. However, this is one systematic review and meta-analysis of observational studies; it does not establish the claim across multiple systematic reviews and meta-analyses. (LLM, conf=0.82)
Experimental — accuracy not yet measuredSelect 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 [43]
The Abstract Results report lower postpartum-depression rates in select analyses, including during the first week after delivery, and the Discussion describes a possible short-term protective effect. The reported subgroup analyses do not establish that the association is particularly strong among women with severe labor pain or high intrapartum stress; the paper discusses pain as a possible explanation, not as a demonstrated subgroup finding. Page numbers are unavailable in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredAcross 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 [43]
The Results (§3.4–3.5; page unavailable) report a borderline lower PPD risk at ≥4 weeks, a significant lower risk in the first week, and potentially protective associations in subgroups. Calling the overall relationship neutral overlooks the first-week finding. The inclusion criteria (§2.2; page unavailable) specify women planning spontaneous vaginal delivery, so the paper does not establish a relationship across delivery modes. (LLM, conf=0.88)
Experimental — accuracy not yet measuredMost 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”
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”
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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
- Li, B., Tang, X., & Wang, T.
- Affiliations
- Shanghai Changning Maternity and Infant Health Hospital (CN)
- Corresponding author
- Wang, Tingting
- Venue
- Medicine
- Published
- 2023-02-22
- Volume
- 102
- Issue
- 8
- Pages
- e33039
- ISSN
- 0025-7974 (ISSN-L)
- PMC
- PMC11309598
- OpenAlex
- W4321748486
- Cited by
- 10
- References
- 6
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 5
- FWCI
- 0.46
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- 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
- neuraxial analgesia, postpartum depression, labor analgesia, labor pain, epidural analgesia, postpartum mental health, Asian populations
- MeSH terms
- Analgesia, Female, Humans, Labor, Obstetric, Pain, Pregnancy, Analgesia, Epidural, Analgesia, Obstetrical, Depression, Postpartum, Pain Management
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