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Cited by 19Maternal Mental Health During Pregnancy and PostpartumAnesthesia and Pain ManagementMaternal and Perinatal Health Interventions

Epidural Labor Analgesia Is Associated with a Decreased Risk of the Edinburgh Postnatal Depression Scale in Trial of Labor after Cesarean: A Multicenter, Prospective Cohort Study

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Sun, Jing, Xiao, Yuci, Zou, Liwei, Liu, Danyong, Huang, Ting, Zheng, Zhao, Yan, Xuetao, Yuan, Aiwu +2 more·2020·BioMed Research International
DOI 10.1155/2020/2408063PMC PMC6991168
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Abstract

Postpartum depression is a disabling mental disorder commonly seen in parturients under trial of labor after cesarean, which causes serious harm to the parturients. The etiology is unclear. We hypothesized that epidural labor analgesia can reduce the incidence rate of postpartum depression. Enrolled multiparas were divided into the epidural labor analgesia group (n = 263) or nonanalgesia group (n = 160) according to their own request. Edinburgh Postnatal Depression Scale was used to assess their mental status at 48 hours and 42 days after delivery. Relative perinatal variables were collected and further analyzed using univariate analysis and multivariate logistic regression analysis to assess the relation of epidural analgesia with the occurrence of postpartum depression under trial of labor after cesarean. The Edinburgh Postnatal Depression Scale score 48 hours ≥ 10 in the no epidural analgesia group was 26.42% while the epidural analgesia group was 8.49% (OR, 0.209; 95% CI, 0.096–0.429; P < 0.001). The Edinburgh Postnatal Depression Scale score 42 day ≥ 10 in the no epidural analgesia group was 25.16% while the epidural analgesia group was 6.59% (OR, 0.235; 95% CI, 0.113–0.469; P < 0.001). The incidence of postpartum depression was significantly lower in the epidural labor analgesia group at 48 hours and 42 days. There was also a significant relation between the Edinburgh Postnatal Depression Scale scores at 48 hours and 42 days after delivery. Epidural analgesia, discomfort within 42 days, and self‐rating anxiety scale are independent predictors of postpartum depression for trial of labor after cesarean in 42 days. Epidural labor analgesia is associated with a decreased risk of postpartum depression. Further study with a large sample size and more centers is needed to evaluate the impact of epidural analgesia on the occurrence of postpartum depression. Chinese Clinical Trial Register, ChiCTR-ONC-17010654.

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  • 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 [38]

    The Conclusion (page unavailable) says epidural labor analgesia may be associated with a decreased risk of postpartum depression in this trial-of-labor-after-cesarean cohort. The Introduction (page unavailable) describes conflicting findings in earlier studies; the paper does not establish a conclusion across systematic reviews and meta-analyses or at the population level. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • 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 [38]

    The Introduction (page not provided) describes conflicting findings: one earlier study found lower postpartum depression rates with epidural analgesia, while another found no difference. The Conclusion (page not provided) says epidural analgesia may be associated with decreased risk in the study’s trial-of-labor-after-cesarean context. The paper does not establish that the relationship is best characterized as neutral across delivery modes at the population level. (LLM, conf=0.86)

    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 [38]

    The Results (section 3.2; page unavailable) report fewer elevated postpartum-depression screening scores among women who received epidural labor analgesia during trial of labor after cesarean, supporting a possible protective association. The study does not establish the broader claim for all neuraxial anesthesia or compare neuraxial with general anesthesia for cesarean delivery. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

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Cited by

Sorted by citations

Authors
Sun, J., Xiao, Y., Zou, L., Liu, D., Huang, T., Zheng, Z., Yan, X., Yuan, A., Li, Y., & Huang, X.
Affiliations
  • Shenzhen Maternity and Child Healthcare Hospital (CN)
  • Jinan University (CN)
Corresponding author
  • Li, Yuantao
  • Huang, Xiaolei
ORCID
Venue
BioMed Research International
Publisher
Wiley
Published
2020-01
Volume
2020
Issue
1
Pages
2408063-2408063
ISSN
  • 1110-7243 (ISSN-L)
  • 2314-6133
  • 2314-6141
DOI
10.1155/2020/2408063
PMC
PMC6991168
OpenAlex
W3000142457
Cited by
19
References
7
Citations by year
2026: 3 · 2024: 1 · 2023: 3 · 2022: 5 · 2021: 4 · 2020: 3
FWCI
2.72
Type
journal article
Language
en
Open access
Licence
Locations
  • BioMed Research International (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Funders
  • Shenzhen Science and Technology Plan (CKCY20180323174659823)
  • SingChn Foundation (CKCY20180323174659823)
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, trial of labor after cesarean, Edinburgh Postnatal Depression Scale, multiparous women, postpartum anxiety, postpartum pain, perinatal mental health, obstetric analgesia
MeSH terms
Adult, Analgesics, Cesarean Section, China, Female, Humans, Labor, Obstetric, Pregnancy, Prospective Studies, Psychiatric Status Rating Scales, Trial of Labor, Analgesia, Epidural, Incidence, Logistic Models, Depression, Postpartum, Pain Management

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