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Cited by 48Maternal Mental Health During Pregnancy and PostpartumAnesthesia and Pain ManagementMaternal and Perinatal Health Interventions

The association between labor epidural analgesia and postpartum depression: a systematic review and meta-analysis

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Almeida, Marcela, Kosman, Katherine A., Kendall, Mark C., De Oliveira, Gildasio S.·2020·BMC Women's Health
DOI 10.1186/s12905-020-00948-0PMC PMC7216422
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Abstract

Background: Previous studies have demonstrated that appropriate treatment for postoperative pain can lead to improvement in depressive symptoms, however the association between adequate intrapartum pain control and the development of postpartum depression is not clear. The purpose of the study was to examine the effects of labor epidural analgesia and postpartum depression. Methods: We performed a quantitative systematic review in compliance with the PRISMA statement. We conducted a search of PubMed, Embase, the Cochrane Database of Systematic Reviews and Google Scholar databases. The primary outcome was a positive screen of postpartum depression among women who received labor epidural analgesia up to 3 months into the postpartum period. Meta-analysis was performed using the random effect model. Results: Of the 148 studies available, 9 studies with 4442 patients were included in the analysis. The use of labor analgesia on positive depression screen compared to control revealed no significant effect, OR (95% CI) of 1.02 (0.62 to 1.66, P = 0.94). Conclusion: Based on current literature, the use of epidural analgesia for pain relief during labor doesn’t appear to affect the likelihood of postpartum depression. Future studies are warranted to further investigate these findings and identity other possible preventative interventions that reduce postpartum depression.

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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 [46]

    The Abstract Results (page unavailable) report no significant overall association between labor epidural analgesia and a positive postpartum-depression screen. The Results (page unavailable) also list one study with significantly less PPD in the epidural group. The review addresses labor epidural analgesia, however, not neuraxial anesthesia across delivery modes, and it does not establish protective effects in particular clinical contexts. (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 [46]

    The Results report a meta-analysis of nine studies involving 4,442 patients, with no significant association between labor epidural analgesia and a positive postpartum-depression screen. The Conclusions likewise report no detected association. The claim is broader than this evidence: the paper evaluates labor epidural analgesia, not neuraxial anesthesia generally. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • 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”

    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 [46]

    The Discussion and Results report no significant association between labor epidural analgesia and postpartum depression. The Background identifies psychosocial risk factors, but the paper does not establish that they dominate analgesia’s effect; the Discussion also cautions that observational studies cannot account for unknown confounders. The evidence concerns labor epidural analgesia specifically, not all neuraxial anesthesia. (LLM, conf=0.84)

    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 [46]

    The Results (Postpartum depression) found no significant association between labor epidural analgesia and postpartum depression (OR 1.02, 95% CI 0.62–1.66). The Discussion says recipients were not less likely to develop postpartum depression, so the paper does not establish even a modest protective effect. It studies labor epidurals, not neuraxial anesthesia broadly or a comparison with general anesthesia for cesarean delivery. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • 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”

    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 [46]

    The Results (Table 1; page not provided) report several studies finding no difference in postpartum depression by epidural use, and the Discussion reports no significant pooled association. The methodological-quality section says some studies did not adjust for known confounders, while Table 2 scores others for comparability. The paper does not establish that the reported null findings were specifically obtained after adjustment for psychosocial confounders; its pooled estimate is not presented as an adjusted estimate. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

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Cited by

Sorted by citations

Authors
Almeida, M., Kosman, K. A., Kendall, M. C., & De Oliveira, G. S.
Affiliations
  • Brigham and Women's Hospital (US)
  • Brown University (US)
Corresponding author
Kendall, Mark C.
ORCID
Venue
BMC Women's Health
Publisher
Springer Science and Business Media LLC
Published
2020-05-11
Volume
20
Issue
1
Pages
99-99
ISSN
1472-6874 (ISSN-L)
DOI
10.1186/s12905-020-00948-0
PMC
PMC7216422
OpenAlex
W3026215373
Cited by
48
References
2
Citations by year
2026: 7 · 2025: 9 · 2024: 6 · 2023: 5 · 2022: 10 · 2021: 9 · 2020: 2
FWCI
1.08
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Women s Health (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
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, intrapartum pain, postoperative pain, maternal mental health, obstetric analgesia
MeSH terms
Analgesics, Female, Humans, Pregnancy, Analgesia, Epidural, Depression, Postpartum, Labor Pain, Pain Management

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