Epidural Labor Analgesia Is Associated with a Decreased Risk of Postpartum Depression: A Prospective Cohort Study
Abstract
Background Postpartum depression is a common psychiatric disorder in parturients after delivery. The etiology remains unclear, and multiple factors may be involved. In this study, we investigated whether epidural labor analgesia was associated with a decreased risk of postpartum depression development. Methods Two hundred fourteen parturients who were preparing for a vaginal delivery were enrolled in this prospective cohort study. Epidural labor analgesia was performed in 107 of 214 patients on their request. Parturients' mental status was assessed with the Edinburgh Postnatal Depression Scale at 3 days and 6 weeks after delivery. A score of 10 or higher on the scale at 6 weeks was used as an indication of postpartum depression. Parturients' characteristics together with perinatal variables were collected. Multivariate logistic regression analysis was performed to assess an association between the use of epidural analgesia and the occurrence of postpartum depression. Results Postpartum depression occurred in 14.0% (15 of 107) of parturients who received epidural labor analgesia and in 34.6% (37 of 107) of those who did not (P Conclusions Epidural labor analgesia was associated with a decreased risk of postpartum depression. Further study with a large sample size is needed to evaluate the impact of epidural analgesia on the occurrence of postpartum depression.
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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.”
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.”
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”
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”
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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Prevalence and Risk Factors of Postpartum Depression in Women: A Systematic Review and Meta‐analysis
Liu, X., Wang, S., & Wang, G. (2022) · Journal of Clinical Nursing · doi:10.1111/jocn.16121 · Cited by 520 · see citing works
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- Authors
- Ding, T., Wang, D.-X., Qu, Y., Chen, Q., & Zhu, S.-N.
- Affiliations
- Peking University First Hospital (CN)
- Corresponding author
- Ding, Ting
- Wang, Dong-Xin
- Qu, Yuan
- Venue
- Anesthesia & Analgesia
- Published
- 2014-08
- Volume
- 119
- Issue
- 2
- Pages
- 383-392
- ISSN
- 0003-2999 (ISSN-L)
- OpenAlex
- W2021387150
- Cited by
- 146
- References
- 11
- Citations by year
- 2026: 6 · 2025: 10 · 2024: 13 · 2023: 11 · 2022: 18 · 2021: 12 · 2020: 26 · 2019: 12 · 2018: 12 · 2017: 11 · 2016: 7 · 2015: 7 · 2014: 1
- FWCI
- 7.98
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Anesthesia & Analgesia (publishedVersion)
- 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
- labor epidural analgesia, postpartum depression, childbirth preparation classes, breastfeeding, Edinburgh Postnatal Depression Scale, perinatal mental health, risk factors for postpartum depression, vaginal delivery, parturients
- MeSH terms
- Adult, Breast Feeding, China, Female, Humans, Labor, Obstetric, Pregnancy, Prospective Studies, Psychiatric Status Rating Scales, Risk Factors, Time Factors, Analgesia, Epidural, Multivariate Analysis, Logistic Models, Odds Ratio, Treatment Outcome, Depression, Postpartum, Prenatal Education
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