Labor Analgesia as a Predictor for Reduced Postpartum Depression Scores: A Retrospective Observational Study
Open accessAbstract
BACKGROUND: Using labor, epidural analgesia has been linked to a reduced risk of postpartum depression, but the role of labor pain relief in this association remains unclear. The goal of this study was to test the hypothesis that effective epidural analgesia during labor is associated with reduced postpartum depression symptomatology. METHODS: A single, institutional, retrospective, observational cohort design was chosen. The primary outcome was Edinburgh postnatal depression scale (EPDS) score, measured at the 6-week postpartum visit. Subjects included in the final analysis had (1) received labor epidural analgesia; (2) pain assessed during labor both before and during initiation of labor epidural analgesia by 0–10 numeric rating scores; and (3) depression risk assessed by the EPDS and documented at their 6-week postpartum visit. Simple and multiple linear regression was used to identify the best model for assessing the association between pain improvement, defined as percent improvement in pain (PIP), and depression, after adjusting for a history of anxiety or depression, other psychiatric history, abuse, trauma, mode of delivery, and other maternal or fetal comorbid diseases. RESULTS: Two hundred one patients were included in the final analysis. Women with higher improvements in pain were associated with lower EPDS scores ( r = 0.025; P = .002). Variables known to be associated with depression (body mass index, anxiety and/or depression, third- and fourth-degree perineal lacerations, and anemia) were significantly correlated with EPDS score and included in the final model. After we adjusted for these covariates, PIP remained a significant predictor of EPDS score ( r = 0.49; P = .008), accounting for 6.6% of the variability in postpartum depression scores. The full model including pain, body mass index, anxiety and/or depression, perineal lacerations, and anemia explained 24% of the variability in postpartum depression scores. CONCLUSIONS: Although the extent of labor pain relief by epidural analgesia predicts lower postpartum depression scores, the relative contribution of PIP to risk for postpartum depression symptoms may be less than other established risk factors for depression. These data support that the clinical significance of labor analgesia in the development of postpartum depression needs to be more clearly defined.
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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 [40]
The Discussion (page unavailable) associates effective labor epidural analgesia with lower postpartum depression symptom scores, supporting a potential protective association in the studied context. But the Methods and Results (page unavailable) show that the analysis included only women who received a labor epidural; cesarean deliveries without labor were excluded. It therefore does not establish a neutral population-level relationship across delivery modes. (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 [40]
The Introduction and Discussion report studies associating labor epidural analgesia with lower postpartum depression risk, and this study found that more effective epidural pain relief was associated with lower depression scores. But the Methods include only women who received epidural analgesia, and the paper does not establish the claimed population-level conclusion across observational studies, systematic reviews, and meta-analyses. Page numbers were not provided in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredNeuraxial 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 [40]
The Discussion (page not provided) associates effective epidural labor analgesia with reduced postpartum depression symptoms, supporting the labor-related portion of the claim. The study examined women who received epidural analgesia during labor; it does not support the claim’s added comparison with general anesthesia for cesarean delivery, which is absent from the verbatim citing sentence. (LLM, conf=0.87)
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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
- Lim, G., Farrell, L. M., Facco, F. L., Gold, M. S., & Wasan, A. D.
- Affiliations
- Department of Anesthesiology
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology
- Department of Neurobiology
- University of Pittsburgh (US)
- Corresponding author
- Lim, Grace
- Farrell, Lia M.
- Venue
- Anesthesia & Analgesia
- Published
- 2018-05
- Volume
- 126
- Issue
- 5
- Pages
- 1598-1605
- ISSN
- 0003-2999 (ISSN-L)
- PMC
- PMC5908733
- OpenAlex
- W2772903265
- Cited by
- 84
- References
- 5
- Citations by year
- 2026: 5 · 2025: 9 · 2024: 5 · 2023: 9 · 2022: 13 · 2021: 16 · 2020: 15 · 2019: 4 · 2018: 8
- FWCI
- 6.65
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Anesthesia & Analgesia (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of General Medical Sciences (T32GM075770)
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK107966)
- National Institute of Neurological Disorders and Stroke (R01NS083347)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (K12HD043441)
- 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, labor analgesia, Edinburgh Postnatal Depression Scale, perineal tears, body mass index, anemia, risk factors for postpartum depression, perinatal mental health
- MeSH terms
- Adult, Female, Humans, Predictive Value of Tests, Pregnancy, Retrospective Studies, Cohort Studies, Analgesia, Epidural, Depression, Postpartum, Labor Pain, Pain Management
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