Labor Epidural Analgesia and Postpartum Depression

Abstract

Introduction: Epidural labor analgesia may decrease the risk of postpartum depression (PPD). Methods:In a secondary analysis of a prospective study, the association between epidural utilization and PPD was evaluated using a Fisher's exact test.PPD was defined as an Edinburgh Postnatal Depression score of > 10 at 6-8 weeks postpartum.Results: 20% (13/65) of women meet criteria for PDD.24% (n=12/50) of women who received epidural labor analgesia developed PPD, compared to 6.7% (n=1/15) of women who did not receive epidural labor analgesia (P = 0.27). Conclusions: Labor epidural analgesia did not reduce the risk of postpartum depression.original study, yet to be published, examined the association of blood biological markers and peripartum depression.The original study also prospectively evaluated for antepartum depression at 8-10 weeks and 24-28 weeks gestation.Epidural status at time of delivery was noted.Women were screened for PPD on their routine postpartum visit at 6-8 weeks postpartum using the Edinburgh Postnatal Depression Scale (EDPS) score of > 10.EPDS has been described as the most common screening tool for postpartum depression evaluation [1].The EDPS is a 10-item questionnaire and is a validated screening tool for depression in pregnant and postpartum women [9].An EPDS score of > 10 has been used in other studies to identify PPD [2,8].A variety of EPDS cut-off scores ranging from 9 to 13 have been used for diagnosis.Participant's corresponding demographic information was gathered antepartum including age, BMI, race, parity, gravida, relationship status with the father, income level, education level and history of psychiatric illness.Following delivery, participant's charts were reviewed to identify utilization or non-utilization of epidural labor analgesia as well as gestational age of the baby at delivery.Statistical analyses were performed using Fisher's exact tests to examine the association between labor epidural and PPD at 6-8 weeks postpartum and other dichotomous variables.T-tests or Wilcoxon rank sum tests were used for continuous variables where appropriate. ResultsEpidural utilization during labor, and PPD status were available for 65 parturients.Demographic characteristics of parturients did not differ between subjects with EDPS score of < 10 compared to those with EDPS score > 10 (Table 1).At 6-8 weeks postpartum, 20% (13/65) of women meet criteria for PPD.Epidural labor analgesia was utilized by the majority of parturients (76.9%; 50/65; Table 1).Parturients who received epidural labor analgesia had a 24% (n=12/50) incidence of PPD compared to a rate of 6.7% (n=1/15) among parturients who did not receive labor analgesia (P = 0.27; Figure 1).Women without PPD had an overall lower BMI compared to