CoChat
Sign Up
Cited by 4Maternal Mental Health During Pregnancy and PostpartumAnesthesia and Pain ManagementMaternal and Perinatal Health Interventions

Labor Epidural Anesthesia and Postpartum Depression Risk: Prospective Observation Study and Mendelian Randomization Analysis

Open access
Zheng, Wei, Gan, Ping, Wan, Xianwen, Wang, Xiuhong, Gong, Jie, Min, Jia·2025·Drug Design, Development and Therapy
DOI 10.2147/dddt.s533306PMC PMC12447957
Open this paper in CoChat — free account

Abstract

Background: Postpartum depression is a common mental disorder in mothers. Although the association between pain and depression is generally accepted, it remains uncertain whether labor epidural analgesia can effectively reduce the risk of postpartum depression. The objective of this study was to investigate the association between labor epidural analgesia and postpartum depression. Methods: A total of 146 parturients with a single-term cephalic pregnancy who were preparing for vaginal delivery were recruited for this observational prospective study. The parturients were divided into a labor epidural analgesia group and a control group (routine care) by preference, with 73 in each group. Sociodemographic characteristics and peripartum data of the parturients were collected. Postpartum depression was defined as a score of ≥ 13 on the Edinburgh Postnatal Depression Scale (EPDS) at 6-weeks postpartum. Multivariable logistic analysis was applied to explore the risk factors for postpartum depression, and Mendelian randomization analyses were used to provide supporting evidence for the association between labor epidural analgesia and postpartum depression at the genetic level. Single-nucleotide polymorphisms associated with epidural or spinal anesthesia and postpartum depression were identified from publicly available genetic dataset of the United Kingdom biobank and FinnGen database. Results: There was no statistically significant difference in the incidence of postpartum depression at 6-weeks postpartum between the epidural and non-epidural groups [12 (16.4%) vs 7 (9.6%), P = 0.219]. The multivariable logistic model suggested that prepartum EPDS scores, satisfaction with income and marital status, pain level before anesthesia, and comorbidity during pregnancy were independent predictors of postpartum depression incidence. Mendelian randomization analyses indicated that neither labor epidural (OR = 0.90, 95% CI: 0.78– 1.05; P = 0.18) nor spinal anesthesia (OR = 1.10, 95% CI: 0.96– 1.27; P = 0.17) potentially reduced the risk of postpartum depression. Conclusion: These findings imply that administration of labor epidural analgesia during delivery has no influence on the incidence of postpartum depression. Registration Number: The study protocol was registered in Chinese Clinical Trial Registry (ChiCTR2300078957). Keywords: postpartum depression, labor epidural analgesia, neuraxial anesthesia, prospective observation study, Mendelian randomization

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.2147/dddt.s533306

Cites

4 of 4 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 35

  1. [2]Kornfield SL, White LK, Waller R, et al. Risk And Resilience Factors Influencing Postpartum Depression And Mother-Infant Bonding During COVID-19. Health Affairs. 2021; 40(10): 1566– 1574. doi: 10.1377/hlthaff.2021.00803 34606353 PMC9351691 · DOI
  2. [3]Parise DC, Gilman C, Petrilli MA, Malaspina D. Childbirth Pain and Post-Partum Depression: does Labor Epidural Analgesia Decrease This Risk? Journal of Pain Research. 2021; 14: 1925– 1933. doi: 10.2147/JPR.S305485 34211295 PMC8242125 · DOI
  3. [5]Mavrogiorgou P, Diop S, Turmes L, et al. Computer-based mother-infant interaction analysis and mental functioning in postpartum depression. Psychiatry Res. 2022; 311: 114506. doi: 10.1016/j.psychres.2022.114506 35287041 · DOI
  4. [6]Wang J, Zhao G, Song G, Liu J. Association between neuraxial labor analgesia and postpartum depression: a meta-analysis. J Affective Disorders. 2022; 311: 95– 102. doi: 10.1016/j.jad.2022.05.095 35594971 · DOI · Paper page
  5. [7]Liu X, Wang S, Wang G. Prevalence and Risk Factors of Postpartum Depression in Women: a Systematic Review and Meta-analysis. J Clin Nurs. 2022; 31(19–20): 2665– 2677. doi: 10.1111/jocn.16121 34750904 · DOI · Paper page
  6. [8]Stewart DE, Vigod SN. Postpartum Depression: pathophysiology, Treatment, and Emerging Therapeutics. Ann Rev Med. 2019; 70: 183– 196. doi: 10.1146/annurev-med-041217-011106 30691372 · DOI · Paper page
  7. [9]Payne JL, Maguire J. Pathophysiological mechanisms implicated in postpartum depression. Front Neuroendocrinol. 2019; 52: 165– 180. doi: 10.1016/j.yfrne.2018.12.001 30552910 PMC6370514 · DOI · Paper page
  8. [10]Jiang Y, Wei D, Xie Y. Causal effects of opioids on postpartum depression: a bidirectional, two-sample Mendelian randomization study. Front Psychiatry. 2023; 14: 1043854. doi: 10.3389/fpsyt.2023.1043854 37151969 PMC10159056 · DOI
  9. [11]Hoirisch-Clapauch S. The Fibrinolytic System in Peripartum Depression. Semin Thromb Hemost. 2023; 49(4): 382– 390. doi: 10.1055/s-0042-1756194 36113504 · DOI
  10. [12]Yim IS, Tanner Stapleton LR, Guardino CM, Hahn-Holbrook J, Dunkel Schetter C. Biological and psychosocial predictors of postpartum depression: systematic review and call for integration. Ann Rev Clin Psychol. 2015; 11: 99– 137. doi: 10.1146/annurev-clinpsy-101414-020426 25822344 PMC5659274 · DOI · Paper page
  11. [13]Chang SR, Chen KH, Lee CN, Shyu MK, Lin MI, Lin WA. Relationships between perineal pain and postpartum depressive symptoms: a prospective cohort study. Int J Nurs Stud. 2016; 59: 68– 78. doi: 10.1016/j.ijnurstu.2016.02.012 27222452 · DOI
  12. [14]Eisenach JC, Pan PH, Smiley R, Lavand’homme P, Landau R, Houle TT. Severity of acute pain after childbirth, but not type of delivery, predicts persistent pain and postpartum depression. Pain. 2008; 140(1): 87– 94. doi: 10.1016/j.pain.2008.07.011 18818022 PMC2605246 · DOI
  13. [15]Li N, Hu L, Li C, Pan X, Tang Y. Effect of Epidural Dexmedetomidine as an Adjuvant to Local Anesthetics for Labor Analgesia: a Meta-Analysis of Randomized Controlled Trials. eCAM. 2021; 2021: 4886970. doi: 10.1155/2021/4886970 34745286 PMC8568549 · DOI
  14. [16]Wang Y, Chen Z, Dang X, Jiang N, Cui K, Su S. Different Doses of Ropivacaine either with Sufentanil or with Dexmedetomidine for Labor Epidural Anesthesia regarding Painless Childbirth: a Retrospective, Multicenter Study. Pharmacology. 2022; 1– 12. doi: 10.1159/000524304 35609521 · DOI
  15. [17]Deng CM, Ding T, Li S, et al. Neuraxial labor analgesia is associated with a reduced risk of postpartum depression: a multicenter prospective cohort study with propensity score matching. J Affective Disorders. 2021; 281: 342– 350. doi: 10.1016/j.jad.2020.12.027 33348177 · DOI
  16. [18]Mo J, Ning Z, Wang X, Lv F, Feng J, Pan L. Association between perinatal pain and postpartum depression: a systematic review and meta-analysis. J Affective Disorders. 2022; 312: 92– 99. doi: 10.1016/j.jad.2022.06.010 35716784 · DOI · Paper page
  17. [19]Kountanis JA, Vahabzadeh C, Bauer S, et al. Labor epidural analgesia and the risk of postpartum depression: a meta-analysis of observational studies. J Clin Anesth. 2020; 61: 109658. doi: 10.1016/j.jclinane.2019.109658 31784304 · DOI · Paper page
  18. [20]Ghanbari-Homaie S, Jenani SP, Faraji-Gavgani L, Hosenzadeh P, Rezaei M. Association between epidural analgesia and postpartum psychiatric disorders: a meta-analysis. Heliyon. 2024; 10(6): e27717. doi: 10.1016/j.heliyon.2024.e27717 38524559 PMC10958359 · DOI · Paper page
  19. [21]Davies NM, Holmes MV, Davey Smith G. Reading Mendelian randomisation studies: a guide, glossary, and checklist for clinicians. BMJ. 2018; 362: k601. doi: 10.1136/bmj.k601 30002074 PMC6041728 · DOI · Paper page
  20. [22]Gibson J, McKenzie-McHarg K, Shakespeare J, Price J, Gray R. A systematic review of studies validating the Edinburgh Postnatal Depression Scale in antepartum and postpartum women. Acta Psychiatrica Scand. 2009; 119(5): 350– 364. doi: 10.1111/j.1600-0447.2009.01363.x 19298573 · DOI
  21. [24]Ding T, Wang DX, Qu Y, Chen Q, Zhu SN. Epidural labor analgesia is associated with a decreased risk of postpartum depression: a prospective cohort study. Anesthesia Analg. 2014; 119(2): 383– 392. doi: 10.1213/ANE.0000000000000107 24797120 · DOI · Paper page
  22. [25]Allen NE, Lacey B, Lawlor DA, et al. Prospective study design and data analysis in UK Biobank. Sci Trans Med. 2024; 16(729): eadf4428. doi: 10.1126/scitranslmed.adf4428 PMC11127744 38198570 · DOI
  23. [26]Kurki MI, Karjalainen J, Palta P, et al. FinnGen provides genetic insights from a well-phenotyped isolated population. Nature. 2023; 613: 7944):508–518. doi: 10.1038/s41586-022-05473-8 PMC9849126 36653562 · DOI · Paper page
  24. [27]Wootton RE, Lawn RB, Millard LAC, et al. Evaluation of the causal effects between subjective wellbeing and cardiometabolic health: mendelian randomisation study. BMJ. 2018; 362: k3788. doi: 10.1136/bmj.k3788 30254091 PMC6155050 · DOI · Paper page
  25. [29]Tan HS, Tan CW, Sultana R, et al. The association between epidural labour analgesia and postpartum depression: a randomised controlled trial. Anaesthesia. 2024; 79(4): 357– 367. doi: 10.1111/anae.16178 37990597 · DOI
  26. [30]Liu ZH, He ST, Deng CM, et al. Neuraxial labour analgesia is associated with a reduced risk of maternal depression at 2 years after childbirth: a multicentre, prospective, longitudinal study. Eur J Anaesthesiol. 2019; 36(10): 745– 754. doi: 10.1097/EJA.0000000000001058 31356375 PMC6738542 · DOI · Paper page
  27. [31]Johnstone SJ, Boyce PM, Hickey AR, Morris-Yatees AD, Harris MG. Obstetric risk factors for postnatal depression in urban and rural community samples. Australian New Zealand J Psychiatry. 2001; 35(1): 69– 74. doi: 10.1046/j.1440-1614.2001.00862.x 11270460 · DOI
  28. [32]Munro A, George RB, Mackinnon SP, Rosen NO. The association between labour epidural analgesia and postpartum depressive symptoms: a longitudinal cohort study. Can J Anaesthesia. 2021; 68(4): 485– 495. doi: 10.1007/s12630-020-01900-4 33403538 · DOI
  29. [33]Edipoglu IS, Aslan DD. Association of postpartum depression and epidural analgesia in women during labor: an observational study. Braz J Anesthesiol. 2021; 71(3): 208– 213. doi: 10.1016/j.bjane.2021.02.021 33941362 PMC9373269 · DOI
  30. [34]Lim G, LaSorda KR, Farrell LM, McCarthy AM, Facco F, Wasan AD. Obstetric pain correlates with postpartum depression symptoms: a pilot prospective observational study. BMC Pregnancy Childbirth. 2020; 20(1): 240. doi: 10.1186/s12884-020-02943-7 32321455 PMC7178606 · DOI
  31. [35]Zhang Y, Johnston L, Ma D, Wang F, Zheng X, Xu X. An exploratory study of the effect of labor pain management on postpartum depression among Chinese women. Ginekologia polska. 2018; 89(11): 627– 636. doi: 10.5603/GP.a2018.0107 30508215 · DOI
  32. [36]Suzumori N, Ebara T, Tamada H, et al. Relationship between delivery with anesthesia and postpartum depression: the Japan Environment and Children’s Study (JECS). BMC Pregnancy Childbirth. 2021; 21(1): 522. doi: 10.1186/s12884-021-03996-y 34301185 PMC8306350 · DOI
  33. [37]Congedo E, Sgreccia M, De Cosmo G. New drugs for epidural analgesia. Curr Drug Target. 2009; 10(8): 696– 706. doi: 10.2174/138945009788982441 19702518 · DOI
  34. [38]Cho H, Lee K, Choi E, et al. Association between social support and postpartum depression. Sci Rep. 2022; 12(1): 3128. doi: 10.1038/s41598-022-07248-7 35210553 PMC8873474 · DOI
  35. [39]Burgess S, Thompson SG, Collaboration CCG. Avoiding bias from weak instruments in Mendelian randomization studies. Int J Epidemiol. 2011; 40(3): 755– 764. doi: 10.1093/ije/dyr036 21414999 · DOI · Paper page

Cited by

Sorted by citations

Authors
Zheng, W., Gan, P., Wan, X., Wang, X., Gong, J., & Min, J.
Affiliations
Nanchang University (CN)
ORCID
Venue
Drug Design, Development and Therapy
Publisher
Informa UK Limited
Published
2025-09
Volume
Volume 19
Pages
8327-8338
ISSN
1177-8881 (ISSN-L)
DOI
10.2147/dddt.s533306
PMC
PMC12447957
OpenAlex
W4414189647
Cited by
4
References
4
Citations by year
2026: 4
FWCI
3.04
Type
journal article
Language
en
Open access
Licence
Locations
  • Drug Design Development and Therapy (publishedVersion, cc-by-nc)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • PubMed Central (publishedVersion, cc-by-nc)
  • Dove Medical Press (Taylor and Francis Group) (submittedVersion, cc-by-nc)
  • 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, spinal anesthesia, perinatal pain, risk factors for postpartum depression, prepartum depression, single nucleotide polymorphisms, genetic association, Mendelian randomization, Edinburgh Postnatal Depression Scale, pregnancy comorbidities, marital status, income satisfaction, vaginal delivery, childbirth pain management, maternal mental health
MeSH terms
Adult, Anesthesia, Epidural, Female, Humans, Labor, Obstetric, Pregnancy, Prospective Studies, Risk Factors, Analgesia, Epidural, Depression, Postpartum, Polymorphism, Single Nucleotide, Mendelian Randomization Analysis

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review