Highlights
- •There may be postpartum depression (PPD) reduction with intrapartum epidural use.
- •Our population-based study examines epidural use and PPD physician and hospital visits.
- •We found no association between epidural and maternal PPD healthcare use.
- •Associations may exist between other analgesia modalities and PPD healthcare use.
- •Further studies of labor analgesia and maternal mental health outcomes are needed.
Abstract
Purpose
To evaluate whether intrapartum epidural use is associated with maternal postpartum
depression presenting for medical care.
Methods
Population-based, matched cohort study including all adult nulliparous women in Ontario,
Canada from 2006 to 2012 without a history of depression, who had a term vaginal delivery.
Seventy covariates including maternal demographics, medical and psychiatric conditions,
prenatal and perinatal complications, and healthcare utilization were measured. Primary
exposure was intrapartum epidural use. Primary outcome was the onset of depression
requiring medical care within 12 months postpartum; and the secondary outcome was
self-harm.
Results
A total of 40303 women who received an intrapartum epidural were matched 1:1 on age, year of cohort
entry, and propensity score to an equal number of women who did not receive an intrapartum
epidural. Overall rate of new onset depression presenting to the healthcare system
was 0.88% within 12 months postpartum. Intrapartum epidural use was not associated
with maternal postpartum physician or hospital visits (adjusted HR 1.05 [95% CI 0.87
to 1.28]) or self-harm (unadjusted HR 0.91 [95% CI 0.57 to 1.48]).
Conclusions
Intrapartum epidural use was not associated with maternal postpartum depression presenting
to the healthcare system in term nulliparous women who had a vaginal delivery. Further
research is needed to determine if intrapartum epidural use is associated with postpartum
depression among women who don’t seek care from a physician.
Keywords
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Article info
Publication history
Published online: April 20, 2018
Accepted:
April 15,
2018
Identification
Copyright
© 2018 Elsevier Ltd. All rights reserved.
