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Original Article| Volume 35, P10-16, August 2018

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Association between intrapartum epidural use and maternal postpartum depression presenting for medical care: a population-based, matched cohort study

  • Y. (Maria) Wu
    Affiliations
    Department of Obstetrics and Gynecology, London Health Sciences Centre, London, Ontario, Canada
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  • E. McArthur
    Affiliations
    Institute for Clinical Evaluative Sciences, Ontario, Canada
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  • S. Dixon
    Affiliations
    Institute for Clinical Evaluative Sciences, Ontario, Canada

    Department of Epidemiology and Biostatistics, London Health Sciences Centre, London Ontario, Canada
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  • J.S. Dirk
    Affiliations
    Institute for Clinical Evaluative Sciences, Ontario, Canada
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  • Author Footnotes
    † ORCID: 0000-0001-7093-558X.
    B.K. Welk
    Correspondence
    Corresponding author at: Dr B. Welk, Department of Surgery and Epidemiology and Biostatistics, Western University, Room B4-667, St Joseph's Health Care, 268 Grosvenor Street, London, ON N6A 4V2, Canada. Fax: +1 519 646 6037.
    Footnotes
    † ORCID: 0000-0001-7093-558X.
    Affiliations
    Institute for Clinical Evaluative Sciences, Ontario, Canada

    Department of Epidemiology and Biostatistics, London Health Sciences Centre, London Ontario, Canada

    Department of Surgery, London Health Sciences Centre, London Ontario, Canada
    Search for articles by this author
  • Author Footnotes
    † ORCID: 0000-0001-7093-558X.
Published:April 20, 2018DOI:https://doi.org/10.1016/j.ijoa.2018.04.005

      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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