Highlights
- •Review of association between neuraxial labor analgesia and postpartum depression.
- •Postpartum depression has long-term health implications.
- •Neuraxial analgesia is not clearly associated with postpartum depression.
- •The interaction between pain and postpartum depression is complex.
Abstract
Background
Postpartum depression (PPD) is the most common complication after childbirth, affecting
10–15% of women. It is associated with serious long-term consequences for the mother
and family. Whether or not neuraxial labor analgesia mitigates the risk is uncertain
and controversial. The purpose of this review was to summarize studies investigating
the association between neuraxial labor analgesia and the incidence of PPD.
Methods
A systematic literature search for randomized controlled trials and cohort studies
reporting the incidence of PPD among parturients who received neuraxial analgesia
compared with non-neuraxial or no analgesia. The primary outcome was the incidence
of PPD between 5 and 12 weeks’ postpartum. Depression was diagnosed using a cutoff
score of ≥10 on the Edinburgh Postnatal Depression scale, a validated screening tool.
The risk of bias of each study was evaluated, and odds ratios and 95% confidence intervals
calculated from raw data or reported as adjusted odds ratios.
Results
Eleven observational studies involving 5717 patients were included. Three studies
had a critical risk, three a serious risk, and five a moderate risk of bias. Two studies
reported significantly lower odds for PPD associated with neuraxial analgesia compared
with non-neuraxial or no analgesia, whereas the odds ratios in the remaining nine
studies were not significantly different.
Conclusions
Our systematic review did not find compelling evidence for an association between
PPD and labor analgesia. Studies were heterogenous in nature and had a high risk of
bias. Further research controlling for confounding factors is recommended to determine
if a relationship exists.
Keywords
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Article info
Publication history
Published online: October 17, 2020
Accepted:
October 10,
2020
Identification
Copyright
© 2020 Elsevier Ltd. All rights reserved.
