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Neuraxial labour analgesia is associated with a reduced risk of maternal depression at 2 years after childbirth

A multicentre, prospective, longitudinal study

Liu, Zhi-Hua; He, Shu-Ting; Deng, Chun-Mei; Ding, Ting; Xu, Ming-Jun; Wang, Lei; Li, Xue-Ying; Wang, Dong-Xin

European Journal of Anaesthesiology (EJA): July 25, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/EJA.0000000000001058
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BACKGROUND Severe labour pain is an important risk factor of postpartum depression, and early depression is associated with an increased risk of long-term depression; whereas the use of epidural analgesia during labour decreases the risk of postpartum depression.

OBJECTIVE To investigate whether neuraxial labour analgesia was associated with a decreased risk of 2-year depression.

DESIGN This was a multicentre, prospective, longitudinal study.

SETTING The study was performed in Peking University First Hospital, Beijing Obstetrics and Gynecology Hospital and Haidian Maternal and Child Health Hospital in Beijing, China, between 1 August 2014 and 25 April 2017.

PATIENTS Five hundred ninety-nine nulliparous women with single-term cephalic pregnancy preparing for vaginal delivery were enrolled.

MAIN OUTCOME MEASURE Depressive symptoms were screened with the Edinburgh Postnatal Depression Scale at delivery-room admission, 6-week postpartum and 2 years after childbirth. A score of 10 or higher was used as the threshold of depression. The primary endpoint was the presence of depression at 2 years after childbirth. The association between the use of neuraxial labour analgesia and the development of 2-year depression was analysed with a multivariable logistic regression model.

RESULTS Five hundred and eight parturients completed 2-year follow-up. Of these, 368 (72.4%) received neuraxial analgesia during labour and 140 (27.6%) did not. The percentage with 2-year depression was lower in those with neuraxial labour analgesia than in those without (7.3 [27/368] vs. 13.6% [19/140]; P = 0.029). After correction for confounding factors, the use of neuraxial analgesia during labour was associated with a significantly decreased risk of 2-year depression (odds ratio 0.455, 95% confidence interval 0.230 to 0.898; P = 0.023).

CONCLUSION For nulliparous women with single-term cephalic pregnancy planning for vaginal delivery, the use of neuraxial analgesia during labour was associated with a reduced risk of maternal depression at 2 years after childbirth.

TRIAL REGISTRATION www.chictr.org.cn: ChiCTR-OCH-14004888 and ClinicalTrials.gov: NCT02823418.

From the Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital (Z-HL, S-TH, C-MD, TD, D-XW), Department of Anesthesiology, Beijing Obstetrics and Gynecology Hospital (M-JX), Department of Anesthesiology, Haidian Maternal & Child Health Hospital (LW) and Department of Biostatistics, Peking University First Hospital, Beijing, China (X-YL)

Correspondence to Dong-Xin Wang, MD, PhD, Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, No. 8 Xishiku Street, Beijing 100034, China Tel: +86 10 83572784; fax: +86 10 66551057; e-mail: wangdongxin@hotmail.com

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© 2019 European Society of Anaesthesiology