701: The effects of antepartum depressive symptoms on post-cesarean opioid consumption

Abstract

To test the hypothesis that antepartum depressive symptoms are associated with increased pain scores and opioid use during postpartum hospitalization. Retrospective cohort of English or Spanish-speaking women > 18 years who had prenatal care for a singleton gestation and delivered by cesarean (CS) at > 36 weeks within a tertiary center during 2017 where all women are screened for depression with an antenatal Edinburgh Depression Scale (EDS). Exclusions included fetal anomalies or death, sickle cell disease, substance misuse, chronic pain, and fibromyalgia. Women with no EDS scores recorded antenatally were excluded. Major depressive symptoms (MDS) were defined as a documented antenatal EDS >=12 and no MDS if EDS< 12. MDS groups were compared with Student’s t-test, Wilcoxon rank sum tests, Chi-square, and exact tests where appropriate. Multiple linear regression modeled pain by MDS status controlling for smoking and anesthesia; model for opioid use included pain as well. Of the 891 patients reviewed, 676 (76%) had documented antenatal EDS scores, and 104 (15.4%) had MDS. Women with MDS were more likely to be single, use tobacco, and have general anesthesia for CS, but were otherwise similar (Table 1). Women with MDS reported higher daily and average pain scores (Table 2). In bivariate analyses, women with MDS used more morphine milligram equivalents (MME) each day during their postpartum hospitalization, leading to a higher total MME use (121mg (60.5-214.5) vs 75mg (28.5-133.5), p< 0.001). However, when adjusted for pain, MME use was not statistically significant (p=0.15). Our study supports an association between antepartum MDS and acute pain after CS leading to increased opioid use. Given the current focus on opioid stewardship, further research into this association, exploration of tailored pain control, and determining whether treatment of antepartum MDS reduces postpartum pain, and therefore opioid use, will be of the utmost priority.View Large Image Figure ViewerDownload Hi-res image Download (PPT)