Epidural Labor Analgesia Is Associated with a Decreased Risk of the Edinburgh Postnatal Depression Scale in Trial of Labor after Cesarean: A Multicenter, Prospective Cohort Study.

Jing Sun,Aiwu Yuan,Yuantao Li,Ting Huang,Danyong Liu,Zhao Zheng,Xuetao Yan,Liwei Zou,Xiaolei Huang,Yuci Xiao

doi:10.1155/2020/2408063

Abstract

Postpartum depression is a disabling mental disorder commonly seen in parturients under trial of labor after cesarean, which causes serious harm to the parturients. The etiology is unclear. We hypothesized that epidural labor analgesia can reduce the incidence rate of postpartum depression. Enrolled multiparas were divided into the epidural labor analgesia group (n = 263) or nonanalgesia group (n = 160) according to their own request. Edinburgh Postnatal Depression Scale was used to assess their mental status at 48 hours and 42 days after delivery. Relative perinatal variables were collected and further analyzed using univariate analysis and multivariate logistic regression analysis to assess the relation of epidural analgesia with the occurrence of postpartum depression under trial of labor after cesarean. The Edinburgh Postnatal Depression Scale score 48 hours ≥ 10 in the no epidural analgesia group was 26.42% while the epidural analgesia group was 8.49% (OR, 0.209; 95% CI, 0.096–0.429; P < 0.001). The Edinburgh Postnatal Depression Scale score 42 day ≥ 10 in the no epidural analgesia group was 25.16% while the epidural analgesia group was 6.59% (OR, 0.235; 95% CI, 0.113–0.469; P < 0.001). The incidence of postpartum depression was significantly lower in the epidural labor analgesia group at 48 hours and 42 days. There was also a significant relation between the Edinburgh Postnatal Depression Scale scores at 48 hours and 42 days after delivery. Epidural analgesia, discomfort within 42 days, and self-rating anxiety scale are independent predictors of postpartum depression for trial of labor after cesarean in 42 days. Epidural labor analgesia is associated with a decreased risk of postpartum depression. Further study with a large sample size and more centers is needed to evaluate the impact of epidural analgesia on the occurrence of postpartum depression. Chinese Clinical Trial Register, ChiCTR-ONC-17010654.

Highlights

Postpartum depression (PPD) is a disabling mental disorder usually occurring within 12 months after maternal production, which causes serious harm to both the mothers and families [1]
A total of 515 pregnant women who opted trial of labor after cesarean (TOLAC) were screened for eligibility, and 55 women were excluded based on criteria (Figure 1). 17 of enrolled parturients did not complete the whole study
423 in total were included in the analysis, among which 263 were given epidural analgesia while 160 were not. 225

Summary

Introduction

Postpartum depression (PPD) is a disabling mental disorder usually occurring within 12 months after maternal production, which causes serious harm to both the mothers and families [1]. Studies have shown that the incidence of PPD among parturients is about 15% to 30% in China, and it receives increasing attention with the implementation of universal two child policy in China [7]. Ese factors are prone to PPD and cause harm to parturients. To parturients, the intensity of labor pain was a factor related to mood disorder in the early postpartum period [14]. Ding Ting et al reported 4 months after delivery, there was a lower incidence rate of PPD in parturients who received epidural and paracervical blockade during vaginal delivery [16]. Besides the conflicting results in the literature, the subjects of previous studies on PPD are almost aiming at nulliparous women rather than pluripara; further study is warranted

Methods

Results

Conclusion