Looking Beyond the Pain: Can Effective Labor Analgesia Prevent the Development of Postpartum Depression?

Abstract

(Anesth Analg. 2018;126:1448–1450) There is emerging evidence of an association among acute postpartum pain, chronic pain, and postpartum depression (PPD). Authors of this editorial discuss the relationship of pain during labor and delivery to PPD found in recent studies. In 2014, Ding et al found the use of labor epidural analgesia to be associated with a reduced risk of PPD [odds ratio, 0.3; 95% confidence interval (CI), 0.12-0.79]. However, this observational study was limited by potential misclassification bias and uncontrolled confounding. A 2018 study by Orbach-Zinger et al found that the rate of PPD among women who intended to use epidural analgesia but delivered without was not different compared with all other groups. In secondary analysis, they found that the relative risk of PPD was, in fact, higher among women who ultimately received epidural analgesia than those who did not use epidural analgesia (risk difference, 7.2%; 95% CI, 2.3%-12.1%). The authors acknowledged that unplanned epidural analgesia may be an indicator for physiologically difficult delivery. Lim et al examined the relationship between quality of intrapartum analgesia and PPD, finding an inverse association between greater improvements in pain and Edinburgh Postnatal Depression Scale scores. Although the effect of labor analgesia on the scores was found to be relatively small, worse labor analgesia was significantly associated with positive score screen (adjusted odds ratio, 6.6; 95% CI, 1.9-22.4).