Neuraxial Labour Analgesia is Associated with a Reduced Risk of Postpartum Depressive Symptoms: A Multicentre, Prospective Cohort Study

Abstract

Background: Neuraxial labour analgesia is associated with reduced postpartum depression but evidence is conflicting. Here we set out to investigate whether neuraxial labour analgesia was associated with a decreased risk of postpartum depressive symptoms (PDS). Methods: In this multicentre, prospective, observational cohort study, 577 nulliparous women with cephalic term singleton pregnancy who planned vaginal delivery self-selected neuraxial analgesia or no analgesia. Perinatal depressive symptoms were screened with the Chinese version Edinburgh Postnatal Depression Scale (EPDS). An EPDS score of ≥10 was used as the threshold of prenatal and postpartum depressive symptoms. The primary outcome was the development of 6-week PDS. Logistic regression models were established to assess the association between the use of labour analgesia and the risk of PDS development. Findings: Of enrolled parturients, 14.6% (84/577) had prenatal depressive symptoms and 17.3% (100/577) developed PDS. The prevalence of PDS was lower in parturients who received neuraxial analgesia than in those who did not (14.9% [62/417] vs. 23.8% [38/160], p=0.012 in all parturients; 10.4% [37/356] vs. 18.2% [25/137], p=0.020 in those without prenatal depressive symptoms). After adjusted with confounding factors, the use of neuraxial analgesia was associated with decreased odds of PDS (odds ratio [OR] 0.55, 95% CI 0.34-0.91, p=0.019 in all parturients; OR 0.50, 95% CI 0.28-0.90, p=0.022 in those without prenatal depressive symptoms). Interpretation: In nulliparae with cephalic term singleton pregnancy and planned vaginal delivery, neuraxial analgesia during labour was associated with a decreased risk of PDS development. Clinical Trial Number: This trial was registered with www.clinicaltrials.gov(NCT02823418). Funding Statement: This study was funded by Capital Characteristic Clinic Project (Z151100004015160), Beijing, China. Declaration of Interests: DM is supported by grants from the British Oxygen Chair, and British Journal of Anaesthesia Fellowship, London, UK. The other authors declare no competing interests. Part of the work was presented as an e-poster at the Euroanaesthesia 2018 Annual Meeting, Copenhagen, Denmark (June 2-4, 2018). Ethics Approval Statement: The study protocol was approved by the local Clinical Research Ethics Committees in Peking University First Hospital (2014[714]).