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Labor Epidural Analgesia and Peripartum Depression: Association and Implications
Abstract Number: F-13
Abstract Type: Original Research
Introduction: Peripartum depression is a common psychiatric disorder affecting women and their families with an incidence of 11-20.4%.1 A recent study found that women choosing epidural labor analgesia had a lower incidence postpartum depression (PPD).2 However, one of the strongest predictors of PPD is antenatal depression (APD) which was not accounted for in the previous study.3 The aim of this study was to examine the association of receiving a labor epidural on PPD rates while accounting for APD.
Methods: This project was a secondary analysis of a prospective study that examined the association of blood biological markers and peripartum depression. Parturients (n=106) were evaluated for APD at 8-10 weeks and 24-28 weeks of gestation and 6-8 weeks postpartum using the Edinburgh Postnatal Depression Scale. Additional information collected included age, BMI, race, parity, gravida, relationship status with the father, income level, education level, history of psychiatric illness, and gestational age of the baby at delivery.
We examined the association between APD and request for labor epidural and the association of labor epidural with development of PPD. The association between labor epidural request and PPD was also evaluated controlling for the presence of APD. Statistical analysis was performed using logistic regression or Fisher’s exact test.
Results: The rate of APD was 19.8%. Parturients with APD had 19 times the odds of experiencing PPD compared to mothers without APD (P<0.001; 95% CI=3.8-92). The majority of parturients requested epidural labor analgesia regardless of the presence (61.9%; n=21) or absence (62.4%; n=85) of APD (P=0.97). The rate of PPD was 20% (n=13/65). Parturients who received epidural labor analgesia had a 24% incidence of PPD compared to a rate of 6.7% among parturients who did not receive labor analgesia (P = 0.27). The relationship between epidural placement and PPD remain non-significant after controlling for APD (P=0.28).
Conclusions: APD was not associated with epidural labor analgesia utilization, but was a significant predictor of PPD. Additionally, a significant association between the development of PPD and request for epidural labor analgesia was not observed while accounting for APD. This study highlights the importance of prospective evaluation of depressive symptoms throughout pregnancy and postpartum. Our data contrasts the previous study by Ding et al., which found epidural labor analgesia to decrease the incidence of PPD.2 Additional studies are needed to ensure replication of these findings and not overlook a potential preventative intervention for the reduction of depression with postpartum onset.
1. MMWR Morb Mortal Wkly Rep 2008; 57:361-6.
2. Anesth Analg 2014 Aug: 119 (2) 383-92.
3. Norhayati MN, Nik Hazlina NH, Asrenee AR, Wan Emilin WM. Magnitude and risk factors for postpartum symptoms: A literature review. J Affect Disord. 2014 Dec 31 [Epub ahead of print]