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Intrapartum Pain Improvement Is a Predictor for Postpartum Depression: The Importance of Labor Pain
Abstract Number: T-60
Abstract Type: Original Research
Background: Pain is a fundamental feature of childbirth, but little is known about the potential psychological ramifications of labor pain. We aimed to identify the association between intrapartum pain relief under labor epidural analgesia, defined by percent improvement in pain (PIP) [1,2], and postpartum depression symptoms.
Methods: 2491 medical records were reviewed. Women who received labor epidural analgesia, who had pain assessed during labor both before and during implementation of labor epidural analgesia by 0-10 numeric rating scores, and who had depression risk assessed by the Edinburgh Postnatal Depression Scale (EPDS) and documented at their six-week postpartum visit, were included in the final analysis. Simple and multiple linear regression was used to identify the best model for assessing the association between pain improvement and depression, after adjusting for history of anxiety or depression, other psychiatric history, abuse, trauma, mode of delivery, and other maternal or fetal co-morbid diseases.
Results: 201 patients received labor epidural analgesia, had intrapartum pain data available, and had the primary outcome of interest. A weak but significant relationship exists between PIP and EPDS (Spearman’s σ = -0.18, P = 0.012). By simple linear regression, women with higher improvements in pain are associated with lower EPDS scores (β = -0.023, F(1, 199)=12.43, P = 0.001). There were no significant interactions between any a priori hypothesized interaction terms. There was no collinearity among variables. In support of the validity of the model, variables previously associated with depression were significantly correlated (body mass index, anxiety/depression, 3rd and 4th degree perineal lacerations, and anemia) and included in the final model. After adjusting for these covariates, PIP remained a significant predictor of EPDS (β = -0.022, t = -2.70, P = 0.008) (Table).
Conclusions: Improvement in pain during labor under epidural analgesia is a significant predictor in the development of postpartum depression symptoms. Labor pain, alongside other established risk factors, is important to the subsequent detection of postpartum depression symptoms. Research aimed at optimization of labor pain management strategies is warranted as part of a multimodal strategy to reduce risk for postpartum depression.
1. Max MB, ed. New York: Raven Press: 1991, 55-95.
2. McQuay HJ, ed. Oxford University Press, 1998, 32-38.