Epidural Labor Analgesia Dose Not Reduce The Score of Edinburgh Postnatal Depression Scale in Japan
Abstract Number: SAT-28
Abstract Type: Original Research
BACKGROUND: Postpartum depression (PPD) is a common psychiatric disorder in parturients after delivery. The Edinburgh Postnatal Depression Scale (EPDS) is a widely used screening tool for PPD, and the reliability and validity of EPDS in Japanese women has been confirmed. However the etiology remains unclear, and multiple factors may be involved. In Japan, not many maternity hospitals and clinics use epidurals, most Japanese parturients alleviate pain in others ways such as breathing, movement, and massage. Furthermore, there is a more positive image of a women capable of natural birth. In this study, we investigated whether epidural labor analgesia was associated with a decreased risk of postpartum depression development in Japan.
METHODS: five hundred nineteen parturients who were preparing for a vaginal delivery were enrolled in this retrospective cohort study. Epidural labor analgesia was performed in 72 of 519 patients on their request. Parturients’ mental status was assessed with the EPDS at 4 days and 2 weeks after delivery. We used the Japanese version of EPDS and the cut-off point of ≧9 in accordance with the previous study. A score of 9 or higher on the scale at 2 weeks was used as an indication of postpartum depression. Parturients’ characteristics together with perinatal variables were collected. Multivariate logistic regression analysis was performed to assess an association between the use of epidural analgesia and the score of EDPH.
RESULTS: Postpartum depression occurred in 8.3% (6 of 72) of parturients who received epidural labor analgesia and in 5.4% (24 of 447) of those who did not (P = 0.25). Use of epidural labor analgesia was not associated with a decreased risk of postpartum depression (odds ratio 1.31, 95% confidence interval 0.46–2.37). The median postpartum EPDS score at 2 weeks was 3 in labor epidural analgesia (range: 0–14, S.D. = 3.40) and also 3 in no epidural labor analgesia (range: 0-18, S.D.=3.12). There was a higher correlation between the EPDS scores at 4 days and those at 2 weeks postpartum in who received epidural labor analgesia than those who did not (Pearson correlation coefficient = 0.74 vs 0.64). The decrease of the EPDS score at 2 weeks in parturients who did not receive epidural analgesia was greater than that of who recieved labor epidural (P<0.01 vs p=0.11).
CONCLUSIONS: Epidural labor analgesia was not associated with decreasing the score of EPDS in Japan. Further study with a large sample size is needed to evaluate the impact of epidural analgesia on the occurrence of postpartum depression.