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Labor Epidural Analgesia Does Not Reduce the Likelihood of Postpartum Depression
Abstract Number: F4B-2
Abstract Type: Original Research
Background: Postpartum depression (PPD) has serious risks including a maternal suicide rate of 1.57 in 100 000.1 Severe postpartum pain is a possible risk factor for the development of PPD.2 Labor epidural analgesia (LEA) may lower the incidence of postpartum depression,3, 4 however, this theory has conflicting results in the literature.5 Our objective was to evaluate the risk of PPD (a score ≥ 10 on the Edinburgh Postnatal Depression Scale (EPDS) 3 months postpartum in women with LEA compared to women without LEA.
A longitudinal prospective observational cohort study was completed with ethics approval between January 2015 and November 2016. Primiparous women ≥ 18 years with uncomplicated, singleton pregnancies at 18-20 weeks gestation were recruited. At 18-20 weeks and 3-months postpartum, eligible women completed email surveys, including the EPDS. Maternal and infant characteristics were obtained from the surveys and OB TraceVue software® while anesthetic characteristics were accessed using the INNOVIAN database. The difference in postpartum depression at 3 months between women who received LEA and women who did not was determined by logistic regression, accounting for confounding variables.
At 3 months postpartum 348 patients completed the survey and were included in the analysis. Women who received LEA (n = 250) were no more likely to have an EPDS ≥ 10 at 3 months postpartum compared with women who did not receive LEA (n = 98) (OR 0.91, 95% CI, 0.50 to 1.65). Variables known to be associated with depression such as ethnicity, age, SES, marital status and baseline EPDS score ≥ 10 were significantly associated with EPDS score ≥ 10 at 3 months and included in the final model (Table 1). After adjusting for these covariates, the EPDS scores at 3 months were still not statistically different between women with and without LEA.
This prospective cohort study did not show an association between LEA and postpartum depression, defined as EPDS ≥10 at 3 months postpartum. This suggests the effect of LEA as a modifiable variable for the development of postpartum depression needs further study.
1. CMAJ. 2017;189(34).
2. Pain. 2008;140(1):87-94.
3. Anesth Analg. 2014;119(2):383-92.
4. Lim G, Anesth Analg. 2017.
5. Clinical Lactation. 2015;6(3).