Postpartum Pain Is Associated with Decreased Risk of Postpartum Depression: A Retrospective Cohort Study
Abstract Number: F5B-4
Abstract Type: Original Research
Postpartum depression (PPD) is a common psychiatric disorder in parturients after delivery. Recent studies have suggested that epidural analgesia is linked to a reduced risk of postpartum depression. However, whether the postpartum pain is associated with PPD remains unclear.
A retrospective data analysis of all term, singleton, nulliparous parturient who delivered at a major teaching institution from June 1, 2015 to December 31, 2017 was conducted. Maternal and neonatal demographics, delivery indication intervention, characteristics, past medical history and outcome data were recorded. Subgroup analysis was conducted in PPD group [Edinburgh postnatal depression scale (EPDS) score≥9 at their 1-week postpartum visit] and non-PPD group (EPDS=0). Additionally, we collected the data of labor and postpartum pain data from the labor onset to discharge. When pain scores≥4, we considered it as inadequate pain control and recorded the frequency of inadequate pain control.
Of 4327 parturient, the PPD group had higher maternal BMI, weight, number of gravity, and worse Apgar 1 min and 5 min scores, lower baby weight and length (P < 0.001). Compared with non PPD group the general anesthesia incidence in PPD group was higher whereas epidural incidence was lower (p<0.0001). More parturient in PPD group had medical history of depression, anxiety, obesity, asthma, HPV, abnormal glucose, substance/drug/physical/sexual abuse, and chronic pain (P < 0.001). PPD group demonstrated significantly higher postpartum pain (p<0.0001).
Postpartum depression has adverse effects on new mothers, their infants, and family relationships. There is growing evidence that EPDS scores ≥9 are strong predictors of postpartum depression. In our study, postpartum depression was diagnosed according to the EPDS score. Our data demonstrated that postpartum pain not the labor pain may have been related to PPD. It is well accepted that non-steroid anti-inflammatory medication is sufficient for postpartum perineal pain. However, parturient with PPD demonstrated inadequate pain control and often need additional analgesia. This implied the high risk patient may need denser analgesia control after delivery. Recent study suggests epidural labor analgesia is associated with a decreased risk of postpartum depression.
1. Ding T, Anesth Analg 2014;119:383
2. Gibson J, Psychiatr Scand 2009;119(5):350
3. Wuytack F, Cochrane Database Syst Rev 2016;14