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Prenatal, Labor, and Postpartum Pain Are Predictors for Postpartum Depression Symptoms: A Prospective Observational Study
Abstract Number: F310-47
Abstract Type: Original Research
Data linking labor pain and postpartum depression are emerging. Robust, prospective evaluations of this relationship while factoring other important variables are lacking. We assessed perinatal pain and other factors predicting postpartum depression (PPD) symptoms.
Third trimester women (sub-stratified on a priori plan to receive or avoid labor epidural analgesia) were longitudinally followed from the prenatal period through labor and delivery, until six weeks and three months postpartum. Electronic labor pain data was collected hourly in real time, capturing pain unpleasantness, intensity, pain management satisfaction, and expectations. Prenatal and postpartum data included anxiety, depression, the Brief Pain Inventory (BPI), as well as surveys on pain catastrophizing, resiliency, and perceived social support and stress. The primary outcome was Edinburgh Postnatal Depression Score (EPDS) as a marker of PPD symptoms. The primary pain variable of interest was the emotional valence of labor pain (unpleasantness burden, area under the curve for entire labor duration). Single and multivariable linear regressions examined perinatal pain variables in relation to EPDS.
Of 72 subjects recruited, 55 planned/received labor epidural analgesia and 17 planned avoidance/avoided it. Intrapartum pain management satisfaction and expectations did not differ between analgesia groups. In the planned epidural group, the emotional valence of labor pain independently predicted six-week EPDS (Labor pain unpleasantness burden, R2=0.42, P = 0.002). In addition to labor pain, prenatal and postpartum pain variables from the BPI independently predicted six-week EPDS. Three-month depression scores were linked to labor and acute pain (six weeks postpartum), but not to chronic (three months postpartum) pain variables.
Pain at all perinatal time points—prenatal, labor, and postpartum—are independent predictors of depression scores at six weeks postpartum. These data support the importance of labor and acute postpartum pain for both acute and long-term PPD symptoms.