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Association between general anesthesia for cesarean delivery and postpartum depression requiring hospitalization.
Abstract Number: O1-02
Abstract Type: Original Research
Background: Pain after childbirth is associated with an increased risk of postpartum depression (PPD) and labor neuraxial analgesia is suggested to decrease the incidence of PPD (1, 2). Furthermore, cesarean delivery and hysterectomy under general anesthesia (GA) are associated with severe acute and persistent pain compared with neuraxial anesthesia (3, 4). This study aimed to test the hypothesis that GA for cesarean delivery is associated with an increased risk of PPD, compared with neuraxial anesthesia.
Methods: A retrospective cohort of women who underwent cesarean delivery in New York State from 2006 to 2014 was constructed based on individually linked hospital discharge records. Exclusion criteria were: having more than 1 cesarean delivery during the study period, residing outside of New York State, having a GA for surgery or a delivery in the year before or in the year after the index delivery. The primary outcome was diagnosis of PPD during the index delivery hospitalization or a readmission within 1 year from hospital discharge. PPD was identified the ICD-9-CM algorithm developed by Savitz (5). The secondary outcomes were: 1) suicidal ideation or self-inflicted injury, 2) anxiety, and 3) post-traumatic stress disorder (PTSD). The odds ratio (OR) of PPD associated with GA was estimated using the inverse probability weighting method.
Results: Of the 428,204 cesarean delivery cases included, 34,356 had a GA (8.0%). Incident PPD was recorded in 1158 women (0.3%); 60% of PPDs were identified during a readmission with a median of 164 days after discharge. GA was associated with 55% increased risk of PPD (adjusted OR 1.55, 95% CI 1.24-1.94) and 118% increased risk of suicidal ideation or self-inflicted injury (adjusted OR 2.18, 95% CI 1.37-3.47) (Table 1). No difference was observed for the risk of anxiety or PTSD.
Conclusions: GA for cesarean delivery is associated with an increased risk of PPD and suicidal ideation or self-inflicted injury. While causality cannot be established, our analysis suggests that screening for PPD after cesarean delivery with GA should be heightened and followed well into the 4th trimester, particularly with our finding of increased suicidal ideation or self-inflicted injury among women having had a GA.
1. Eisenach, Pain 2008;140:87-94
2. Lim, Anesth Analg 2018;126:1598-605
3. Catro-Alves, Anesth Analg 2011;113:1480-6
4. Nikolajsen, Acta Anaesthesiol Scand 2004;48:111-6
5. Savitz, Ann Epidemiol 2011;21:399-406