Labor epidural analgesia and the risk of postpartum depression: A meta-analysis of observational studies

Joanna A Kountanis; Christie Vahabzadeh; Samuel Bauer; Maria Muzik; Ruth Cassidy; Casey Aman; Mark MacEachern; Melissa E Bauer

doi:10.1016/j.jclinane.2019.109658

Labor epidural analgesia and the risk of postpartum depression: A meta-analysis of observational studies

J Clin Anesth. 2020 May:61:109658. doi: 10.1016/j.jclinane.2019.109658. Epub 2019 Nov 26.

Authors

Joanna A Kountanis¹, Christie Vahabzadeh², Samuel Bauer³, Maria Muzik⁴, Ruth Cassidy⁵, Casey Aman⁶, Mark MacEachern⁷, Melissa E Bauer⁸

Affiliations

¹ Department of Anesthesiology, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109, United States of America. Electronic address: kountani@med.umich.edu.
² Department of Anesthesiology, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109, United States of America. Electronic address: youngcar@med.umich.edu.
³ Department of Obstetrics and Gynecology, Oakland University William Beaumont School of Medicine, 586 Pioneer Drive, Rochester, MI 48309, United States of America. Electronic address: Samuel.Bauer@beaumont.org.
⁴ Department of Psychiatry, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109, United States of America. Electronic address: muzik@med.umich.edu.
⁵ Department of Anesthesiology, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109, United States of America. Electronic address: ruthcass@med.umich.edu.
⁶ Department of Anesthesiology, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109, United States of America. Electronic address: ctaman@umich.edu.
⁷ University of Michigan Taubman Health Sciences Library, 1135 Catherine Street, Ann Arbor, MI 48109, United States of America. Electronic address: markmac@umich.edu.
⁸ Department of Anesthesiology, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109, United States of America. Electronic address: mbalun@med.umich.edu.

PMID: 31784304
DOI: 10.1016/j.jclinane.2019.109658

Abstract

Study objective: This study aims to systematically review the literature to evaluate the association between labor epidural analgesia (LEA) and postpartum depression (PPD).

Design: Meta-analysis.

Setting: Obstetric patients delivering vaginally with or without LEA in a hospital.

Interventions: This study aimed to investigate the effects of providing LEA on developing PPD.

Measurements: Pooled odds ratios (OR) and 95% confidence intervals (CI) were calculated using the random effects model.

Results: A total of 356 full text articles were reviewed. Eleven articles studying 85,928 patients met inclusion criteria. The pooled unadjusted OR 1.03 and 95% CI (0.77, 1.37) suggest that LEA is not associated with a decreased risk of developing PPD.

Conclusions: Labor epidural analgesia was not shown to confer protection against developing PPD according to this meta-analysis. Future studies are needed to explore whether other aspects of LEA, beyond its presence or absence, influence the onset of PPD.

Keywords: Analgesia; Depression; Epidural; Labor pain; Obstetrics; Postpartum; Risk factors.

Publication types

Meta-Analysis

MeSH terms

Analgesia, Epidural* / adverse effects
Analgesia, Obstetrical* / adverse effects
Depression, Postpartum* / epidemiology
Depression, Postpartum* / etiology
Female
Humans
Labor, Obstetric*
Observational Studies as Topic
Odds Ratio
Pregnancy