In the results of a study conducted at Brigham & Women’s Hospital in Boston, Massachusetts, presented at the 2018 American Society of Anesthesiology meeting, postpartum pain, rather than labor pain, was related to postpartum depression (PPD). Previous studies have suggested a link between epidural analgesia and reduced risk for postpartum depression, but the association between postpartum pain and postpartum depression has remained unclear.
Researchers conducted a retrospective data analysis, examining 4327 term, singleton, nulliparous parturients who delivered at a major teaching institution between 2015 and 2017. They recorded maternal and neonatal demographics, delivery indication intervention, characteristics, past medical history and outcomes, as well as data on labor and postpartum pain from onset to discharge.
Overall, the PPD group had a higher maternal body mass index (BMI), weight, number of gravity, and worse Apgar 1 minute and 5 minute scores. Infants of mothers with PPD tended to have lower weight and length. The group with PPD also had a higher rate of general anesthesia incidence compared with the non-PPD group, although the epidural incidence was lower. A history of depression, anxiety, obesity, asthma, HPV, abnormal glucose, substance/drug/physical/sexual abuse, and chronic pain were all more common in parturients in the PPD group.
While it is widely accepted that nonsteroidal anti-inflammatory medication is sufficient for postpartum perineal pain, parturients in the PPD group exhibited inadequate pain control and tended to need additional analgesia. Researchers noted that “this implied [that] the high-risk patient may need denser analgesia control after delivery.”
Zhou J, Tang N, Mi T, et al. Postpartum pain is associated with increased risk of postpartum depression: a retrospective cohort study. Presented at: ANASTHESIOLOGY 2018, October 13-17, San Francisco, California. Poster A2029.