Chin Wen Tan1, Rehena Sultana, Michelle Z L Kee, Michael J Meaney, Ban Leong Sng. 1. From the Department of Women's Anaesthesia, KK Women's and Children's Hospital (CWT, BLS), Duke-NUS Medical School (CWT, BLS), Centre for Quantitative Medicine, Duke-NUS Medical School (RS), Singapore Institute for Clinical Sciences (MZLK, MJM), Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore (MJM) and Department of Psychiatry, McGill University, Montreal, Quebec, Canada (MJM).
Abstract
BACKGROUND: Postpartum depression (PPD) affects 10 to 15% of women and is associated with socio-economic burden and maternal morbidity. Recent studies showed that epidural analgesia may be associated with the development of PPD, although this association remains inconclusive. OBJECTIVE: To investigate the role of perinatal demographic, analgesic and psychological factors that may be related to PPD. DESIGN: Prospective, longitudinal multiethnic cohort study. SETTING: Singapore's two major public maternity institutions. PATIENTS: Pregnant women recruited during antenatal consultation and with follow-up 3 months postdelivery at Singapore hospitals with maternity services. INTERVENTION: None. MAIN OUTCOME MEASURES: The primary outcome of PPD was assessed 3 months postdelivery using the Edinburgh Postnatal Depression Scale to investigate an association with the use of labour epidural analgesia. The associations between PPD and anxiety and depression at 26 weeks' gestation predelivery were also evaluated. Demographic, analgesic, psychological factors and intrapartum data were analysed. RESULTS: There were 651 women with 152 cases (23.3%) of PPD and 499 controls (76.7%) at 3 months after childbirth. There was no significant difference between women who received labour epidural analgesia (95 of 385, 24.7%) and those who did not receive epidural analgesia (57 of 266, 21.4%) (unadjusted odds ratio 1.20, 95% confidence interval 0.83 to 1.75, P = 0.3361) in the incidence of PPD 3 months postdelivery. Predelivery anxiety and depression were positively associated with PPD 3 months postdelivery. CONCLUSION: Our study did not demonstrate an association between PPD at 3 months postdelivery and labour epidural analgesia. TRIAL REGISTRATION: NCT01174875.
BACKGROUND: Postpartum depression (PPD) affects 10 to 15% of women and is associated with socio-economic burden and maternal morbidity. Recent studies showed that epidural analgesia may be associated with the development of PPD, although this association remains inconclusive. OBJECTIVE: To investigate the role of perinatal demographic, analgesic and psychological factors that may be related to PPD. DESIGN: Prospective, longitudinal multiethnic cohort study. SETTING: Singapore's two major public maternity institutions. PATIENTS: Pregnant women recruited during antenatal consultation and with follow-up 3 months postdelivery at Singapore hospitals with maternity services. INTERVENTION: None. MAIN OUTCOME MEASURES: The primary outcome of PPD was assessed 3 months postdelivery using the Edinburgh Postnatal Depression Scale to investigate an association with the use of labour epidural analgesia. The associations between PPD and anxiety and depression at 26 weeks' gestation predelivery were also evaluated. Demographic, analgesic, psychological factors and intrapartum data were analysed. RESULTS: There were 651 women with 152 cases (23.3%) of PPD and 499 controls (76.7%) at 3 months after childbirth. There was no significant difference between women who received labour epidural analgesia (95 of 385, 24.7%) and those who did not receive epidural analgesia (57 of 266, 21.4%) (unadjusted odds ratio 1.20, 95% confidence interval 0.83 to 1.75, P = 0.3361) in the incidence of PPD 3 months postdelivery. Predelivery anxiety and depression were positively associated with PPD 3 months postdelivery. CONCLUSION: Our study did not demonstrate an association between PPD at 3 months postdelivery and labour epidural analgesia. TRIAL REGISTRATION: NCT01174875.