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Xiao Y, Tao Y, Hu Y, Liao Z. Global research trends in labor analgesia: A bibliometric analysis from 2013 to 2023. Heliyon 2024; 10:e36960. [PMID: 39281528 PMCID: PMC11402232 DOI: 10.1016/j.heliyon.2024.e36960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 08/25/2024] [Accepted: 08/26/2024] [Indexed: 09/18/2024] Open
Abstract
Objective In the past decade, thousands of original articles focus on labor analgesia have published. However, little has been published in the literature that includes a bibliometric analysis of labor analgesia. Therefore, this study is designed to analyze the current status of research on labor analgesia over the past ten years and explore potential directions for the future. Methods We retrieved the Web of Science Core Collection (WOSCC) for labor analgesia articles published from 2013 to 2023 and extracted the data from the literature. To perform the bibliometric analysis, we used CiteSpace (6.2. R5) and VOS viewer (1.6.19) as our primary analysis tools. Results A total of 2406 articles were included, and the number of publications has increased steadily in the last ten years. The United States was the leading contributor to the area, and Harvard University was the most productive institution. The American Journal of Obstetrics and Gynecology was the most cited and influential journal. The most co-cited reference was "Epidural versus non-epidural or no analgesia for pain management in labour". The labels of the co-citation cluster have identified the characteristics of 5major clusters, such as "postpartum depression", "programmed intermittent epidural bolus", "childbirth experience" "intrapartum maternal fever" and "dural puncture", which play important roles in this field. Keywords co-occurrence and keywords burst detection showed that "vaginal birth", "postpartum depression", "maternal fever", "inflammation", "systematic review", "guidelines", "decreased risk" and "scale" were the most recent and most prominent topics of labor analgesia. Discussion This study provided a global review of labor analgesia using bibliometric and visual techniques to provide an intuitive understanding of this topic and identify hotspots and research trends. Notably, intrapartum fever and postpartum depression have emerged as hotpots and trends in labor analgesia research, reflecting the current research landscape.
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Affiliation(s)
- Yang Xiao
- Department of Anesthesiology and Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yunkai Tao
- Department of Anesthesiology and Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yajiao Hu
- Department of Anesthesiology and Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhimin Liao
- Department of Anesthesiology and Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
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Ghanbari-Homaie S, Jenani SP, Faraji-Gavgani L, Hosenzadeh P, Rezaei M. Association between epidural analgesia and postpartum psychiatric disorders: A meta-analysis. Heliyon 2024; 10:e27717. [PMID: 38524559 PMCID: PMC10958359 DOI: 10.1016/j.heliyon.2024.e27717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 03/26/2024] Open
Abstract
Aim Women during the postpartum period are at risk for psychiatric disorders such as postpartum depression (PPD), post-traumatic stress disorder (PTSD), and anxiety. It is controversial whether labour epidural analgesia have a protective role on PPD, PTSD, and anxiety or not. This study is a meta-analysis of previously published observational studies to investigate the association between epidural analgesia and PPD, PTSD, and anxiety. Methods We searched Cochran Library, PubMed, ProQuest, EMBASE, Scopus, Web of Science, PsycINFO, and MEDLINE from inception until December 2022. The outcome measures were positive screen of PPD, PTSD, and anxiety among women who received labour epidural analgesia. The Newcastle-Ottawa Scale was used to assess the quality of the observational studies. Statistical analysis was performed using Stata 17.0 software. The mean differences or odds ratios were pooled based on random effect. Results We included 31 studies (12,064 women) in the review. The meta-analysis of PPD studies reported mean (standard deviation) showed no significant association between epidural analgesia and PPD (Mean Difference = 0.01; 95% Confidence Interval = -0.14 to 0.16; p-value = 0.88). The meta-analysis of PPD studies reported percentage showed no statistically significant difference in terms of the chance of depression between the exposed and non-exposed groups (Log Odds Ratio = -0.61; 95% CI = -1.48 to 0.26; p-value = 0.17). The meta-analysis of PPD studies reported OR showed indicate a lower chance of depression in the epidural group compared to the non-epidural group (Effect size = 1.01; 95% CI = 0.64 to 1.38; P-value = 0.00). In the case of PTSD, due to the heterogeneity of the tools and the methodology of the studies, it was impossible to reach a definitive conclusion and measure the studies in a meta-analysis. The meta-analysis of anxiety studies showed that no significant association between epidural analgesia and anxiety (MD = -1.36; 95% CI = -3.38 to 1.14; p-value = 0.29). Conclusion Based on the meta-analysis of observational studies, epidural analgesia for labour pain relief has no protective effect on postpartum psychiatric disorders.
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Affiliation(s)
- Solmaz Ghanbari-Homaie
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyedeh-Pooneh Jenani
- Academic Board Member, Department of Midwifery, Islamic Azad University of Medical Science, Marand, Tabriz, Iran
| | - Leili Faraji-Gavgani
- Research Center for Evidence Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Pooya Hosenzadeh
- Clinical Research Development Unit of Taleghani Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mansour Rezaei
- Department of Anesthesiology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Xu S, Yang J, Li J, Zhang M, Sun J, Liu Q, Yang J. Esketamine pretreatment during cesarean section reduced the incidence of postpartum depression: a randomized controlled trail. BMC Anesthesiol 2024; 24:20. [PMID: 38200438 PMCID: PMC10777554 DOI: 10.1186/s12871-023-02398-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Postpartum depression (PPD) is a common mental disease in postpartum women, which has received more and more attention in society. Ketamine has been confirmed for its rapid antidepressant effect in women with PPD. We speculate that esketamine, an enantiomer of ketamine, pretreatment during cesarean can also reduce the incidence of PPD. METHODS All the parturients enrolled in the study were randomly assigned to two groups: the esktamine group (0.2 mg/kg esketamine) and the control group (a same volume of saline). All the drugs were pumped for 40 min started from the beginning of the surgery. The Amsterdam Anxiety and Information Scale (APAIS) scores before the surgery, the Edinburgh postnatal depression scale (EPDS) scores at 4 d and 42 d after surgery, the Pain Numerical Rating Scale (NRS) scores at 6 h, 12 h, 24 h and 48 h post-operation were evaluated, as well as the adverse reactions were recorded. RESULTS A total of 319 parturients were analyzed in the study. The incidence of PPD (EPDS score > 9) in the esketamine group was lower than the control group at 4 days after surgery (13.8% vs 23.1%, P = 0.0430) but not 42 days after surgery (P = 0.0987). Esketamine 0.2 mg/kg could reduce the NRS score at 6 h,12 h and 24 h after surgery, as well as the use of vasoactive drugs during surgery (P < 0.05). The incidences of maternal dizziness (17.0%), blurred vision (5%), illusion (3.8%) and drowsiness (3.8%) in the esketamine group were higher than those of control group (P < 0.05). CONCLUSIONS Intraoperative injection of esketamine (0.2 mg/kg) prevented the occurrence of depression (EPDS score > 9) at 4 days after delivery but not 42 days. Esketamine reduced the NRS scores at 6 h, 12 h and 24 h after surgery, but the occurrence of maternal side effects such as dizziness, blurred vision, drowsiness and hallucination were increased. TRIAL REGISTRATION Registered in the Chinese Clinical Trial Registry (ChiCTR2100053422) on 20/11/2021.
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Affiliation(s)
- Shixia Xu
- Department of Anesthesiology, Nanjing Medical University, Nanjing, 210000, Jiangsu, China
- Department of Anesthesiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210000, Jiangsu, China
| | - Jiaojiao Yang
- Department of Anesthesiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210000, Jiangsu, China
| | - Jing Li
- Department of Anesthesiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210000, Jiangsu, China
| | - Min Zhang
- Department of Anesthesiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210000, Jiangsu, China
| | - Jie Sun
- Department of Anesthesiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, 210000, Jiangsu, China
| | - Qingren Liu
- Department of Anesthesiology, Xishan People's Hospital of Wuxi City, Wuxi, 214105, China
| | - Jianjun Yang
- Department of Anesthesiology, Nanjing Medical University, Nanjing, 210000, Jiangsu, China.
- Department of Anesthesiology, Pain and Perioperative Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China.
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Jin S, Munro A, George RB. The association between labour epidural analgesia and postpartum depression in primiparous patients: a historical cohort study. Can J Anaesth 2023; 70:1909-1916. [PMID: 37726496 DOI: 10.1007/s12630-023-02568-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/16/2023] [Accepted: 04/05/2023] [Indexed: 09/21/2023] Open
Abstract
PURPOSE Peripartum pain has been associated with postpartum depression (PPD), and labour epidural analgesia (LEA) may be able to modify this risk. The objective of this historical cohort study was to examine the association between LEA and PPD among primiparous patients. METHODS With institutional research ethics board approval, a provincial perinatal database was searched for primiparous patients who delivered a liveborn singleton infant between 2004 and 2018. Those patients who experienced PPD following their first delivery were identified by a history of PPD in the perinatal records of their second pregnancy. We used logistic regression to compute odds ratios (ORs) for the association between LEA and PPD and performed an adjusted analysis to control for confounding variables. RESULTS A total of 35,437 primiparous patients were identified, 67% (n = 23,599) of whom received LEA. In the cohort, 3.7% (n = 1,296) of patients developed PPD. Patients who received LEA had increased odds of developing PPD compared with patients who did not receive LEA (adjusted OR, 1.29; 95% confidence interval [CI], 1.12 to 1.48). In a multivariable regression model, LEA remained a significant predictor for PPD, as did body mass index, pre-existing anxiety, and maternal antidepressant use. CONCLUSION This historical cohort study found an association between LEA and PPD among primiparous patients who subsequently had a second pregnancy in the same province. The findings call into question the hypothesis that LEA decreases the risk for PPD and further illustrates the complexities of PPD.
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Affiliation(s)
- Sherry Jin
- Department of Anesthesia, Humber River Hospital, Toronto, ON, Canada
- Department of Women's and Obstetric Anesthesia, IWK Health, Halifax, NS, Canada
| | - Allana Munro
- Department of Women's and Obstetric Anesthesia, IWK Health, Halifax, NS, Canada.
- Department of Anesthesia, Pain Management, and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada.
| | - Ronald B George
- Department of Anesthesiology and Pain Management, University of Toronto, Toronto, ON, Canada
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Zhang R, Sheng W, Liu F, Zhang J, Bai W. Establishment and Validation of a Machine Learning-Based Prediction Model for Termination of Pregnancy via Cesarean Section. Int J Gen Med 2023; 16:5567-5578. [PMID: 38034896 PMCID: PMC10685106 DOI: 10.2147/ijgm.s413736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 11/14/2023] [Indexed: 12/02/2023] Open
Abstract
Objective This study aimed to investigate the risk factors of cesarean section and establish a prediction model for cesarean section based on the characteristics of pregnant women. Methods The clinical characteristics of 2552 singleton pregnant women who delivered a live baby between January 2020 and December 2021 were retrospectively reviewed. They were divided into vaginal delivery group (n = 1850) and cesarean section group (n = 702). These subjects were divided into training set (2020.1-2021.6) and validation set (2021.7-2021.12). In the training set, univariate analysis, Lasso regression, and Boruta were used to screen independent risk factors for cesarean section. Four models, including Logistic Regression (LR), K-Nearest Neighbor (KNN), Classification and Regression Tree (CART), and Random forest (RF), were established in the training set using K-fold cross validation, hyperparameter optimization, and random oversampling techniques. The best model was screened, and Sort graph of feature variables, univariate partial dependency profile, and Break Down profile were delineated. In the validation set, the confusion matrix parameters were calculated, and receiver operating characteristic curve (ROC), precision recall curve (PRC), calibration curve, and clinical decision curve analysis (DCA) were delineated. Results The risk factors of cesarean section included age and height of women, weight at delivery, weight gain, para, assisted reproduction, abnormal blood glucose during pregnancy, pregnancy hypertension, scarred uterus, premature rupture of membrane (PROM), placenta previa, fetal malposition, thrombocytopenia, floating fetal head, and labor analgesia. RF had the best performance among the four models, and the accuracy of confusion matrix parameters was 0.8956357. The Matthews correlation coefficient (MCC) was 0.753012. The area under ROC (AUC-ROC) was 0.9790787, and the area under PRC (AUC-PRC) was 0.957888. Conclusion RF prediction model for caesarean section has high discrimination performance, accuracy and consistency, and outstanding generalization ability.
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Affiliation(s)
- Rui Zhang
- Department of Obstetrics and Gynaecology, Beijing Shijitan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Weixuan Sheng
- Department of Anesthesiology, Beijing Shijitan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Feiran Liu
- Department of Obstetrics and Gynaecology, Beijing Shijitan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Jin Zhang
- Department of Obstetrics and Gynaecology, Beijing Shijitan Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Wenpei Bai
- Department of Obstetrics and Gynaecology, Beijing Shijitan Hospital, Capital Medical University, Beijing, People’s Republic of China
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Zhuang J, Chen Q, Liu C, Zuo R, Zhang Y, Dang J, Wang Z. Investigating the association between maternal childbirth intention, labor epidural analgesia, and postpartum depression: A prospective cohort study. J Affect Disord 2023; 324:502-510. [PMID: 36586623 DOI: 10.1016/j.jad.2022.12.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 08/26/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Postpartum depression (PPD) is a general depressive episode after childbirth. Studies have shown that unmatched analgesic intention increases the risk of PPD, but the use of labor epidural analgesia (LEA) during childbirth can reduce this risk. We aimed to investigate the association between maternal childbirth intention, LEA, and PPD and risk factors that may be related to PPD. METHODS A total of 590 mothers were included in this prospective cohort study. Demographic, prenatal, intrapartum and postpartum data were recorded. We investigated the association between childbirth intention, LEA and PPD and assessed the interactions between two factors. Logistic regression analysis was used to screen variables that might be associated with the occurrence of PPD. RESULTS Overall, 130 of 451 women completing the study at 3 months had PPD (28.8 %). We did not find an association between unmatched childbirth intention, use of LEA and PPD (adjustOR = 0.684 CI 0.335-1.396, p = 0.296; adjustOR = 0.892, CI 0.508-1.565, p = 0.690). Chronic pain affecting daily life, prenatal EPDS, SAS, SSRS score, family accompaniment during labor, and 1-day numerical rating scale (NRS) score were significantly associated with PPD (p < 0.05). LIMITATIONS In the 3-month follow-up, we only recorded the EPDS score, not the pain score, and did not evaluate the association between postpartum chronic pain and PPD. CONCLUSIONS The association between maternal childbirth intention, LEA and PPD was not significant. Chronic pain affecting daily life, prenatal EPDS, SAS, SSRS score, family accompaniment during labor, and 1-day NRS score were significantly related to the occurrence of PPD (p < 0.05).
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Affiliation(s)
- Jingwen Zhuang
- Xuzhou Medical University, Xuzhou 221004, Jiangsu, China
| | - Qianmin Chen
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221004, Jiangsu, China
| | - Chao Liu
- Xuzhou Medical University, Xuzhou 221004, Jiangsu, China
| | - Ronghua Zuo
- Xuzhou Medical University, Xuzhou 221004, Jiangsu, China
| | - Yuhan Zhang
- Xuzhou Medical University, Xuzhou 221004, Jiangsu, China
| | - Jingjing Dang
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221004, Jiangsu, China
| | - Zhiping Wang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, 209 Tongshan Road, Xuzhou 221004, Jiangsu, China; Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou 221004, Jiangsu, China.
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Bishop DG, Fernandes NL, Dyer RA, Sumikura H, Okada H, Suga Y, Shen F, Xu Z, Liu Z, Vasco M, George RB, Guasch E. Global issues in obstetric anaesthesia: perspectives from South Africa, Japan, China, Latin America and North America. Int J Obstet Anesth 2023; 54:103648. [PMID: 36930996 DOI: 10.1016/j.ijoa.2023.103648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/12/2023] [Accepted: 02/20/2023] [Indexed: 03/02/2023]
Abstract
South Africa is classified as a low- and middle-income country, with a complex mixture of resource-rich and resource-limited settings. In the major referral hospitals, the necessary skill level exists for the management of complex challenges. However, this contrasts with the frequently-inadequate skill levels of anaesthesia practitioners in resource-limited environments. In Japan, obstetricians administer anaesthesia for 40% of caesarean deliveries and 80% of labour analgesia. Centralisation of delivery facilities is now occurring and it is expected that obstetric anaesthesiologists will be available 24 h a day in centralised facilities in the future. In China, improvements in women's reproductive, maternal, neonatal, child, and adolescent health are critical government policies. Obstetric anaesthesia, especially labour analgesia, has received unprecedented attention. Chinese obstetric anaesthesiologists are passionate about clinical research, focusing on efficacy, safety, and topical issues. The Latin-American region has different landscapes, people, languages, and cultures, and is one of the world's regions with the most inequality. There are large gaps in research, knowledge, and health services, and the World Federation of Societies of Anaesthesiologists is committed to working with governmental and non-governmental organisations to improve patient care and access to safe anaesthesia. Anaesthesia workforce challenges, exacerbated by coronavirus disease 2019, beset North American healthcare. Pre-existing struggles by governments and decision-makers to improve health care access remain, partly due to unfamiliarity with the role of the anaesthesiologist. In addition to weaknesses in work environments and dated standards of work culture, the work-life balance demanded by new generations of anaesthesiologists must be acknowledged.
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Affiliation(s)
- D G Bishop
- Perioperative Research Group, Department of Anaesthetics, Critical Care and Pain Management, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - N L Fernandes
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, South Africa
| | - R A Dyer
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, South Africa
| | - H Sumikura
- Department of Anesthesiology and Pain Medicine, Juntendo University, Japan
| | - H Okada
- Department of Anesthesiology and Pain Medicine, Juntendo University, Japan
| | - Y Suga
- Department of Anesthesiology and Pain Medicine, Juntendo University, Japan
| | - F Shen
- Department of Anaesthesiology, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynaecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Z Xu
- Department of Anaesthesiology, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynaecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Z Liu
- Department of Anaesthesiology, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynaecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - M Vasco
- Director of Clinical Simulation, Universidad CES, Medellín, Colombia
| | - R B George
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - E Guasch
- Division Chief Obstetric Anaesthesia, Hospital Universitario La Paz, Madrid, Spain.
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Li B, Tang X, Wang T. Neuraxial analgesia during labor and postpartum depression: Systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e33039. [PMID: 36827052 PMCID: PMC11309598 DOI: 10.1097/md.0000000000033039] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 01/31/2023] [Accepted: 01/31/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Severe pain has been linked to depression, which raises the question of whether neuraxial analgesia during childbirth is associated with a reduced risk of postpartum depression. This association has been explored, but previous studies did not control or analyze relevant confounders. We conducted a systematic review and meta-analysis to determine the association between neuraxial analgesia and postpartum depression. METHODS A systematic review was conducted using PubMed, Embase, and the Cochrane Central Register of Controlled Trials. Studies that tested the effect of neuraxial analgesia during labor on depression or depressive symptoms in the first year postpartum were included. Relevant articles were extracted independently by 2 authors. RESULTS In total, 14 studies (86,231 women) were included. The association between neuraxial analgesia and the long-term incidence of postpartum depression after childbirth was the risk ratio = 0.75, 95% confidence interval (CI): 0.56-1.00, P = .05; I2 = 79%, P < .00001. There was a significant association (pooled risk ratio = 0.55, 95% CI: 0.34-0.90, P = .02; I2 = 55%, P = .06) between neuraxial analgesia and the incidence of postpartum depression in the first week after delivery. The subgroup analysis showed a trend suggesting that in Asian populations, those who received neuraxial analgesia had lower postpartum depression rates than those who received non-neuraxial analgesia (risk ratio = 0.57, 95% CI: 0.38-0.86; P = .008; I2 = 82%) at ≥4 weeks after delivery. CONCLUSION Neuraxial analgesia may be beneficial for the short-term and long-term mental effects of parturient women, especially for short term after delivery. High-quality studies addressing the role of neuraxial analgesia during labor and its impact on postpartum depression remain necessary.
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Affiliation(s)
- Bin Li
- Department of Anesthesia, Changning Maternity and Infant Health Hospital, Shanghai, China
| | - Xiaohui Tang
- Department of Anesthesia, Changning Maternity and Infant Health Hospital, Shanghai, China
| | - Tingting Wang
- Department of Anesthesia, Changning Maternity and Infant Health Hospital, Shanghai, China
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Tong S, Rao C, Min S, Li H, Quan D, Chen D, Zhu Y. Obstetric anesthesia clinic childbirth course combined with labor epidural analgesia is associated with a decreased risk of postpartum depression : a prospective cohort study. BMC Anesthesiol 2022; 22:389. [PMID: 36522711 PMCID: PMC9753281 DOI: 10.1186/s12871-022-01931-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 12/05/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Postpartum depression (PPD) is a serious complication commonly seen in postnatal women. In this paper, an investigation was conducted to see if obstetric anesthesia clinic childbirth course combined with labor epidural analgesia (LEA) was associated with a decreased risk of PPD. METHODS Six hundred fifty-five nulliparous women were enrolled in this prospective cohort study. The parturients were divided into 4 groups, with Group C being the control group, Group AC received the obstetric anesthesia clinic childbirth course only, Group LEA received LEA only, and Group AC + LEA received both the obstetric anesthesia clinic childbirth course and LEA. Maternal and neonatal variables in the perinatal period were recorded. PPD at 6 weeks was assessed using the Chinese version of the Edinburgh Postpartum Depression Scale (EPDS), where a score ≥ 10 is the threshold for PPD. Multivariate logistic regression analysis was performed to assess the association between obstetric anesthesia clinic childbirth course combined with LEA and postpartum depression. RESULTS A total of 124 maternities had EPDS ≥10 points, the incidence of PPD was 18.9%。The incidence of PPD and EPDS scores were significantly lower in Group AC + LEA than in Group C (12.1% vs 26.8%, P < 0.05; 6 (5, 7) vs 7 (5, 11), P < 0.05). Received an anesthesia clinic childbirth course combined with LEA was associated with a decreased risk of PPD (OR 0.273, 95% CI, 0.100-0.743, P = 0.013). Multivariate logistic regression analysis identified 5 other independent factors for PPD, including maternal SAS score in the delivery room, W-DEQ score in the delivery room, living in a confinement center, EPDS score at 1st week postpartum and perinatal care satisfaction . CONCLUSIONS Received an obstetrics anesthesia clinic childbirth course combined with LEA for nulliparous women with a single term cephalic pregnancy was associated with a decreased risk of PPD at 6 weeks. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR2000039163. Registered on 20/10/2020.
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Affiliation(s)
- Shanshan Tong
- grid.452206.70000 0004 1758 417XDepartment of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016 People’s Republic of China
| | - Chuanhua Rao
- grid.452506.0Department of Anesthesiology, Jiangjin Central Hospital of Chongqing, No.725 Jiangzhou Avenue, Dingshan Street, Jiangjin District, Chongqing, China
| | - Su Min
- grid.452206.70000 0004 1758 417XDepartment of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, No.1 Youyi Road, Yuzhong District, Chongqing, 400016 People’s Republic of China
| | - Hua Li
- grid.452506.0Department of Obstetrics, Jiangjin Central Hospital of Chongqing, Chongqing, China
| | - Dongqun Quan
- grid.452506.0Department of Obstetrics, Jiangjin Central Hospital of Chongqing, Chongqing, China
| | - Daping Chen
- grid.452506.0Department of Obstetrics, Jiangjin Central Hospital of Chongqing, Chongqing, China
| | - Yuanmao Zhu
- grid.452506.0Department of Pain, Jiangjin Central Hospital of Chongqing, Chongqing, China
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Lian W, Ding J, Xiong T, Liuding J, Nie L. Determinants of delayed onset of lactogenesis II among women who delivered via Cesarean section at a tertiary hospital in China: a prospective cohort study. Int Breastfeed J 2022; 17:81. [PMID: 36451171 PMCID: PMC9714018 DOI: 10.1186/s13006-022-00523-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 11/19/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Cesarean birth is associated with a higher prevalence of delayed onset of lactogenesis II (DOLII) than vaginal birth. DOLII refers to the delayed initiation of copious milk production beyond 72 h after birth. This study aimed to determine the prevalence of, and factors associated with, DOLII among women who delivered via Cesarean section in China. METHODS This prospective longitudinal cohort study recruited 468 women who delivered via Cesarean section at a tertiary hospital in China from 9 October 2021 to 17 May 2022. Face-to-face interviews were conducted during their delivery hospital stay to obtain information about demographic, medical, and breastfeeding factors. We assessed the onset of lactogenesis on postpartum day four, based on the maternal perception of changes in breast fullness. The Edinburgh Postnatal Depression Scale (EPDS) was used to screen for postpartum depression. Women with DOLII were interviewed via telephone or WeChat daily for one week postpartum to determine the timing of the onset of lactogenesis II. Univariate and multivariable logistic regression analyses were used to identify the determinants of DOLII. RESULTS DOLII was experienced by 156 of 468 participants (33.3%). After adjusting for potential confounders, the odds of DOLII were 95% higher in primiparous women than multiparous women (adjusted odds ratio [aOR] 1.95; 95% confidence interval [CI] 1.29, 2.98), 75% higher in women with a serum albumin concentration < 35 g / L than women with normal serum albumin concentrations (aOR 1.78; 95% CI 1.09, 2.99), increased by 2.03-fold in women with an EPDS score ≥ 10 than women with an EPDS score < 10 (aOR 2.03; 95% CI 1.35, 3.07), and decreased in women with a higher number of breastfeeding sessions in the first 48 h postpartum (aOR 0.88; 95% CI 0.83, 0.93). CONCLUSIONS One-third of women with Cesarean section delivery experienced DOLII. DOLII was more likely in women who were primiparous, had a serum albumin concentration < 35 g / L, had a lower frequency of breastfeeding sessions, and had an EPDS score ≥ 10. Women with these risk factors who deliver via Cesarean section may need early breastfeeding support to ensure successful lactation.
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Affiliation(s)
- Weining Lian
- grid.412633.10000 0004 1799 0733Department of Quality Control, The First Affiliated Hospital of Zhengzhou University, Jianshe Road, Er-Qi District, Zhengzhou City, 450052 Henan Province China
| | - Juan Ding
- grid.412633.10000 0004 1799 0733Department of Quality Control, The First Affiliated Hospital of Zhengzhou University, Jianshe Road, Er-Qi District, Zhengzhou City, 450052 Henan Province China
| | - Tiantian Xiong
- grid.207374.50000 0001 2189 3846Medical College of Zhengzhou University, 40 Daxue Road, Er-Qi District, Zhengzhou City, 450052 Henan Province China
| | - Jiandi Liuding
- grid.41156.370000 0001 2314 964XSchool of Traditional Chinese Medicine of Nanjing University, 282 Hanzhong Road, Nanjing City, 210029 Jiangsu Province China
| | - LinTao Nie
- grid.412633.10000 0004 1799 0733Department of Quality Control, The First Affiliated Hospital of Zhengzhou University, Jianshe Road, Er-Qi District, Zhengzhou City, 450052 Henan Province China
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11
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Lin R, Lu Y, Luo W, Zhang B, Liu Z, Xu Z. Risk factors for postpartum depression in women undergoing elective cesarean section: A prospective cohort study. Front Med (Lausanne) 2022; 9:1001855. [PMID: 36250100 PMCID: PMC9553994 DOI: 10.3389/fmed.2022.1001855] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPostpartum depression (PPD) has adverse effects on maternal and child health. Cesarean section (CS) is suggested to be associated with PPD, but no study has examined the risk factors for PPD in women who underwent CS. Therefore, this study aimed to investigate this association.MethodsA prospective observational study was conducted between December 2020 and September 2021. In total, 590 women who underwent elective CS participated in this study. Data were collected using a questionnaire through a face-to-face interview at three time points: 32nd week of gestation, 2 days postpartum, and 6 weeks postpartum. PPD was defined by an Edinburgh Postnatal Depression Scale (EPDS) score of ≥ 11 at 6 weeks postpartum. Multivariate logistic regression analysis was performed to identify the risk factors for PPD.ResultsAmong the 590 women, 25.4% had PPD (142/590). After adjustment for the confounding factors, high antenatal self-rating anxiety scale score (OR = 1.10, 95% CI = 1.04–1.16), PPD symptoms (EPDS ≥ 11) at 2 days postpartum (OR = 6.17, 95% CI = 1.35–28.31), and pain at 6 weeks postpartum (OR = 2.14, 95% CI = 1.24–3.69) were independently associated with PPD.ConclusionPrenatal anxiety, PPD symptoms occurring at an early postoperative stage, and pain at 6 weeks postpartum may be associated with an increased risk of PPD among women who undergo CS.
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Affiliation(s)
- Rong Lin
- Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yan Lu
- Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Wei Luo
- Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Bing Zhang
- Clinical and Translational Research Center, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Zhiqiang Liu
- Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
- *Correspondence: Zhiqiang Liu,
| | - Zhendong Xu
- Department of Anesthesiology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
- Zhendong Xu,
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Association between perinatal pain and postpartum depression: A systematic review and meta-analysis. J Affect Disord 2022; 312:92-99. [PMID: 35716784 DOI: 10.1016/j.jad.2022.06.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/31/2022] [Accepted: 06/08/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION In recent years, clinical studies have shown that perinatal pain could increase the risk of postpartum depression, while such a conclusion appears controversial. Therefore, we conducted this systematic review and meta-analysis to explore the association between perinatal pain and postpartum depression, and to evaluate the effectiveness of epidural labor analgesia in reducing the risk of postpartum depression. METHODS PubMed, Web of Science, Embase and Cochrane Library were searched from inception to Jan 30th, 2022. The effect size of the meta-analysis was calculated using odds ratio and 95 % confidence interval. Statistical analysis was performed using Stata 15.0 software. RESULTS There were 19 studies included with a total of 96,378 patients. Among the included studies, 10 investigated the association between perinatal pain and the risk of postpartum depression, and 9 reported that between labor analgesia and the risk of postpartum depression. The results of meta-analysis showed that perinatal pain increased the risk of postpartum depression [OR = 1.43, 95% CI (1.23, 1.67), p<0.05], and epidural analgesia could reduce the risk of postpartum depression [OR = 0.42, 95% CI (0.33, 0.55), p < 0.05]. LIMITATIONS Source of heterogeneity in the association between perinatal pain and PPD could not be identified due to the limitations of the original studies. There were mainly cohort studies included in the assessment for effectiveness of epidural analgesia in reducing the incidence of postpartum pain. Therefore, we look forward to more RCTs to confirm our results. CONCLUSION Perinatal pain is one of the risk factors for postpartum depression, and epidural analgesia could reduce the risk of PPD. This result might provide guidance for clinical practice. However, psychological health counseling should be combined with epidural analgesia for perinatal pain to reduce the risk of PPD.
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Du W, Bo L, Xu Z, Liu Z. Childbirth Pain, Labor Epidural Analgesia, and Postpartum Depression: Recent Evidence and Future Directions. J Pain Res 2022; 15:3007-3015. [PMID: 36186756 PMCID: PMC9519391 DOI: 10.2147/jpr.s379580] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 09/17/2022] [Indexed: 11/27/2022] Open
Abstract
Pregnancy and childbirth are major life events for women and their families, characterized by physical, psychological, and emotional changes that can trigger anxiety, depression, and mental disorders in susceptible individuals. Acute labor pain is an independent risk factor for persistent pain in the postpartum period and is associated with depressive disorders. Epidural analgesia is a well-established technique that has commonly been regarded as the gold standard in pain management during labor. Although the relationships between labor pain, labor epidural analgesia, and postpartum depression have been studied by many investigators, the results of these studies are conflicting. Some literature suggest that labor epidural analgesia is associated with a reduction in the incidence of postpartum depression; however, other studies have failed to demonstrate this association. Unmet analgesic needs expectations, unmet birth expectations, and/or the quality of social support during labor may contribute to postpartum depression. The limitations of the published studies included differential misclassification of study variables and residual confounding, variations in the diagnosis of depression, and incomplete history data. Thus, future studies should include information on sociodemographic and patient-level variables and assessments of pain during labor or in the postpartum period. Better management of labor pain should be provided to prevent long-term morbidity and improve maternal and neonatal outcomes. Anesthesiologists could collaboratively work with obstetricians and perinatal psychiatrists to ensure that hospitals prioritize screening and treatment for postpartum depression.
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Affiliation(s)
- Weijia Du
- Department of Anesthesiology, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Lulong Bo
- Faculty of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai, People’s Republic of China
| | - Zhendong Xu
- Department of Anesthesiology, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
| | - Zhiqiang Liu
- Department of Anesthesiology, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of China
- Correspondence: Zhiqiang Liu; Zhendong Xu, Department of Anesthesiology, Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai Institute of Maternal-Fetal Medicine and Gynecologic Oncology, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, 200092, People’s Republic of China, Tel +86 13816877756; +86 13817029904, Email ;
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Wang J, Zhao G, Song G, Liu J. Association between neuraxial labor analgesia and postpartum depression: A meta-analysis. J Affect Disord 2022; 311:95-102. [PMID: 35594971 DOI: 10.1016/j.jad.2022.05.095] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 05/10/2022] [Accepted: 05/15/2022] [Indexed: 01/16/2023]
Abstract
BACKGROUND Labor and delivery complications, particularly pain, are important risk factors for postpartum depression (PPD). Neuraxial labor analgesia can effectively relieve labor pain; however, the association between neuraxial labor analgesia and PPD, if any, has not been established. METHODS PubMed, MEDLINE, EMBASE, ClinicalTrials.gov, and Cochrane Library were searched. The incidence of PPD was the primary outcome. The secondary outcome was the difference in postpartum Edinburgh Postpartum Depression Scale scores between the neuraxial labor analgesia and control groups. Subgroup analyses and post-hoc meta-regression were performed. RESULTS Nineteen studies with a total of 8758 parturients were identified. Neuraxial labor analgesia did not decrease PPD risk compared to the control group (OR = 0.84, 95% CI: 0.58-1.23); however, after being stratified by PPD prevalence, neuraxial labor analgesia decreased the risk for PPD in the high prevalence (>14%) subgroup (OR = 0.61, 95% CI: 0.39-0.94) and increased the risk for PPD in the low prevalence (<14%) subgroup (OR = 1.56, 95% CI: 1.16-2.10) compared to the control group. Meta-regression analysis showed that the association between neuraxial labor analgesia and PPD was influenced by PPD prevalence. There was no difference in the postpartum Edinburgh Postpartum Depression Scale scores between the neuraxial labor analgesia and control groups (WMD = -0.11, 95% CI: -0.56-0.34). LIMITATION Heterogeneity and a limited number of randomized controlled trials may bias the interpretation of the results. CONCLUSION Neuraxial labor analgesia had a protective effect when administered to parturients in the region with a high prevalence of PPD, but became a risk factor when administered to parturients in the region with a low prevalence of PPD.
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Affiliation(s)
- Jian Wang
- Department of Anesthesiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Ge Zhao
- Department of Obstetrics, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Guang Song
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jing Liu
- Department of Obstetrics, The First Affiliated Hospital of China Medical University, Shenyang, China.
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Wang Y, Xu F, Zhao S, Han L, Huang S, Zhu H, Ding Y, Ma L, Zhao W, Zhang T, Chen X. Procedural analgesic interventions in China: a national survey of 2198 hospitals. BMC Anesthesiol 2022; 22:250. [PMID: 35933333 PMCID: PMC9356406 DOI: 10.1186/s12871-022-01783-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 07/22/2022] [Indexed: 11/18/2022] Open
Abstract
Background Humane treatment requires the provision of appropriate sedation and analgesia during medical diagnosis and treatment. However, limited information is available about the status of procedural analgesic interventions in Chinese hospitals. Therefore, a nationwide survey was established to identify challenges and propose potential improvement strategies. Methods Forty-three members of the Pain Group of Chinese Society of Anesthesiology established and reviewed the questionnaire, which included (1) general information on the hospitals, (2) the sedation/analgesia rate in gastrointestinal endoscopy, labor, flexible bronchoscopy, hysteroscopy in China, (3) staff assignments, (4) drug use for procedural analgesic interventions, and (5) difficulties in procedural analgesic interventions. The data were obtained using an online questionnaire sent to the chief anesthesiologists of Chinese hospitals above Grade II or members of the Pain Group of Chinese Society of Anesthesiology. Results Valid and complete questionnaires were received from 2198 (44.0%) hospitals, of which 64.5% were Grade III. The overall sedation/analgesia rates were as follows: gastroscopy (50.6%), colonoscopy (53.7%), ERCP (65.9%), induced abortion (67.5%), labor (42.3%), hysteroscopy (67.0%) and fiber bronchoscopy (52.6%). Compared with Grade II hospitals, Grade III hospitals had a higher proportion of procedural analgesic interventions services except for induced abortion. On average (median [IQR]), each anesthesiologist performed 5.7 [2.3—11.4] cases per day, with 7.3 [3.2—13.6] performed in Grade III hospitals and 3.4 [1.8—6.8] performed in Grade II hospitals (z = -7.065, p < 0.001). Conclusions Chinese anesthesiologists have made great efforts to achieve procedural analgesic interventions, as evidenced by the increased rate. The uneven health care provided by hospitals at different levels and in different regions and the lack of anesthesiologists are the main barriers to optimal procedural analgesic interventions. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-022-01783-6.
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Affiliation(s)
- Yafeng Wang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Feng Xu
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Shuai Zhao
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Linlin Han
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Shiqian Huang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Hongyu Zhu
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yuanyuan Ding
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Lulin Ma
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Wenjing Zhao
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Tianhao Zhang
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xiangdong Chen
- Department of Anesthesiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Kocak MY, Göçen NN, Akin B. The Effect of Listening to the Recitation of the Surah Al-Inshirah on Labor Pain, Anxiety and Comfort in Muslim Women: A Randomized Controlled Study. JOURNAL OF RELIGION AND HEALTH 2022; 61:2945-2959. [PMID: 34302588 DOI: 10.1007/s10943-021-01356-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/17/2021] [Indexed: 06/13/2023]
Abstract
This study aimed to identify whether listening to the recitation of the Surah Al-Inshirah (94th Chapter of the Holy Qur'an) during labor had any effect on women's pain, anxiety and comfort levels. Designed as a randomized controlled trial, the study was performed with the participation of 126 pregnant Muslim women. The study showed that listening to the recitation of the Surah Al-Inshirah during labor had positive effects on the women's pain, anxiety and comfort levels. In this respect, it is recommended that based on individuals' religious beliefs, spiritual elements such as surahs, prayers and hymns be integrated into the midwifery care offered during labor.
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Affiliation(s)
- Mine Yilmaz Kocak
- Midwifery Department, Faculty of Health Science, Selcuk University, Aladdin Keykubat Campus Ardıçlı, No: 299, 42250, Selҫuklu, Konya, Turkey
| | - Nazlı Nur Göçen
- T.C. Ministry Health Konya Provincial Health Directorate Dr. Ali Kemal Belviranlı Obstetrics and Pediatrics Hospital, Konya, Turkey
| | - Bihter Akin
- Midwifery Department, Faculty of Health Science, Selcuk University, Aladdin Keykubat Campus Ardıçlı, No: 299, 42250, Selҫuklu, Konya, Turkey.
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Deng CM, Ding T, Liu ZH, He ST, Ma JH, Xu MJ, Wang L, Li M, Liang WL, Li XY, Ma D, Wang DX. Impact of maternal neuraxial labor analgesia exposure on offspring's neurodevelopment: A longitudinal prospective cohort study with propensity score matching. Front Public Health 2022; 10:831538. [PMID: 35968440 PMCID: PMC9373030 DOI: 10.3389/fpubh.2022.831538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 07/12/2022] [Indexed: 02/01/2023] Open
Abstract
Background Neuraxial analgesia is widely used to relieve labor pain; its effects on long-term neurodevelopment of offspring remain unclear. This study was designed to investigate the influence of maternal neuraxial labor analgesia on offspring mental development. Methods This was a predefined secondary analysis of a 2-year prospective longitudinal study. Nulliparous women with single-term cephalic pregnancy preparing for vaginal delivery self-selected neuraxial analgesia or not during labor. Mothers and their offspring were followed up 2 years later. children's mental development was assessed with the bayley scales of infant development. A multivariable logistic model was used to identify factors associated with below-average mental development (Mental Development Index <90). Results A Total of 508 pairs of mothers and children completed a 2-year follow-up. after propensity score matching, 387 pairs were included in the analysis. In both cohorts, the proportions with below-average mental development were slightly lower in children whose mothers received neuraxial labor analgesia, although not statistically significant [in the full cohort: 9.8 % (36/368) vs. 15.7% (22/140), P = 0.060; In the matched cohort: 8.3% (21/254) vs. 14.3% (19/133), P = 0.065]. A higher 2-year depression score (in the full cohort: Odds Ratio 1.15, 95% CI 1.08–1.22, P < 0.001; In the matched cohort: Odds Ratio 1.09, 95% CI 1.01–1.18, P = 0.037), but not neuraxial analgesia exposure, was associated with an increased risk of below-average mental development. Conclusions Maternal depression at 2 years was associated with the risk of below-average mental development, whereas maternal exposure to neuraxial labor analgesia was not. Clinical Trial Registration The study was registered with www.chictr.org.cn (ChiCTR-OCH-14004888) and ClinicalTrials.gov (NCT02823418).
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Affiliation(s)
- Chun-Mei Deng
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Ting Ding
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Zhi-Hua Liu
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Shu-Ting He
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Jia-Hui Ma
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
| | - Ming-Jun Xu
- Department of Anesthesiology, Beijing Obstetrics and Gynecology Hospital, Beijing, China
| | - Lei Wang
- Department of Anesthesiology, Haidian Maternal & Child Health Hospital, Beijing, China
| | - Ming Li
- Department of Pediatrics, Peking University First Hospital, Xicheng District, Beijing, China
| | - Wei-Lan Liang
- Department of Pediatrics, Peking University First Hospital, Xicheng District, Beijing, China
| | - Xue-Ying Li
- Department of Biostatistics, Peking University First Hospital, Beijing, China
| | - Daqing Ma
- Section of Anesthetics, Pain Management and Intensive Care, Department of Surgery and Cancer, Imperial College London, Chelsea and Westminster Hospital, London, United Kingdom
| | - Dong-Xin Wang
- Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, China
- Outcomes Research Consortium, Cleveland, OH, United States
- *Correspondence: Dong-Xin Wang ;
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Binyamin Y, Wainstock T, Sheiner E, Battat TL, Reuveni I, Leibson T, Pariente G. The association between epidural analgesia during labor and mother-infant bonding. J Clin Anesth 2022; 80:110795. [PMID: 35489303 DOI: 10.1016/j.jclinane.2022.110795] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 03/19/2022] [Accepted: 03/25/2022] [Indexed: 11/19/2022]
Abstract
STUDY OBJECTIVE This study was aimed to assess the association between the use of epidural analgesia during labor and mother-infant bonding. DESIGN A cross-sectional study. SETTING Maternity ward at Soroka University Medical Center during 2020. PATIENTS Women who delivered a singleton live-born infant vaginally in their immediate post-partum period. INTERVENTIONS Women completed questionnaires. 25 items post-partum bonding questionnaire (PBQ) to assess mother-infant bonding (A high score on the PBQ indicates impaired mother-infant bonding) and the Edinburgh postnatal depression scale (EPDS) questionnaire to assess risk for post-partum depression. MEASUREMENTS The study used PBQ questionnaire and four sub-scales to assess mother-infant bonding and the EPDS questionnaire to assess risk for post- partum depression. Generalized linear regression models (gamma) were constructed to examine the association between epidural analgesia and mother-infant bonding total score and impaired bonding sub- scale, while adjusting for confounders Additional information such as pregnancy complications and sociodemographic data was drawn from women's medical records. MAIN RESULTS A total of 234 women were included in the final analysis, of them 126 (53.8%) delivered with epidural analgesia. The total PBQ score was significantly lower among women who received epidural analgesia compared to women without epidural analgesia (7.6 vs. 10.2, p = 0.024), demonstrating a better mother -infant bonding. Using two multivariable linear regression models, controlling for confounders such as maternal age and educational status, epidural analgesia during labor was independently associated with a better mother -infant bonding total score and better impaired bonding sub-scale score (Beta coefficient-0.252, 95% CI -0.5; -0.006, p = 0.045 and Beta coefficient - 0.34, 95% CI -0.52; -0.08, p = 0.01 for mother-infant bonding total score and sub-scale score, respectively). No differences in post-partum depression risks were found between the groups (EDPS≥13, 5.7% vs. 13%, p = 0.058). CONCLUSION Our study demonstrated better mother -infant bonding among women delivering with epidural analgesia.
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Affiliation(s)
- Yair Binyamin
- Department of Anesthesiology, Soroka University Medical Center and the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Tamar Wainstock
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Talya Lanxner Battat
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Inbal Reuveni
- Department of Psychiatry, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Tom Leibson
- Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada; Division of Clinical Pharmacology and Toxicology, Hospital for Sick Children, Toronto, ON, Canada
| | - Gali Pariente
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben Gurion University of the Negev, Beer-Sheva, Israel
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Cherel Q, Burey J, Rousset J, Picard A, Mirza D, Dias C, Jacquet H, Mariani P, Raffegeau N, Saupin I, Bornes M, Lapidus N, Quesnel C, Garnier M. Epidural analgesia information sessions provided by anesthetic nurses: impact on satisfaction and anxiety of parturient women a prospective sequential study. BMC Anesthesiol 2022; 22:105. [PMID: 35413841 PMCID: PMC9002221 DOI: 10.1186/s12871-022-01647-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 03/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Information on epidural analgesia delivered to parturient women is frequently incomplete, making it difficult for expectant mothers to make an appropriate choice for their delivery. We assessed the impact of a multimodal information session on epidural analgesia delegated to anesthetic nurses on new-mothers' satisfaction. METHODS We performed a prospective sequential study including parturient women who gave birth with epidural analgesia. During the first period, information on epidural analgesia was delivered by anesthetists during the scheduled anesthesia consultation, according to French standard-of-care. Then, a dedicated information session about epidural analgesia provided by anesthetic nurses was implemented. The primary endpoint was the satisfaction of women with the quality of information received. Main secondary endpoints were knowledge of women about epidural analgesia, anxiety before epidural catheter placement, and satisfaction with delivery. RESULTS 259 and 298 women were included during the first and second periods respectively, among whom 178 and 188 were analyzed. Information on epidural analgesia delivered by anesthetic nurses was associated with improvement of new-mothers' satisfaction with information received (9 (8-10) vs. 10 (9-10) - p < 0.001). Moreover, information delivered by anesthetic nurses was associated with decreased anxiety before epidural catheter placement (4 (1-8) vs. 3 (1-6) - p = 0.006) and increased satisfaction with delivery (8 (7-10) vs. 9 (8-10) - p = 0.01). Women's knowledge on epidural analgesia was durably increased when information was delivered by anesthetic nurses compared to conventional information by anesthetists. After adjustment, the only variable associated with both new mothers' satisfaction with information and delivery was the information session taught by anesthetic nurses. CONCLUSIONS Information sessions on epidural analgesia delivered by anesthetic nurses was associated with improved satisfaction of women with their delivery. Such information sessions may be used in maternity wards to improve new-mothers' childbirth experience.
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Affiliation(s)
- Quentin Cherel
- Service d'anesthésie, réanimation et médecine périopératoire, Hôpital Tenon, Sorbonne Université, GRC29, APHP, DMU DREAM, 4 rue de la Chine, 75020, Paris, France
| | - Julien Burey
- Service d'anesthésie, réanimation et médecine périopératoire, Hôpital Tenon, Sorbonne Université, GRC29, APHP, DMU DREAM, 4 rue de la Chine, 75020, Paris, France
| | - Julien Rousset
- Service d'anesthésie, réanimation et médecine périopératoire, Hôpital Tenon, Sorbonne Université, GRC29, APHP, DMU DREAM, 4 rue de la Chine, 75020, Paris, France
| | - Anne Picard
- Service d'anesthésie, réanimation et médecine périopératoire, Hôpital Tenon, Sorbonne Université, GRC29, APHP, DMU DREAM, 4 rue de la Chine, 75020, Paris, France
| | - Dimitra Mirza
- Service d'anesthésie, réanimation et médecine périopératoire, Hôpital Tenon, Sorbonne Université, GRC29, APHP, DMU DREAM, 4 rue de la Chine, 75020, Paris, France
| | - Christina Dias
- Service d'anesthésie, réanimation et médecine périopératoire, Hôpital Tenon, Sorbonne Université, GRC29, APHP, DMU DREAM, 4 rue de la Chine, 75020, Paris, France
| | - Hélène Jacquet
- Service d'anesthésie, réanimation et médecine périopératoire, Hôpital Tenon, Sorbonne Université, GRC29, APHP, DMU DREAM, 4 rue de la Chine, 75020, Paris, France
| | - Paule Mariani
- Service d'anesthésie, réanimation et médecine périopératoire, Hôpital Tenon, Sorbonne Université, GRC29, APHP, DMU DREAM, 4 rue de la Chine, 75020, Paris, France
| | - Nathalie Raffegeau
- Service d'anesthésie, réanimation et médecine périopératoire, Hôpital Tenon, Sorbonne Université, GRC29, APHP, DMU DREAM, 4 rue de la Chine, 75020, Paris, France
| | - Isabelle Saupin
- Service d'anesthésie, réanimation et médecine périopératoire, Hôpital Tenon, Sorbonne Université, GRC29, APHP, DMU DREAM, 4 rue de la Chine, 75020, Paris, France
| | - Marie Bornes
- Service de gynécologie-obstétrique, Hôpital Tenon, Sorbonne Université, APHP, DMU ORIGYNE, 4 rue de la Chine, 75020, Paris, France
| | - Nathanaël Lapidus
- Département de Santé Publique, Hôpital Saint-Antoine, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique IPLESP, APHP, Sorbonne Université, 184 rue du Faubourg St Antoine, 75012, Paris, France
| | - Christophe Quesnel
- Service d'anesthésie, réanimation et médecine périopératoire, Hôpital Tenon, Sorbonne Université, GRC29, APHP, DMU DREAM, 4 rue de la Chine, 75020, Paris, France
| | - Marc Garnier
- Service d'anesthésie, réanimation et médecine périopératoire, Hôpital Tenon, Sorbonne Université, GRC29, APHP, DMU DREAM, 4 rue de la Chine, 75020, Paris, France.
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20
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Ren Z, Wang M, Aldhabi M, Zhang R, Liu Y, Liu S, Tang R, Chen Z. Low-dose S-ketamine exerts antidepressant-like effects via enhanced hippocampal synaptic plasticity in postpartum depression rats. Neurobiol Stress 2022; 16:100422. [PMID: 34977283 PMCID: PMC8686162 DOI: 10.1016/j.ynstr.2021.100422] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/11/2021] [Accepted: 12/13/2021] [Indexed: 11/05/2022] Open
Abstract
Rapid antidepressant effects of S-ketamine have repeatedly been confirmed in patients with depression, as well as in chronic unpredictable mild stress (CUMS) animal models. However, the pharmacological study of S-ketamine for anti-postpartum depression has not been considered. In this study, the classical method of reproductive hormone withdrawal was used to construct a rat model of postpartum depression (PPD). Subsequently, the study evaluated the effects of low-dose S-ketamine on behavior and synaptic plasticity, which is related to depression, in the hippocampus of PPD rats. Multiple behavioral tests were used to evaluate depression-like behaviors in PPD models. Synaptic plasticity of the hippocampus can be demonstrated by Western blot, Golgi staining, transmission electron microscopy, and electrophysiological recording. Our study provides insight into the role of low-dose S-ketamine in antidepressant as well as antianxiety and indicates that maintaining synaptic plasticity is a key target for S-ketamine therapy for postpartum depression induced by reproductive hormone withdrawal.
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Affiliation(s)
- Zhuoyu Ren
- Department of Anesthesiology, Qingdao Women and Children's Hospital of Qingdao University, Qingdao, Shandong, China
| | - Mingling Wang
- Shandong Provincial Medicine and Health Key Laboratory of Clinical Anesthesia, School of Anesthesiology, Weifang Medical University, Weifang, Shandong, China
| | - Mokhtar Aldhabi
- Department of Urology of the Affiliated Hospital of Qingdao Binhai University, Qingdao, Shandong, China
| | - Rui Zhang
- Shandong Provincial Medicine and Health Key Laboratory of Clinical Anesthesia, School of Anesthesiology, Weifang Medical University, Weifang, Shandong, China
| | - Yongxin Liu
- Shandong Provincial Medicine and Health Key Laboratory of Clinical Anesthesia, School of Anesthesiology, Weifang Medical University, Weifang, Shandong, China
| | - Shaoyan Liu
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Rundong Tang
- Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Zuolei Chen
- Department of Anesthesiology, Qingdao Women and Children's Hospital of Qingdao University, Qingdao, Shandong, China.,Department of Anesthesiology of the Affiliated Hospital of Qingdao Binhai University, Qingdao, Shandong, China
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21
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Xiong PT, Poehlmann J, Stowe Z, Antony KM. Anxiety, Depression, and Pain in the Perinatal Period: A Review for Obstetric Care Providers. Obstet Gynecol Surv 2021; 76:692-713. [PMID: 34854926 DOI: 10.1097/ogx.0000000000000958] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Importance Maternal depression and anxiety may not only increase vulnerability for the development of postpartum depression and anxiety but may increase the perception of obstetric pain. Objective This review focuses on the relationship among depression, anxiety, and pain during pregnancy and postpartum. We will first review common clinical screening tools for depression, anxiety, and pain. Then, the existing evidence describing the relationship of depression, anxiety, and pain will be covered. Evidence Acquisition Queries for publications in PubMed, Google Scholar, and the CINAHL (Cumulative Index to Nursing and Allied Health Literature) were completed. Both searches were limited to publications within the last 20 years. Literatures on subtopics obtained from the references of publications identified in the initial search were not limited by publication year. Results A total of 19 total publications were identified regarding postpartum depression and pain; 17 were identified in the initial search, and 2 related to postpartum depression, anxiety, and pain were found by reviewing references. Eleven studies were identified regarding postpartum anxiety and pain; 4 were found in the original search, and 7 were identified by reviewing the references. Conclusions and Relevance The relationship between postpartum depression and pain is well characterized in the literature. However, the relationship between postpartum anxiety and pain is less well defined, and further research is needed. The interaction between maternal mental health and pain emphasizes the importance of screening for these conditions and also counseling and educating patients about expectations regarding intrapartum and postpartum pain.
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Affiliation(s)
- Pa Ta Xiong
- Medical Student, School of Medicine and Public Health
| | - John Poehlmann
- Resident Physician, Department of Obstetrics and Gynecology, University of Wisconsin-Madison
| | - Zachary Stowe
- Professor, Department of Psychiatry, University of Wisconsin-Madison, Wisconsin Psychiatric Institute and Clinics
| | - Kathleen M Antony
- Associate Professor, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Wisconsin-Madison, Madison, WI
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22
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Relationship between delivery with anesthesia and postpartum depression: The Japan Environment and Children's Study (JECS). BMC Pregnancy Childbirth 2021; 21:522. [PMID: 34301185 PMCID: PMC8306350 DOI: 10.1186/s12884-021-03996-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 07/09/2021] [Indexed: 11/14/2022] Open
Abstract
Background Postpartum depression is one of the most commonly experienced psychological disorders for women after childbirth, usually occurring within one year. This study aimed to clarify whether women with delivery with anesthesia, including epidural analgesia, spinal-epidural analgesia, and paracervical block, had a decreased risk of postpartum depression after giving birth in Japan. Methods The Japan Environment and Children’s Study (JECS) was a prospective cohort study that enrolled registered fetal records (n = 104,065) in 15 regions nationwide in Japan. Binomial logistic regression analyses were performed to calculate the adjusted odd ratios (aORs) for the association between mode of delivery with or without anesthesia and postpartum depression at one-, six- and twelve-months after childbirth. Results At six months after childbirth, vaginal delivery with anesthesia was associated with a higher risk of postpartum depression (aOR: 1.233, 95% confidence interval: 1.079–1.409), compared with vaginal delivery without analgesia. Nevertheless, the risk dropped off one year after delivery. Among the pregnant women who requested delivery with anesthesia, 5.1% had a positive Kessler-6 scale (K6) score for depression before the first trimester (p < 0.001), which was significantly higher than the proportions in the vaginal delivery without analgesia (3.5%). Conclusions Our data suggested that the risk of postpartum depression at six months after childbirth tended to be increased after vaginal delivery with anesthesia, compared with vaginal delivery without analgesia. Requests for delivery with anesthesia continue to be relatively uncommon in Japan, and women who make such requests might be more likely to experience postpartum depressive symptoms because of underlying maternal environmental statuses.
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23
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Perinatal depression. Int Anesthesiol Clin 2021; 59:45-51. [PMID: 34001697 DOI: 10.1097/aia.0000000000000325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
This review summarizes recent evidences regarding the potential influences of epidural labor analgesia (ELA) on the outcomes of neonates and children. Terms and relevant words including “ELA,” “ELA and neonatal outcomes,” “ELA and children's development,” and “ELA and children's neurocognitive development” were used to search articles published in PubMed database up to October 2019. Original articles and reviews regarding potential influences of ELA on neonates and children were identified. Relevant references of the selected articles were also screened. The anesthetics used during ELA can be absorbed, enter the fetus, and produce neonatal depression; however, these effects are less severe than those during systematic opioid analgesia. The impact of anesthetic exposure during ELA on children's neurodevelopment has not been fully studied, but would be mild if any. ELA increases the risk of intrapartum maternal fever; the latter may be harmful to neonatal outcomes. The use of ELA may increase birth injury by increasing instrumental delivery, although long-term adverse events are rare. On the other hand, ELA may reduce maternal depression and, thus, produce favorable effects on neurocognitive development in childhood; but evidences are still lacking in this aspect. ELA may produce both favorable and unfavorable effects on neonates and children. These effects should be discussed with parturient women before making decisions. The potential harmful effects should be carefully managed. The overall impacts of ELA on neonatal and children's outcomes need to be studied further.
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25
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Munro A, George RB, Mackinnon SP, Rosen NO. The association between labour epidural analgesia and postpartum depressive symptoms: a longitudinal cohort study. Can J Anaesth 2021; 68:485-495. [PMID: 33403538 DOI: 10.1007/s12630-020-01900-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/01/2020] [Accepted: 09/21/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pain is a risk factor for postpartum depression (PPD) and labour epidural analgesia (LEA) may lower the incidence of PPD. We evaluated depressive symptoms risk at three, six, and 12 months postpartum in women with LEA compared with women without LEA. METHODS With ethics approval, hypotheses were tested using data from a longitudinal prospective observational cohort study between January 2015 and January 2019 in nulliparous women aged ≥ 18 yr with uncomplicated, singleton pregnancies. Email surveys were completed at baseline (18-20 weeks' gestation) and at three-, six- and 12 months postpartum, including the Edinburgh Postpartum Depression Scale (EPDS). Maternal, infant, and anesthesia characteristics were abstracted from electronic databases. The EPDS scores at three, six, and 12 months postpartum were analyzed using generalized estimating equations with and without covariates. RESULTS Of the 909 women who consented to participate, 709 women were included in the study. Antenatal EPDS scores, not LEA, predicted postpartum depressive symptom risk (P < 0.001). The adjusted 95% confidence intervals suggest mean EPDS scores differ from 1.0 point lower in the LEA group at 12 months to 1.5 points higher in the no LEA group at three months on its 0-30 scale. All the confidence intervals included zero at three, six, and 12 months, so were considered non-significant (P > 0.05). CONCLUSION This study did not identify an association between LEA and risk of depressive symptoms postpartum, although small mean differences between groups cannot be ruled out. Future studies should focus on other modifiable variables that influence the development of PPD.
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Affiliation(s)
- Allana Munro
- Department of Women's & Obstetric Anesthesia, IWK Health Centre, 5850/5980 University Ave, Halifax, NS, B3K 6R8, Canada.
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS, Canada.
| | - Ronald B George
- Department of Anesthesia and Perioperative Care, UCSF, San Francisco, CA, USA
| | - Sean P Mackinnon
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Natalie O Rosen
- Department of Psychology & Neuroscience, Dalhousie University, Halifax, NS, Canada
- Department of Obstetrics and Gynecology, Dalhousie University, Halifax, NS, Canada
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26
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Orbach-Zinger S, Heesen M, Grigoriadis S, Heesen P, Halpern S. A systematic review of the association between postpartum depression and neuraxial labor analgesia. Int J Obstet Anesth 2020; 45:142-149. [PMID: 33221120 DOI: 10.1016/j.ijoa.2020.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/21/2020] [Accepted: 10/10/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Postpartum depression (PPD) is the most common complication after childbirth, affecting 10-15% of women. It is associated with serious long-term consequences for the mother and family. Whether or not neuraxial labor analgesia mitigates the risk is uncertain and controversial. The purpose of this review was to summarize studies investigating the association between neuraxial labor analgesia and the incidence of PPD. METHODS A systematic literature search for randomized controlled trials and cohort studies reporting the incidence of PPD among parturients who received neuraxial analgesia compared with non-neuraxial or no analgesia. The primary outcome was the incidence of PPD between 5 and 12 weeks' postpartum. Depression was diagnosed using a cutoff score of ≥10 on the Edinburgh Postnatal Depression scale, a validated screening tool. The risk of bias of each study was evaluated, and odds ratios and 95% confidence intervals calculated from raw data or reported as adjusted odds ratios. RESULTS Eleven observational studies involving 5717 patients were included. Three studies had a critical risk, three a serious risk, and five a moderate risk of bias. Two studies reported significantly lower odds for PPD associated with neuraxial analgesia compared with non-neuraxial or no analgesia, whereas the odds ratios in the remaining nine studies were not significantly different. CONCLUSIONS Our systematic review did not find compelling evidence for an association between PPD and labor analgesia. Studies were heterogenous in nature and had a high risk of bias. Further research controlling for confounding factors is recommended to determine if a relationship exists.
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Affiliation(s)
- S Orbach-Zinger
- Department of Anesthesia, Beilinson Hospital, Petach Tikvah, Israel; Affiliated with Saklar Medical School, Tel Aviv University, Tel Aviv, Israel.
| | - M Heesen
- Department of Anesthesia, Kantonsspital Baden, Switzerland
| | - S Grigoriadis
- Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - P Heesen
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - S Halpern
- Department of Anesthesia, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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27
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Lim G, Levine MD, Mascha EJ, Wasan AD. Labor Pain, Analgesia, and Postpartum Depression: Are We Asking the Right Questions? Anesth Analg 2020; 130:610-614. [PMID: 32068588 DOI: 10.1213/ane.0000000000004581] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Grace Lim
- From the Department of Anesthesiology & Perioperative Medicine.,Department of Obstetrics, Gynecology, and Reproductive Sciences
| | - Michele D Levine
- Department of Obstetrics, Gynecology, and Reproductive Sciences.,Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Edward J Mascha
- Departments of Quantitative Health Sciences and Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio
| | - Ajay D Wasan
- From the Department of Anesthesiology & Perioperative Medicine.,Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh, Pittsburgh, Pennsylvania
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