From the Department of Anesthesiology.
Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology.
Anesth Analg. 2018 May;126(5):1598-1605. doi: 10.1213/ANE.0000000000002720.
Using labor, epidural analgesia has been linked to a reduced risk of postpartum depression, but the role of labor pain relief in this association remains unclear. The goal of this study was to test the hypothesis that effective epidural analgesia during labor is associated with reduced postpartum depression symptomatology.
A single, institutional, retrospective, observational cohort design was chosen. The primary outcome was Edinburgh postnatal depression scale (EPDS) score, measured at the 6-week postpartum visit. Subjects included in the final analysis had (1) received labor epidural analgesia; (2) pain assessed during labor both before and during initiation of labor epidural analgesia by 0-10 numeric rating scores; and (3) depression risk assessed by the EPDS and documented at their 6-week postpartum visit. Simple and multiple linear regression was used to identify the best model for assessing the association between pain improvement, defined as percent improvement in pain (PIP), and depression, after adjusting for a history of anxiety or depression, other psychiatric history, abuse, trauma, mode of delivery, and other maternal or fetal comorbid diseases.
Two hundred one patients were included in the final analysis. Women with higher improvements in pain were associated with lower EPDS scores (r = 0.025; P = .002). Variables known to be associated with depression (body mass index, anxiety and/or depression, third- and fourth-degree perineal lacerations, and anemia) were significantly correlated with EPDS score and included in the final model. After we adjusted for these covariates, PIP remained a significant predictor of EPDS score (r = 0.49; P = .008), accounting for 6.6% of the variability in postpartum depression scores. The full model including pain, body mass index, anxiety and/or depression, perineal lacerations, and anemia explained 24% of the variability in postpartum depression scores.
Although the extent of labor pain relief by epidural analgesia predicts lower postpartum depression scores, the relative contribution of PIP to risk for postpartum depression symptoms may be less than other established risk factors for depression. These data support that the clinical significance of labor analgesia in the development of postpartum depression needs to be more clearly defined.
使用分娩镇痛（硬膜外麻醉）与产后抑郁症风险降低有关，但分娩疼痛缓解在这种关联中的作用尚不清楚。本研究旨在检验以下假设，即在分娩过程中进行有效的硬膜外镇痛与产后抑郁症状减少相关。
选择了单一、机构、回顾性、观察性队列设计。主要结局是在产后 6 周就诊时使用爱丁堡产后抑郁量表（EPDS）进行评分。最终分析包括以下内容：（1）接受分娩硬膜外镇痛；（2）在开始分娩硬膜外镇痛之前和期间，通过 0-10 数字评分量表评估分娩时的疼痛；（3）通过 EPDS 评估抑郁风险，并在产后 6 周就诊时记录。采用简单和多元线性回归来确定疼痛改善（疼痛改善百分比，PIP）与抑郁之间关联的最佳模型，调整焦虑或抑郁病史、其他精神病史、滥用、创伤、分娩方式和其他母婴或胎儿合并症等因素。
共有 201 名患者纳入最终分析。疼痛改善程度较高的女性 EPDS 评分较低（r=0.025；P=0.002）。与抑郁相关的已知变量（体重指数、焦虑和/或抑郁、三度和四度会阴裂伤以及贫血）与 EPDS 评分显著相关，并纳入最终模型。在调整这些协变量后，PIP 仍然是 EPDS 评分的显著预测因素（r=0.49；P=0.008），解释了产后抑郁评分变化的 6.6%。包括疼痛、体重指数、焦虑和/或抑郁、会阴裂伤和贫血在内的全模型解释了产后抑郁评分变化的 24%。
尽管硬膜外镇痛缓解分娩疼痛的程度预测了较低的产后抑郁评分，但 PIP 对产后抑郁症状风险的相对贡献可能小于其他已确立的抑郁风险因素。这些数据支持需要更明确地定义分娩镇痛在产后抑郁发展中的临床意义。
