Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.
Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Scand J Pain. 2020 Jul 28;20(3):591-602. doi: 10.1515/sjpain-2020-0025.
Background and aims A considerable research-literature focuses on pain during labor and associations with postpartum persistent pain and depression, with findings pointing in various directions. The aim of this study was to examine the role of labor pain and overall birth experience in the development of pain and depression 8 weeks after delivery. Methods The study sample was drawn from the Akershus Birth Cohort. Data from multiple sources were used, including the hospital's birth record (n = 4,391), questionnaire data from gestational week 17 of pregnancy (n = 3,752), 8 weeks postpartum (n = 2,217), and two questions about pain and birth experience asked within 48 h after delivery (n = 1,221). The Edinburgh Postnatal Depression Scale was used to measure postpartum depression, a single question was used to measure persistent pain 8 weeks postpartum, while pain and birth experience were measured by numeric rating scales. A history of pre-pregnant depression and chronic pain were measured through self-report questions in gestational week 17. A total of 645 women had complete data from all sources. We applied multiple imputation techniques to handle missing responses on the two questions about pain and birth experience. Results The results showed that neither labor pain nor birth experience were associated with persistent pain 8 weeks postpartum, whereas pain before pregnancy (OR 3.70; 95% CI 2.71-5.04) and a history of depression (OR 2.31; 95% CI 1.85-2.88) were statistically significant predictors of persistent pain. A negative birth experience was significantly (OR 1.16; 95% CI 1.04-1.29) associated with postpartum depression, whereas labor pain intensity was not. A history of depression (OR 3.95; 95% CI 2.92-5.34) and pre-pregnancy pain (OR 2.03; 95% CI 1.37-3.01) were important predictors of postpartum depression 8 weeks after delivery. Conclusions and implications Whilst the relationship between labor pain intensity and postpartum pain and depression remain unclear, our results do imply the need to screen for previous depression and chronic pain conditions in pregnant women, as well as consider preventive measures in those who screen positive.
大量研究文献集中于分娩疼痛以及与产后持续性疼痛和抑郁之间的关联，但研究结果指向不同方向。本研究旨在检验分娩疼痛和整体分娩体验在产后 8 周时疼痛和抑郁发展中的作用。
研究样本来自阿克什胡斯出生队列。使用了多种来源的数据，包括医院分娩记录（n=4391）、妊娠 17 周的问卷调查数据（n=3752）、产后 8 周（n=2217）、以及产后 48 小时内询问的关于疼痛和分娩体验的两个问题（n=1221）。采用爱丁堡产后抑郁量表（Edinburgh Postnatal Depression Scale）来衡量产后抑郁，采用一个问题来衡量产后 8 周的持续性疼痛，而疼痛和分娩体验则通过数字评分量表来衡量。怀孕 17 周时通过自我报告问题来衡量孕前的抑郁和慢性疼痛史。共有 645 名女性的所有来源数据完整。我们应用多项缺失值插补技术处理关于疼痛和分娩体验的两个问题的缺失值。
结果显示，分娩疼痛和分娩体验均与产后 8 周的持续性疼痛无关，而孕前疼痛（OR 3.70；95%CI 2.71-5.04）和抑郁史（OR 2.31；95%CI 1.85-2.88）是持续性疼痛的统计学显著预测因子。负面的分娩体验（OR 1.16；95%CI 1.04-1.29）与产后抑郁显著相关，而分娩疼痛强度则没有。抑郁史（OR 3.95；95%CI 2.92-5.34）和孕前疼痛（OR 2.03；95%CI 1.37-3.01）是产后 8 周时产后抑郁的重要预测因子。
虽然分娩疼痛强度与产后疼痛和抑郁之间的关系仍不清楚，但我们的结果确实表明需要对孕妇进行孕前抑郁和慢性疼痛状况的筛查，并对筛查阳性者考虑采取预防措施。
