Department of Anesthesiology, The First Affiliated Hospital of China Medical University, Shenyang, China.
Department of Obstetrics, The First Affiliated Hospital of China Medical University, Shenyang, China.
J Affect Disord. 2022 Aug 15;311:95-102. doi: 10.1016/j.jad.2022.05.095. Epub 2022 May 18.
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.
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.
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).
Heterogeneity and a limited number of randomized controlled trials may bias the interpretation of the results.
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.
分娩和分娩并发症，特别是疼痛，是产后抑郁症（PPD）的重要危险因素。椎管内分娩镇痛可以有效缓解分娩疼痛；然而，椎管内分娩镇痛与 PPD 之间的关联尚未确定。
检索了 PubMed、MEDLINE、EMBASE、ClinicalTrials.gov 和 Cochrane Library。PPD 的发病率是主要结局。次要结局是椎管内分娩镇痛组和对照组产后爱丁堡产后抑郁量表评分的差异。进行了亚组分析和事后荟萃回归。
确定了 19 项共 8758 名产妇的研究。与对照组相比，椎管内分娩镇痛并未降低 PPD 的风险（OR=0.84，95%CI：0.58-1.23）；然而，根据 PPD 流行率分层后，在高流行率（>14%）亚组中，椎管内分娩镇痛降低了 PPD 的风险（OR=0.61，95%CI：0.39-0.94），而在低流行率（<14%）亚组中增加了 PPD 的风险（OR=1.56，95%CI：1.16-2.10）与对照组相比。荟萃回归分析表明，椎管内分娩镇痛与 PPD 之间的关联受 PPD 流行率的影响。椎管内分娩镇痛组和对照组产后爱丁堡产后抑郁量表评分无差异（WMD=-0.11，95%CI：-0.56-0.34）。
异质性和随机对照试验数量有限可能会影响结果的解释。
在 PPD 高流行地区，椎管内分娩镇痛对产妇有保护作用，但在 PPD 低流行地区，椎管内分娩镇痛对产妇成为危险因素。
