Department of Women's Anaesthesia, KK Women's and Children's Hospital, Singapore, Singapore.
Anaesthesiology and Perioperative Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.
Anaesthesia. 2024 Apr;79(4):357-367. doi: 10.1111/anae.16178. Epub 2023 Nov 21.
There is conflicting evidence regarding the association between epidural labour analgesia and risk of postpartum depression. Most previous studies were observational trials with limited ability to account for confounders. We aimed to determine if epidural analgesia was associated with a significant change in the incidence of postpartum depression in this randomised controlled trial. We enrolled women aged 21-50 years old with a singleton fetus ≥ 36 weeks gestation. Patients were advised regarding available labour analgesic modalities during enrolment (epidural block; intramuscular pethidine; nitrous oxide; or intravenous remifentanil). On request for analgesia, patients were offered the modality that they had been allocated randomly to first. Blinded investigators recorded patient and obstetric characteristics within 24 h of delivery and assessed for postpartum depression at 6-10 weeks following delivery using the Edinburgh Postnatal Depression Scale (score ≥ 13 considered positive for postpartum depression). The modified intention-to-treat population consisted of all patients who received any form of labour analgesia, while per-protocol consisted of patients who received their randomised modality as their first form of labour analgesia. Of 881 parturients allocated randomly (epidural n = 441, non-epidural n = 440), we analysed 773 (epidural n = 389, non-epidural n = 384); 62 (15.9%) of women allocated to epidural group developed postpartum depression compared with 65 (16.9%) women allocate to the non-epidural group. There were no significant differences in the incidence of postpartum depression between the two groups (adjusted risk difference (95%CI) 1.6 (-3.0-6.3%), p = 0.49). Similar results were obtained with per-protocol analysis (adjusted risk difference (95%CI) -1.0 (-8.3-6.3%), p = 0.79). We found no significant difference in the risk of postpartum depression between patients who received epidural labour analgesia and those who utilised non-epidural analgesic modalities.
关于硬膜外分娩镇痛与产后抑郁风险之间的关联，现有证据相互矛盾。大多数先前的研究为观察性试验，对混杂因素的处理能力有限。我们旨在通过这项随机对照试验，确定硬膜外镇痛是否与产后抑郁发生率的显著变化相关。我们招募了年龄在 21-50 岁之间、胎龄≥36 周的单胎产妇。在入组时，患者被告知可用的分娩镇痛方式（硬膜外阻滞；肌肉注射哌替啶；笑气；或静脉注射瑞芬太尼）。在要求镇痛时，患者可选择他们最初随机分配的镇痛方式。盲法研究者在分娩后 24 小时内记录患者和产科特征，并在分娩后 6-10 周使用爱丁堡产后抑郁量表（评分≥13 分认为产后抑郁阳性）评估产后抑郁。改良意向治疗人群包括接受任何形式分娩镇痛的所有患者，而方案人群包括接受随机镇痛方式作为其首次分娩镇痛的患者。在 881 名随机分配的产妇中（硬膜外组 n=441，非硬膜外组 n=440），我们分析了 773 名（硬膜外组 n=389，非硬膜外组 n=384）；与非硬膜外组的 65 名（16.9%）女性相比，分配到硬膜外组的 62 名（15.9%）女性出现产后抑郁。两组之间产后抑郁发生率无显著差异（调整风险差异（95%CI）1.6（-3.0-6.3%），p=0.49）。方案人群分析也得到了类似结果（调整风险差异（95%CI）-1.0（-8.3-6.3%），p=0.79）。我们发现，接受硬膜外分娩镇痛的患者与使用非硬膜外镇痛方式的患者之间，产后抑郁的风险无显著差异。
