Neuraxial Labor Analgesia and the Incidence of Postpartum Depression

Peking University First Hospital599 enrolled

Overview

Postpartum depression (PPD) affects approximately 15% of women during the first year after giving birth, and is common across cultures. The etiology of postpartum depression is not totally clear. The severe pain experienced during childbirth was reported to be associated with the development of postpartum depression. The purpose of the present study is to evaluate whether use of neuraxial labor analgesia can reduce the incidence of postpartum depression.

Postpartum depression (PPD) affects approximately 15% of women during the first year after giving birth, and is common across cultures. In postpartum Chinese women, the reported incidence ranged from 6.5% to 29.5%. The etiology of postpartum depression is not totally clear. Identified risk factors include previous maternal blues, unplanned pregnancy, lack of marital or social support, and previous psychiatric illnesses. Furthermore, the severe pain experienced during childbirth was reported to be associated with the occurrence of postpartum depression. A recent study of the investigators found that use of epidural analgesia during labor was associated with decreased risk of postpartum depression. However, several limitations existed in that study and further evidence is needed to reconfirm the finding. The purpose of the present study is to reevaluate whether use of neuraxial labor analgesia can reduce the incidence of postpartum depression.

Study Type

OBSERVATIONAL

Enrollment

599

Conditions

Parturition Analgesia, Obstetrical Depression, Postpartum

Interventions

No neuraxial labor analgesiaPROCEDURE

Neuraxial analgesia will not be performed. Analgesics will be prescribed by the obstetricians according to routine practice.

Neuraxial labor analgesiaPROCEDURE

Epidural or combined spinal-epidural labor analgesia will be performed when the cervix is dilated to 1 cm or more and continued until the cervix is fully dilated to 10 cm.

Eligibility

Sex: FEMALEMin age: 18 YearsMax age: 34 Years

Medical Language ↔ Plain English

Inclusion Criteria: 1. Primiparae between 18 and 34 years of age with term single cephalic pregnancy; 2. Admitted to the delivery room during daytime working hours (from 8 am to 5 pm). 3. Preparing to deliver vaginally. Exclusion Criteria: 1. History of psychiatric disease (indicate those that are diagnosed before or during pregnancy by psychiatrists); 2. Presence of contraindications to epidural analgesia, which includes: (1) History of infectious disease of the central nervous system (poliomyelitis, cerebrospinal meningitis, encephalitis, etc.); (2) History of spinal or intra-spinal disease (trauma or surgery of spinal column, intra-spinal canal mass, etc.); (3) Systemic infection (sepsis); (4) Skin or soft tissue infection at the site of epidural puncture; (5) Coagulopathy. 3. Other reasons that are considered unsuitable for study participation.

Outcomes

Primary Outcomes

The incidence of postpartum depression

Postpartum depression will be defined by a score of 10 or more on the Edinburgh Postnatal Depression Scale.

Time frame: At 42 days after delivery

Secondary Outcomes

The mode of delivery

The mode of delivery includes spontaneous delivery, instrumental delivery, and Caesarean delivery.

Time frame: At the time of delivery

Neonatal Apgar score

The Apgar score ranges from 0 to 10, with higher score indicating a better outcome. Scores 7 and above are generally normal; 4 to 6, fairly low; and 3 and below are generally regarded as critically low and cause for immediate resuscitative efforts.

Time frame: At 1 and 5 minutes after delivery

Status of baby feeding

The mode of baby feeding include breast feeding, mixed feeding, and formula feeding.

Time frame: At 24 hours and 42 days after delivery

Severity of pain

Severity of pain is evaluated with Numeric Rating Scale (NRS), where 0 indicates no pain and 10 the most severe pain.

Time frame: At 24 hours and 42 days after delivery

Persistent pain

Persistence pain is defined as a NRS pain score ≥1 that persisted since childbirth.

Time frame: At 42 days after delivery

Persistent pain affecting daily life

One of the following activities (including walking, mood, sleep or concentration) is affected by persistent pain, as judged by parturients themselves.

Data from ClinicalTrials.gov

This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.