Low-dose Ketamine and Postpartum Depression in Parturients With Prenatal Depression

Peking University First Hospital64 enrolled

Overview

Postpartum depression is common in mothers early after childbirth and produces harmful effects not only on mothers, but also on infants and young children. Parturients with prenatal depression are at increased of postpartum depression. Low-dose ketamine can be used for antidepressant therapy. We hypothesize that low-dose ketamine has a therapeutic effect on parturients with prenatal depression. This study is designed to investigate whether low-dose ketamine administered during cesarean delivery can decrease the incidence of postpartum depression in parturients with prenatal depression.

Postpartum depression refers to maternal depression developed early after childbirth, with reported incidences varied from 15% to 20%. The development of postpartum depression produces harmful effects not only on mothers, but also on infants and young children. Prenatal depression or high depression score is an independent risk factor for the development of postpartum depression. Ketamine is commonly used as an general anesthetic. In addition, low-dose ketamine is recommended for antidepressant therapy. We hypothesize that low-dose ketamine has a therapeutic effect on parturients with prenatal depression. However, evidences in this aspect are insufficient. The purpose of this study is to investigate whether low-dose ketamine administered during cesarean delivery can decrease the incidence of postpartum depression in parturients with prenatal depression.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

QUADRUPLE

Enrollment

Conditions

Perinatal Depression

Eligibility

Sex: FEMALEMin age: 18 YearsMax age: 45 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Parturients with age from 18 to 45 years and scheduled for elective cesarean delivery; * Prenatal depression score (EPDS) of 10 or higher; * Provide written informed consents. Exclusion Criteria: * Refused to participate in the study; * History of schizophrenia or other disease that prevent normal communication before delivery; * Presence of contraindications to neuraxial anesthesia, including central nervous system diseases (such as poliomyelitis), spinal diseases (such as spinal canal tumor, lumbar disc prolapse, history of spinal trauma), systemic infection (such as sepsis, bacteremia), local infection in the site of puncture, or coagulopathy; * Severe complications during pregnancy (such as severe preeclampsia, placenta accreta, HELLP syndrome); * Severe comorbidity before pregnancy (such as severe cardiac dysfunction); * Scheduled to undergo cesarean delivery under general anesthesia; * Other reasons that are considered unsuitable for study participation.

Outcomes

Primary Outcomes

The score of postpartum depression at 48 hous after childbirth.

Postpartum depression is assessed with Edinburgh postnatal depression scale (EPDS) at 48 hours after childbirth. The EPDS is a 10-item self-rating post-natal depression scale. Each item is scored from 0 to 3, resulting an overall score ranging from 0-30; a high score indicates severe depression.

Time frame: At 48 hours after delivery.

Secondary Outcomes

Time of first breast feeding.

Time frame: From delivery to 24 hours after delivery.

The proportion of neonates with breast feeding.

Time frame: At 24 hours after delivery.

Duration of neonatal sleep within 24 hours after delivery.

Time frame: During the first 24 hours after delivery.

Length of stay in hospital after delivery.

Time frame: From childbirth up to 30 days after delivery.

The score of postpartum depression at 42 days after delivery.

Postpartum depression is assessed with EPDS at 42 days after childbirth.

Time frame: At 42 days after delivery.

Incidence of postpartum depression at 42 days after delivery.

Postpartum depression is assessed with EPDS at 42 days after childbirth. A EPDS score of 10 or above is defined as postpartum depression.

Time frame: At 42 days after delivery.

Incidence of maternal complications with 42 days after delivery.

Time frame: From childbirth up to 42 days after delivery.

Incidence of neonatal complications with 42 days after delivery.