Labor Analgesia Reduces the Risk of Postpartum Depression in Women with Single-Term Pregnancy: A Prospective Cohort Clinical Study

Background: Postpartum depression (PPD) is a frequent mental disorder during the first year after delivery. Previous studies reported that patients with labor analgesia revealed lower incidence of PPD compared to those without. However, most pregnant women gave birth by labor analgesia or cesarean section in China, it is still unclear that whether there is a difference of the effects of labor analgesia and cesarean section on PPD. Methods: : A single-centered, prospective cohort clinical study was designed. One hundred ninety-eight patients with single pregnancy at full term were allocated to receive epidural labor analgesia (group LA) or cesarean section with epidural anesthesia (group CS) according to the maternal preference of delivery and professional suggetions of obstetricians and anesthesiologists. PPD was assessed with Edinburgh Postnatal Depression Scale (EPDS) scores ≥10 at 6 weeks postpartum. Maternal and neonatal variables in the perinatal period were recorded. Multivariate logistical regression analysis was conducted to evaluate the associated factors of PPD. Results: : 11 patients in group LA and 26 patients in group CS was diagnosed as PPD. The incidence of PPD in group LA was lower than group CS ( P =0.011). Eight potential predictor factors (labor analgesia, family income, duration of labor, antenatal depression, perinatal classes attending, neonate of male, EPDS scores at 3 days postpartum and adverse event at 6 weeks postpartum) were correlated with PPD. And it was reported in the final model that labor analgesia was the protective factor of PPD, however, high family income and EPDS scores at 3 days postpartum were associated with an increased risk of PPD. Conclusions: : Patients with epidural labor analgesia were associated with lower incidence of PPD compare to those with cesarean section with epidural anesthesia. Epidural labor analgesia, family income and EPDS scores in the early postpartum period were the independent predictors of PPD. Trial registration: This clinical trial was registered at the Chinese Clinical Trial Registry (http://www.chictr.org.cn/index.aspx). Number: ChiCTR1900020510. Registered on: 3/1/2019.