Analysis of Intrathecal Labor Analgesia and the Causes of Maternal Postpartum Depression After Cesarean Section

BACKGROUND : Postpartum depression (PPD) is a common complication after childbirth, and its etiology may be related to several factors. In this study, we investigated the prevalence and causes of PPD in women who underwent vaginal delivery with intrathecal labor analgesia and women who underwent cesarean section. METHODS: A total of 242 women who gave birth from July 2022to July 2023 participated in this retrospective case‒control study, including 127 women who underwent cesarean section and 115 women who underwent vaginal delivery and received intrathecal labor analgesia. The clinical data of the study participants were collected, and anxiety, depression and PPD were assessed by the Self-Rating Anxiety Scale (SAS), Self-Rating Depression Scale (SDS) and the Chinese version of the Edinburgh Postnatal Depression Scale (EPDS); questionnaires were administered and telephone follow-up was conducted on the first day of the antenatal period. The Chinese version of the EPDS was used to assess maternal psychological status at 6 weeks after delivery, and an EPDS score ≥10 points at 6 weeks after delivery was used as an indicator of PPD. The related factors affecting the occurrence of PPD were analyzed by one-way analysis, and the independent risk factors affecting the occurrence of PPD were analyzed by multifactorial logistic regression. RESULTS: The incidence of PPD was approximately 5.0% (12/242) in the women who underwent vaginal delivery and received intrathecal labor analgesia and 11.1% (27/242) in those who underwent cesarean section. Multifactorial logistic regression analysis showed that advanced maternal age was a risk factor for PPD (odds ratio [OR], 1.31, 95% confidence interval [95% CI], 1.04-1.66; P=0.02); prenatal anxiety (OR: 8.48, 95% CI: 2.73-26.27; P=0.02) and depression (OR: 10.99, 95% CI: 2.18-55.37; P<0.001) were also risk factors for PPD. A second birth was a protective factor against PPD (OR: 0.09, 95% CI: 0.01-0.57, P<0.05). CONCLUSION: Advanced maternal age and prenatal anxiety and depression were associated with the development of PPD in women who underwent vaginal delivery with intrathecal labor analgesia and those who underwent cesarean section. Obstetricians and gynecologists can identify mothers at high risk of PPD at an early stage and provide psychological counseling for mothers to reduce the incidence of PPD. However, studies with large sample sizes are still needed.