Neuraxial Labor Analgesia and the Incidence of Postpartum Depression

Study Overview
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Brief Summary
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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.

Detailed Description
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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.

Official Title
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Impact of Neuraxial Labor Analgesia on the Incidence of Postpartum Depression: a Prospective, Observational, Multicenter Cohort Study

Conditions
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Parturition, Analgesia, Obstetrical, Depression, Postpartum

Intervention / Treatment
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* Procedure: No neuraxial labor analgesia
* Procedure: Neuraxial labor analgesia


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Primiparae between 18 and 34 years of age with term single cephalic pregnancy; Admitted to the delivery room during daytime working hours (from 8 am to 5 pm). Preparing to deliver vaginally. Exclusion Criteria: History of psychiatric disease (indicate those that are diagnosed before or during pregnancy by psychiatrists); 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. Other reasons that are considered unsuitable for study participation.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 34 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No neuraxial labor analgesia<br>For patients who do not accept neuraxial labor analgesia, analgesics will be prescribed by obstetricians according to routine practice. | Procedure: No neuraxial labor analgesia<br>* Neuraxial analgesia will not be performed. Analgesics will be prescribed by the obstetricians according to routine practice.<br>|
| Neuraxial labor analgesia<br>For patients who accept neuraxial labor analgesia, epidural analgesia or combined spinal-epidural analgesia will be provided when the cervix is dilated to 1 cm or more and continued until the cervix is fully dilated to 10 cm. | Procedure: Neuraxial labor analgesia<br>* 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.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The incidence of postpartum depression | Postpartum depression will be defined by a score of 10 or more on the Edinburgh Postnatal Depression Scale. | At 42 days after delivery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The mode of delivery | The mode of delivery includes spontaneous delivery, instrumental delivery, and Caesarean delivery. | 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. | At 1 and 5 minutes after delivery | 
| Status of baby feeding | The mode of baby feeding include breast feeding, mixed feeding, and formula feeding. | 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. | At 24 hours and 42 days after delivery | 
| Persistent pain | Persistence pain is defined as a NRS pain score ≥1 that persisted since childbirth. | 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. | At 42 days after delivery | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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primipara, childbirth, neuraxial labor analgesia, postpartum depression