Neuraxial labour analgesia is associated with a reduced risk of maternal depression at 2 years after childbirth A multicentre, prospective, longitudinal study
Neuraxial labour analgesia is associated with a reduced risk of maternal depression at 2 years after childbirth A multicentre, prospective, longitudinal study
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DOI：
10.1097/eja.0000000000001058
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发表时间：
2019-10-01
影响因子：
3.6
通讯作者：
Wang, Dong-Xin
中科院分区：
文献类型：
--
作者：
Liu, Zhi-Hua;He, Shu-Ting;Wang, Dong-Xin
严重的分娩疼痛是产后抑郁症的重要危险因素，早期抑郁症与长期抑郁症的风险增加有关;而分娩期间使用硬膜外镇痛可降低产后抑郁症的风险。目的探讨分娩镇痛是否与降低2年抑郁症的风险有关。设计：多中心、前瞻性、纵向研究。地点：2014年8月1日至2017年4月25日，在北京大学第一医院、北京妇产科医院和北京市海淀区妇幼保健院进行。599例单胎头位妊娠准备阴道分娩的初产妇纳入研究。主要观察指标：采用爱丁堡产后抑郁量表，于入院时、产后6周及产后2年进行抑郁症状筛查。10分或更高的分数被用作抑郁症的阈值。主要终点是分娩后2年抑郁症的存在。采用多因素logistic回归模型分析了使用分娩镇痛与2年抑郁症发生之间的关系。结果508例产妇完成2年随访。其中368例（72.4%）在分娩过程中接受了椎管内镇痛，140例（27.6%）未接受。使用椎管内分娩镇痛的患者中2年抑郁的百分比低于未使用椎管内分娩镇痛的患者（7.3 [27/368] vs. 13.6% [19/140]; P = 0.029）。校正混杂因素后，分娩期间使用椎管内镇痛与2年抑郁风险显著降低相关（比值比0.455，95%可信区间0.230 - 0.898; P = 0.023）。结论：对于单胎头位妊娠计划阴道分娩的初产妇，分娩期间使用椎管内镇痛与分娩后2年母亲抑郁风险降低相关。
BACKGROUND Severe labour pain is an important risk factor of postpartum depression, and early depression is associated with an increased risk of long-term depression; whereas the use of epidural analgesia during labour decreases the risk of postpartum depression. OBJECTIVE To investigate whether neuraxial labour analgesia was associated with a decreased risk of 2-year depression. DESIGN This was a multicentre, prospective, longitudinal study. SETTING The study was performed in Peking University First Hospital, Beijing Obstetrics and Gynecology Hospital and Haidian Maternal and Child Health Hospital in Beijing, China, between 1 August 2014 and 25 April 2017. PATIENTS Five hundred ninety-nine nulliparous women with single-term cephalic pregnancy preparing for vaginal delivery were enrolled. MAIN OUTCOME MEASURE Depressive symptoms were screened with the Edinburgh Postnatal Depression Scale at delivery-room admission, 6-week postpartum and 2 years after childbirth. A score of 10 or higher was used as the threshold of depression. The primary endpoint was the presence of depression at 2 years after childbirth. The association between the use of neuraxial labour analgesia and the development of 2-year depression was analysed with a multivariable logistic regression model. RESULTS Five hundred and eight parturients completed 2-year follow-up. Of these, 368 (72.4%) received neuraxial analgesia during labour and 140 (27.6%) did not. The percentage with 2-year depression was lower in those with neuraxial labour analgesia than in those without (7.3 [27/368] vs. 13.6% [19/140]; P = 0.029). After correction for confounding factors, the use of neuraxial analgesia during labour was associated with a significantly decreased risk of 2-year depression (odds ratio 0.455, 95% confidence interval 0.230 to 0.898; P = 0.023). CONCLUSION For nulliparous women with single-term cephalic pregnancy planning for vaginal delivery, the use of neuraxial analgesia during labour was associated with a reduced risk of maternal depression at 2 years after childbirth.