Obstetric Anesthesia and Postpartum Depression

拟议项目的广泛、长期目标是通过以下方式改善孕产妇健康成果 在分娩住院期间提供优质产科麻醉护理。 产后抑郁症在美国是一个严重的孕产妇健康问题，影响到1/4的人 七名产妇，尤其是种族和少数民族妇女。严重的产后疼痛与 产后抑郁症的风险增加。疼痛强度和产后抑郁症的风险 通过对阴道分娩使用神经轴止痛法(即硬膜外或脊椎止痛法)或 神经轴麻醉在剖宫产中的应用。神经轴性止痛或麻醉技术是最有效的 减轻产后疼痛的循证干预措施，但在种族和少数民族中未得到充分利用 女人。以前的研究结果并不一致，关于神经轴的使用之间的联系 分娩的止痛或麻醉和产后抑郁的风险。上一版本的不一致 研究可能是由于没有考虑到新发现的产后强烈风险因素。 抑郁，在评估产后抑郁的风险时。事实上，严重的孕产妇并发症在 分娩住院(即严重的产妇发病率)和严重的新生儿并发症(例如早产 出生、死产)最近被认为与产后抑郁风险显著增加有关。假设减少了 与神经轴向镇痛或分娩麻醉相关的产后抑郁症风险可能是 当发生严重的产妇或新生儿并发症时进行修改。 理清神经轴向镇痛或麻醉、母体或新生儿之间的相互关系 并发症和产后抑郁症，我们将分析住院、门诊和急诊的数据 纽约州2006至2018年的部门出院记录由医疗费用和 医疗研究和质量机构的利用项目(HCUP)。我们将使用复杂的 统计和流行病学方法，包括因果推断技术，如相互作用和调解 分析，并根据种族和民族对我们的分析进行分层。 拟议的项目可以为改善产科麻醉的可及性提供科学证据 护理，特别是对种族和少数民族妇女的护理，以减少产后抑郁症的风险 产妇心理健康结果方面的差异。

The broad, long-term objective of the proposed project is to improve maternal health outcomes by providing access to quality obstetric anesthesia care during delivery hospitalization. Postpartum depression is a serious maternal health problem in the United States, affecting one in seven parturient, especially racial and ethnic minority women. Severe postpartum pain is associated with an increased risk of postpartum depression. Pain intensity and the risk of postpartum depression could be reduced through the use of neuraxial analgesia for vaginal delivery (i.e., epidural or spinal analgesia) or neuraxial anesthesia for cesarean delivery. Neuraxial analgesic or anesthetic techniques are the most effective evidence-based interventions to relieve postpartum pain but are underutilized in racial and ethnic minority women. Results of previous research are inconsistent on the association between the use of neuraxial analgesia or anesthesia for childbirth and the risk of postpartum depression. Inconsistency of previous research might be due to the non-consideration of newly identified strong risk factors for postpartum depression, when estimating the risk of postpartum depression. Indeed, serious maternal complications during delivery hospitalizations (i.e., severe maternal morbidity) and severe neonatal complications (e.g., preterm birth, stillbirth) have been recently linked to a significantly increased risk of PPD. The hypothesized decreased risk of postpartum depression associated with neuraxial analgesia or anesthesia for childbirth could be modified when severe maternal or neonatal complications occur. To untangle the interrelationships among neuraxial analgesia or anesthesia, maternal or neonatal complications, and postpartum depression, we will analyze data from inpatient, outpatient, and emergency department discharge records in New York State from 2006 to 2018 provided by the Healthcare Cost and Utilization Project (HCUP) of the Agency for Healthcare Research and Quality. We will use sophisticated statistical and epidemiologic methods, including causal inference techniques such as interaction and mediation analysis, and stratify our analyses according to race and ethnicity. The proposed project could provide scientific evidence for improving access to obstetric anesthesia care, especially for racial and ethnic minority women, to reduce the risk of postpartum depression and disparities in maternal mental health outcomes.