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产妇保健成果： 在分娩住院期间提供优质产科麻醉护理。 在美国，产后抑郁症是一个严重的产妇健康问题， 7名产妇，特别是少数民族妇女。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可能是 通过使用阴道分娩的神经轴镇痛来减少（即，硬膜外或脊髓镇痛）或 剖宫产术中的轴索麻醉神经轴镇痛或麻醉技术是最有效的 缓解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 妇女以往的研究结果不一致的使用neuraxial之间的关联 分娩镇痛或麻醉和产后抑郁症的风险。与先前的不一致 研究可能是由于没有考虑新发现的产后严重危险因素， 抑郁症，当估计产后抑郁症的风险。事实上，严重的产妇并发症， 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 分娩，死产）最近与PPD风险显著增加有关。假设的减少 与分娩时的神经轴镇痛或麻醉相关的产后抑郁风险可能是 当发生严重的产妇或新生儿并发症时进行修改。 解开神经轴镇痛或麻醉，产妇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 医疗成本提供的2006年至2018年纽约州的出院记录， 医疗保健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，包括因果推理技术，如互动和调解 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提供科学依据 护理，特别是对少数种族和民族妇女的护理，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.