Obstetric Anesthesia and Postpartum Depression

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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.