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TOPLINE:

Neuraxial anesthesia during cesarean delivery was associated with a lower risk for postpartum depression than general anesthesia.

METHODOLOGY:

• Researchers conducted a retrospective cohort study using data from the South Korean National Health Insurance Service database to assess the link between the type of anesthesia and the risk for postpartum depression.
• They included 890,801 mothers who had a first-time cesarean delivery between 2015 and 2023. During these deliveries, 555,373 (62.3%) women received neuraxial anesthesia (spinal, epidural, or combined spinal-epidural anesthesia) and 335,428 (37.7%) received general anesthesia.
• The primary endpoint was newly diagnosed postpartum depression occurring within a year following cesarean delivery, identified using diagnostic codes for depressive episode and recurrent depressive disorder.
• The analysis used 1:1 propensity score matching, with 302,511 mothers included in each anesthesia group.

TAKEAWAY:

• In the matched cohort, neuraxial anesthesia was associated with a lower risk for postpartum depression than general anesthesia (hazard ratio [HR], 0.88; P < .001). The association remained significant after adjusting for confounding factors (adjusted HR [aHR], 0.83; P < .001).
• Histories of psychiatric conditions, particularly schizophrenia (aHR, 2.93; P < .001), bipolar disorder (aHR, 2.25; P < .001), and sleep disorders (aHR, 2.23; P < .001), before pregnancy were the strongest clinical predictors of postpartum depression.
• Recipients of Medical Aid and mothers with infants born extremely preterm (< 28 weeks) had a higher risk for postpartum depression (aHR, 2.77 and aHR, 1.35; P < .001 for both).
• Neuraxial anesthesia showed clinical advantages over general anesthesia across all maternal age groups. The protective association of neuraxial anesthesia was similar in mothers with or without a history of psychiatric conditions before pregnancy.

IN PRACTICE:

“[The] findings suggest that the choice of anesthetic technique is a modifiable perioperative factor that can influence long-term maternal mental health,” the researchers reported. “Given the increasing global incidence of both cesarean sections and maternal mental health disorders, our findings suggest that [neuraxial anesthesia] should be prioritized as the preferred anesthetic technique whenever clinically feasible to optimize long-term maternal psychological well-being,” they added.

SOURCE:

The study was led by Tak Kyu Oh, MD, of the Department of Anesthesiology and Pain Medicine at Seoul National University Bundang Hospital in Seongnam, South Korea. It was published online on June 3 in Anaesthesia Critical Care & Pain Medicine.

LIMITATIONS:

Information on the severity of depressive symptoms or psychosocial and behavioral variables was lacking. The diagnosis of postpartum depression based on diagnostic codes from insurance claims may lead to an underestimation of the actual incidence. The researchers could not consider specific anesthetic dosages, the total duration of anesthesia, or the occurrence of complications during surgery, all of which could independently affect postoperative psychological recovery. 

DISCLOSURES:

No funding sources were disclosed for this study. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.