Pharmacologic labour analgesia and its relationship to postpartum psychiatric disorders: a scoping review

Allana Munro, Hilary MacCormick, Atul Sabharwal, Ronald B George, Allana Munro, Hilary MacCormick, Atul Sabharwal, Ronald B George

Abstract

Purpose: This scoping review aimed to summarize the current literature on postpartum psychiatric disorders (e.g., postpartum depression, postpartum anxiety, postpartum post-traumatic stress disorder) and the possible relationship of these disorders to the use of pharmacologic labour analgesia (e.g., epidural analgesia, nitrous oxide, parenteral opioids) to identify knowledge gaps that may aid in the planning of future research.

Sources: PubMed, PsycINFO, CINAHL, and EMBASE were searched from inception to November 9, 2018 for studies that included both labour analgesia and the postpartum psychiatric disorders specified above.

Principal findings: Two reviewers assessed the studies and extracted the data. Of the 990 identified citations, 17 studies were included for analysis. Existing studies have small sample sizes and are observational cohorts in design. Patient psychiatric risk factors, method of delivery, and type of labour analgesia received were inconsistent among studies. Most studies relied on screening tests for diagnosing postpartum psychiatric illness and did not assess the impact of labour analgesia on postpartum psychiatric illness as the primary study objective.

Conclusions: Future studies should correlate screen-positive findings with clinical diagnosis; consider adjusting the timing of screening to include the antepartum period, early postpartum, and late postpartum periods; and consider the degree of labour pain relief and the specific pharmacologic labour analgesia used when evaluating postpartum psychiatric disorders.

References

    1. Munk-Olsen T, Agerbo E. Does childbirth cause psychiatric disorders? A population-based study paralleling a natural experiment. Epidemiology 2015; 26: 79-84.
    1. Munk-Olsen T, Laursen TM, Pedersen CB, Mors O, Mortensen PB. New parents and mental disorders: a population-based register study. JAMA 2006; 296: 2582-9.
    1. Johannsen BM, Larsen JT, Laursen TM, Bergink V, Meltzer-Brody S, Munk-Olsen T. All-cause mortality in women with severe postpartum psychiatric disorders. Am J Psychiatr 2016; 173: 635-42.
    1. Knight M, Nair M, Tuffnell D, et al. Saving Lives, Improving Mothers’ Care: Surveillance of maternal deaths in the UK 2012–14 and lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009–14. Oxford, UK: University of Oxford; 2016. Available from URL: (accessed December 2019).
    1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Washington, DC; 2013.
    1. Eisenach JC, Pan PH, Smiley R, Lavand’homme P, Landau R, Houle TT. Severity of acute pain after childbirth, but not type of delivery, predicts persistent pain and postpartum depression. Pain 2008; 140: 87-94.
    1. Pearson R, Evans J, Kounali D, et al. Maternal depression during pregnancy and the postnatal period: rRisks and possible mechanisms for offspring depression at 18 years. JAMA Psychiatry 2013; 70: 1312-9.
    1. Ding T, Wang D, Qu Y, Chen Q, Zhu S. Epidural labor analgesia is associated with a decreased risk of postpartum depression: a prospective cohort study. Anesth Analg 2014; 119: 383-92.
    1. Hiltunen P, Raudaskoski T, Ebeling H, Moilanen I. Does pain relief during delivery decrease the risk of postnatal depression? Acta Obstet Gynecol Scand 2004; 83: 257-61.
    1. Lim G, Farrell LM, Facco FL, Gold MS, Wasan AD. Labor analgesia as a predictor for reduced postpartum depression scores: a retrospective observational study. Anesth Analg 2018; 126: 1598-605.
    1. Nahirney M, Metcalfe A, Chaput KH. Administration of epidural labor analgesia is not associated with a decreased risk of postpartum depression in an urban Canadian population of mothers: a secondary analysis of prospective cohort data. Local Reg Anesth 2017; 10: 99-104.
    1. Adewuya AO. The maternity blues in Western Nigerian women: prevalence and risk factors. Am J Obstet Gynecol 2005; 193: 1522-5.
    1. Zivoder I, Martic-Biocina S, Veronek J, Ursulin-Trstenjak N, Sajko M, Paukovic M. Mental disorders/difficulties in the postpartum period. Psychiatr Danub 2019; 31(Suppl 3): 338-44.
    1. Boudou M, Teissèdre F, Walburg V, Chabrol H. Association between the intensity of childbirth pain and the intensity of postpartum blues (French). Encephale 2007; 33: 805-10.
    1. Degner D. Differentiating between “baby blues,” severe depression, and psychosis. BMJ 2017; DOI: .
    1. Matthey S, Barnett B, Howie P, Kavanagh DJ. Diagnosing postpartum depression in mothers and fathers: whatever happened to anxiety? J Affect Disord 2003; 74: 139-47.
    1. Reck C, Struben K, Backenstrass M, et al. Prevalence, onset and comorbidity of postpartum anxiety and depressive disorders. Acta Psychiatr Scand 2008; 118: 459-68.
    1. Wisner KL, Sit DK, McShea MC, et al. Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings. JAMA Psychiatry 2013; 70: 490-8.
    1. Grekin R, O’Hara MW. Prevalence and risk factors of postpartum posttraumatic stress disorder: a meta-analysis. Clin Psychol Rev 2014; 34: 389-401.
    1. Moher D, Liberati A, Tetzlaff J, Altman D, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009; .
    1. Riazanova OV, Alexandrovich YS, Ioscovich AM. The relationship between labor pain management, cortisol level and risk of postpartum depression development: a prospective nonrandomized observational monocentric trial. Rom J Anaesth Intensive Care 2018; 25: 123-30.
    1. Zanardo V, Volpe F, Parotto M, Giiberti L, Selmin A, Straface G. Nitrous oxide labor analgesia and pain relief memory in breastfeeding women. J Matern Fetal Neonatal Med 2017; 24: 3243-8.
    1. Wu YM, McArthur E, Dixon S, Dirk JS, Welk BK. Association between intrapartum epidural use and maternal postpartum depression presenting for medical care: a population-based, matched cohort study. Int J Obstet Anesth 2018; 35: 10-6.
    1. Ferber SG, Granot M, Zimmer EZ. Catastrophizing labor pain compromises later maternity adjustments. Am J Obstet Gynecol 2005; 192: 826-31.
    1. Gürber S, Baumeler L, Grob A, Surbek D, Stadlmayr W. Antenatal depressive symptoms and subjective birth experience in association with postpartum depressive symptoms and acute stress reaction in mothers and fathers: a longitudinal path analysis. Eur J Obstet Gynecol Reprod Biol 2017; 215: 68-74.
    1. Lyons S. A prospective study of post traumatic stress symptoms 1 month following childbirth in a group of 42 first-time mothers. J Reprod Infant Psychol 1998; 16: 91-105.
    1. Orbach-Zinger S, Landau R, Harousch A, et al. The relationship between women’s intention to request a labor epidural analgesia, actually delivering with labor epidural analgesia, and postpartum depression at 6 weeks: a prospective observational study. Anesth Analg 2018; 126: 1590-7.
    1. Séjourne N, De la Hammaide M, Moncassin A, O’Reilly A, Chabrol H. Study of the relations between the pain of childbirth and postpartum, and depressive and traumatic symptoms (French). Gynecol Obstet Fertil Senol 2018; 46: 658-63.
    1. Suhitharan T, Pham TP, Chen H, et al. Investigating analgesic and psychological factors associated with risk of postpartum depression development: a case-control study. Neuropsychiatr Dis Treat 2016; 12: 1333-9.
    1. Boudou M, Séjourne N, Chabrol H. Childbirth pain, perinatal dissociation and perinatal distress as predictors of posttraumatic stress symptoms (French). Gynecol Obstet Fertil 2007; 35: 1136-42.
    1. Gosselin P, Chabot K, Béland M, Goulet-Gervais L, Morin AJ. Fear of childbirth among nulliparous women: relations with pain during delivery, post-traumatic stress symptoms, and postpartum depressive symptoms (French). Encephale 2016; 42: 191-6.
    1. Floris L, Irion O, Courvoisier D. Influence of obstetrical events on satisfaction and anxiety during childbirth: a prospective longitudinal study. Psychol Health Med 2017; 22: 969-77.
    1. Kozinszky Z, Dudas RB. Validation studies of the Edinburgh Postnatal Depression Scale for the antenatal period. J Affect Disord 2015; 176: 95-105.
    1. Myers ER, Aubuchon-Endsley N, Bastian LA, et al. Efficacy and Safety of Screening for Postpartum Depression. Rockville (MD): Agency for Healthcare Research and Quality (US); 2013; No.: 13-EHC064-EF.
    1. Harris B, Huckle P, Thomas R, Johns S, Fung H. The use of rating scales to identify post-natal depression. Br J Psychiatry 1989; 154: 813-7.
    1. Toledo P, Miller ES, Wisner KL. Looking beyond the pain: can effective labor analgesia prevent the development of postpartum depression? Anesth Analg 2018; 126: 1448-50.
    1. Bassano CM, Townsend KM, Walton AC, Blomquist JL, Handa VL. The maternal childbirth experience more than a decade after delivery. Am J Obstet Gynecol 2017; 217(342): e1-8.
    1. Norhayati MN, Hazlina NH, Asrenee AR, Emilin WM. Magnitude and risk factors for postpartum symptoms: a literature review. J Affect Disord 2015; 175: 34-52.
    1. Bhusal B, Bhandari N, Chapagai M, Gavidia T. Validating the Edinburgh Postnatal Depression Scale as a screening tool for postpartum depression in Kathmandu. Nepal. Int J Ment Health Syst 2016; DOI: .
    1. Austin MP, Highet N; Expert Working Group. Mental Health Care in the Perinatal Period: Australian Clinical Practice Guideline. Melbourne: Centre of Perinatal Excellence - 2017. Available from URL: (accessed December 2019).
    1. El-Hachem C, Rohayem J, Bou Khalil R, et al. Early identification of women at risk of postpartum depression using the Edinburgh Postnatal Depression Scale (EPDS) in a sample of Lebanese women. BMC Psychiatry 2014; DOI: .

Source: PubMed

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