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Anesthesia and analgesia 分娩时硬膜外镇痛与产后抑郁症状: 一项基于人群的纵向队列研究。

影响因子：6.627 DOI：10.1213/ANE.0000000000004292

作者： Eckerdal P,Kollia N,Karlsson L,Skoog-Svanberg A,Wikström AK,Högberg U,Skalkidou A 发表时间：2020-07-10 16:00:36

from：《ANESTHESIA AND ANALGESIA》

keywords： Eckerdal PKollia NKarlsson LSkoog-Svanberg AWikström AKHögberg USkalkidou A

关键词：

Abstract

BACKGROUND:Severe pain has been linked to depression, which raises the question of whether epidural analgesia (EDA) during childbirth is associated with a reduced risk of postpartum depression (PPD). This association has been explored previously, but the studies were restricted by small sample sizes and the inability to control for relevant confounders. This study aimed to investigate the association between the administration of EDA and the development of PPD after adjusting for sociodemographic, psychosocial, and obstetric variables. METHODS:Data were retrieved from the Biology, Affect, Stress, Imaging and Cognition (BASIC) project (2009-2017), a population-based longitudinal cohort study of pregnant women conducted at Uppsala University Hospital, Sweden. The outcome was PPD at 6 weeks postpartum, defined as a score of ≥12 points on the Edinburgh Postnatal Depression Scale (EPDS). Information was collected through medical records and self-reported web-based questionnaires during pregnancy and 6 weeks after childbirth. Only primiparous women with spontaneous start of childbirth were included (n = 1503). The association between EDA and PPD was examined in multivariable logistic regression models, adjusting for sociodemographic, psychosocial, and obstetric variables. Results are presented as odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS:Of the 1503 women included in the analysis, 800 (53%) reported use of EDA during childbirth. PPD at 6 weeks postpartum was present in 193 (13%) women. EDA was not associated with higher odds of PPD at 6 weeks postpartum after adjusting for suspected confounders (age, fear of childbirth, antenatal depressive symptoms; adjusted OR [aOR] = 1.22; 95% CI, 0.87-1.72). CONCLUSIONS:EDA was not associated with the risk of PPD at 6 weeks postpartum after adjusting for sociodemographic, psychosocial, and obstetric variables. However, these findings do not preclude a potential association between PPD and childbirth pain or other aspects of EDA that were not assessed in this study.

摘要

背景: 严重的疼痛与抑郁有关，这就提出了一个问题，分娩时硬膜外镇痛 (EDA) 是否与产后抑郁 (PPD) 风险降低有关。这种关联以前已经被探索过，但是研究受到样本量小和无法控制相关混杂因素的限制。本研究旨在调整社会人口学、心理社会和产科变量后，探讨EDA给药与PPD发展的相关性。方法: 从生物学，情感，压力，影像学和认知 (基础) 项目 (2009-2017) 中检索数据，瑞典乌普萨拉大学医院进行的一项基于人群的孕妇纵向队列研究。结局为产后 6 周的PPD，定义为爱丁堡产后抑郁量表 (EPDS) 评分 ≥ 12 分。在怀孕期间和分娩后 6 周，通过病历和自我报告的网络问卷收集信息。仅纳入自然开始分娩的初产妇 (n = 1503)。在多变量logistic回归模型中检查EDA和PPD之间的关联，校正社会人口学、社会心理和产科变量。结果以比值比 (ORs) 表示，95% 置信区间 (CIs)。结果: 在纳入分析的 1503 例妇女中，800 例 (53%) 报告在分娩时使用EDA。193 (13%) 的妇女在产后 6 周出现PPD。在校正可疑混杂因素 (年龄、对分娩的恐惧、产前抑郁症状; 校正OR [aOR] = 1.22; 95% CI，0.87-1.72)。结论: 在调整社会人口学、心理社会和产科变量后，EDA与产后 6 周PPD的风险无关。然而，这些发现并不排除PPD与分娩疼痛或本研究中未评估的EDA的其他方面之间的潜在关联。

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