Does General Anesthesia for Cesarean Increase Odds of Severe Postpartum Depression?
BACKGROUND AND PURPOSE:
Studies have looked at general vs regional anesthesia and risk for postoperative depressive disorders, but not in the context of cesarean delivery
Guglielminotti et al. (Anesthesia & Analgesia, 2020) analyzed whether general anesthesia for cesarean delivery is associated with increased risk of severe postpartum depression (PPD) vs neuraxial anesthesia
Retrospective cohort study
Women who delivered with cesarean in New York State hospitals between January 2006 and December 2013
Occurrence of PPD
The composite of suicidal ideation or self-inflicted injury (i.e. suicidality)
Posttraumatic stress disorders (PTSD)
Results adjusted for confounding | Propensity score matching used
428,204 cesarean delivery cases
General anesthesia: 8%
Severe PPD requiring hospitalization: 1158 women
General anesthesia during cesarean delivery was associated with
Increased risk for PPD: Adjusted odds ratio (aOR) 1.54 (95% CI, 1.21 to 1.95)
Increased risk for suicidal ideation or self-inflicted injury: aOR (1.91; 95% CI, 1.12 to 3.25)
The following were not found to be significantly associated with general anesthesia (insufficient evidence)
Anxiety disorders: aOR, 1.37 (95% CI, 0.97 to 1.95)
PTSD aOR, 1.50 (95% CI, 0.50 to 4.47)
The use of general anesthesia during cesarean delivery vs neuraxial anesthesia is associated with a
54% increased odds of PPD
91% increased odds of suicidal ideation or self-inflicted injury
The authors conclude that if results of this study are confirmed
General anesthesia should be limited to situations where truly necessary (current best practice)
If required, providing mental health services to exposed patients
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