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#Grand Rounds

Does General Anesthesia for Cesarean Increase Odds of Severe Postpartum Depression?

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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

METHODS:

  • Retrospective cohort study
  • Participants
    • Women who delivered with cesarean in New York State hospitals between January 2006 and December 2013
  • Primary outcome
    • Occurrence of PPD
  • Secondary outcomes
    • The composite of suicidal ideation or self-inflicted injury (i.e. suicidality)
    • Anxiety disorders
    • Posttraumatic stress disorders (PTSD)
  • Results adjusted for confounding | Propensity score matching used

RESULTS:

  • 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)

CONCLUSION:

  • 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

Learn More – Primary Sources:

Exposure to General Anesthesia for Cesarean Delivery and Odds of Severe Postpartum Depression Requiring Hospitalization

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The Four Maternal Characteristics that Predict Postpartum Depression Severity
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