#Grand Rounds

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
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

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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