General anesthesia in cesarean deliveries increases odds of postpartum depression by 54%

Summary: Women who are given a general anesthetic during a cesarean section delivery have a 54% higher risk of developing postpartum depression. The odds of suicidal thoughts or self-inflicting injury increased to 91%. The study points to a potential protective effect on mental health for regional anesthesia during cesarean section compared to general anesthetic.

Source: Columbia University

A new study shows that having general anesthesia in cesarean delivery is linked with significantly increased odds of severe postpartum depression requiring hospitalization, thoughts of suicide or self-inflicted injury. The findings from research conducted at Columbia University Mailman School of Public Health and Columbia University Irving Medical Center are published online in Anesthesia and Analgesia.

The study is the first to examine the effect of the mode of anesthesia for cesarean delivery on the risk of postpartum depression (PPD) and the possible protective effect of having regional anesthesia for cesarean delivery on maternal mental health compared with general anesthesia.

Postpartum depression in the U.S. has increased seven-fold in the past 15 years, and it now affects up to 1 in 7 women, yielding about 550,000 annual new cases.

“General anesthesia for cesarean delivery may increase the risk of postpartum depression because it delays the initiation of mother to infant skin-to-skin interaction and breastfeeding, and often results in more acute and persistent postpartum pain,” said Jean Guglielminotti, MD, PhD, in the Department of Anesthesiology and the Department of Epidemiology at Columbia Mailman School, and first author. “These situations are often coupled with a new mother’s dissatisfaction with anesthesia in general, and can lead to negative mental health outcomes.”

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Postpartum depression in the U.S. has increased seven-fold in the past 15 years, and it now affects up to 1 in 7 women, yielding about 550,000 annual new cases. Image is in the public domain.

The researchers used hospital discharge records of cesarean delivery cases performed in New York State hospitals between 2006 and 2013. Of the 428,204 cesarean delivery cases included in the analysis, 34,356 or 8 percent of the women had general anesthesia. Severe postpartum depression requiring hospitalization was recorded in 1,158 women (3 percent); of which 60 percent were identified during readmission to the hospital, after approximately 164 days post-discharge. Compared to regional anesthesia in cesarean delivery, general anesthesia was associated with a 54 percent increased odds of postpartum depression. The odds increased to 91 percent for suicidal thoughts or self-inflicting injury.

While general anesthesia is associated with the shortest decision-to-delivery interval in case of an emergency delivery, there is no evidence that it improves outcomes for the baby but there is mounting evidence that there can be adverse consequences for mothers, noted Dr. Guglielminotti.

“Our findings underscore the need to avoid using general anesthesia for cesarean delivery whenever possible, and to provide mental health screening, counseling, and other follow-up services to obstetric patients exposed to general anesthesia,” said co-author Guohua Li, MD, DrPH, Finster Professor of Epidemiology and Anesthesiology.

Funding: This study was supported by the Agency for Healthcare Research and Quality (1 R03 HS025787-01).

About this neuroscience research article

Source:
Columbia University
Media Contacts:
Stephanie Berger – Columbia University
Image Source:
The image is in the public domain.

Original Research: Closed access
“Exposure to General Anesthesia for Cesarean Delivery and Odds of Severe Postpartum Depression Requiring Hospitalization”. Guglielminotti, Jean MD, PhD; Li, Guohua MD, Dr PH.
Anesthesia & Analgesia doi:10.1213/ANE.0000000000004663.

Abstract

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

BACKGROUND:
Previous research suggests that, compared with regional anesthesia, general anesthesia is associated with increased odds of postoperative depressive disorders. No study has specifically evaluated the possible protective effect of neuraxial anesthesia for cesarean delivery on maternal mental health compared with general anesthesia. This exploratory study was designed to test the hypothesis that general anesthesia for cesarean delivery is associated with increased odds of severe postpartum depression (PPD) requiring hospitalization compared with neuraxial anesthesia.

METHODS:
This retrospective cohort study included cesarean delivery cases performed in New York State hospitals between January 2006 and December 2013. Exclusion criteria were as follows: (1) having >1 cesarean delivery during the study period; (2) residing outside of New York State; (3) having a general anesthetic for other surgery or delivery in the previous year or in the year after the index case. The primary outcome was the occurrence of PPD, and the secondary outcomes were: (1) the composite of suicidal ideation or self-inflicted injury (ie, suicidality); (2) anxiety disorders; and (3) posttraumatic stress disorders (PTSD). Primary and secondary outcomes were identified during the delivery hospitalization and up to 1 year after delivery. Adjusted odds ratios (aORs) and 95% confidence interval (CI) of adverse psychiatric outcomes associated with general anesthesia were estimated using propensity score matching.

RESULTS:
Of the 428,204 cesarean delivery cases included, 34,356 had general anesthesia (8.0%). Severe PPD requiring hospitalization was recorded in 1158 women (2.7/1000; 95% CI, 2.5–2.9); of them, 60% were identified during readmission, with a median of 164 days after discharge. Relative to neuraxial anesthesia, general anesthesia in cesarean delivery was associated with a 54% increased odds of PPD (aOR, 1.54; 95% CI, 1.21–1.95) and a 91% increased odds of suicidal ideation or self-inflicted injury (aOR, 1.91; 95% CI, 1.12–3.25). There was insufficient evidence in these data that general anesthesia was associated with anxiety disorders (aOR, 1.37; 95% CI, 0.97–1.95) or PTSD (aOR, 1.50; 95% CI, 0.50–4.47).

CONCLUSIONS:
General anesthesia for cesarean delivery is associated with increased odds of severe PPD requiring hospitalization, suicidal ideation, and self-inflicted injury. If confirmed, these preliminary findings underscore the need to avoid the use of general anesthesia for cesarean delivery whenever possible, and to provide mental health screening, counseling, and other follow-up services to obstetric patients exposed to general anesthesia.

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