Association between epidural analgesia and postpartum psychiatric disorders: A meta-analysis

Women during the postpartum period are at risk for psychiatric disorders such as postpartum depression (PPD), post-traumatic stress disorder (PTSD), and anxiety. It is controversial whether labour epidural analgesia have a protective role on PPD, PTSD, and anxiety or not. This study is a meta-analysis of previously published observational studies to investigate the association between epidural analgesia and PPD, PTSD, and anxiety.

We searched Cochran Library, PubMed, ProQuest, EMBASE, Scopus, Web of Science, PsycINFO, and MEDLINE from inception until December 2022. The outcome measures were positive screen of PPD, PTSD, and anxiety among women who received labour epidural analgesia. The Newcastle-Ottawa Scale was used to assess the quality of the observational studies. Statistical analysis was performed using Stata 17.0 software. The mean differences or odds ratios were pooled based on random effect.

We included 31 studies (12,064 women) in the review. The meta-analysis of PPD studies reported mean (standard deviation) showed no significant association between epidural analgesia and PPD (Mean Difference = 0.01; 95% Confidence Interval = -0.14 to 0.16; p-value = 0.88). The meta-analysis of PPD studies reported percentage showed no statistically significant difference in terms of the chance of depression between the exposed and non-exposed groups (Log Odds Ratio = -0.61; 95% CI = -1.48 to 0.26; p-value = 0.17). The meta-analysis of PPD studies reported OR showed indicate a lower chance of depression in the epidural group compared to the non-epidural group (Effect size = 1.01; 95% CI = 0.64 to 1.38; P-value = 0.00). In the case of PTSD, due to the heterogeneity of the tools and the methodology of the studies, it was impossible to reach a definitive conclusion and measure the studies in a meta-analysis. The meta-analysis of anxiety studies showed that no significant association between epidural analgesia and anxiety (MD = -1.36; 95% CI = -3.38 to 1.14; p-value = 0.29).

Based on the meta-analysis of observational studies, epidural analgesia for labour pain relief has no protective effect on postpartum psychiatric disorders.