Maternal Depression and Opioid Use After Cesarean Delivery

To evaluate the association between self-reported history of maternal depression by treatment status and opioid use after cesarean delivery.

This was a secondary analysis of a multicenter randomized trial of individuals who underwent cesarean delivery at 12 U.S. hospitals from 2020 to 2022. We evaluated two exposures for patients with a self-reported history of depression assessed on the enrollment form: treatment (pharmacologic or nonpharmacologic therapy during pregnancy) or no treatment. The primary outcome was inpatient oral opioid use in morphine milligram equivalents (MMEs) per day from 12 hours after cesarean delivery through hospital discharge. Secondary outcomes included outpatient opioid use (MMEs of opioid prescriptions through 6 weeks postpartum) and moderate-to-severe perceived pain (score 4 or higher) and interference in daily activities (score 4 or higher) on a validated questionnaire, the BPI (Brief Pain Inventory, score 1-10) at 1 week after discharge. Multivariable modeling (quantile regression for continuous outcomes and logistic regression for binary outcomes) evaluated the association between untreated or treated depression compared with no depression and the selected outcomes.

Of 5,504 study participants, 1,507 (27.4%) had self-reported depression, of whom 663 (44.0%) were treated. Those with depression were more likely to have a chronic pain condition (19.5% untreated, 18.9% treated, and 8.5% no depression, P <.0001), to use tobacco (22.5% untreated, 18.9% treated, and 8.1% no depression, P <.0001), and to experience disordered sleep (median score [IQR] 57.9 [52.8-63.7] for untreated, 59.3 [53.8-64.2] for treated, and 55.7 [50.3-60.6] for no depression, P <.0001). In adjusted modeling, neither treated nor untreated depression was associated with inpatient postpartum MMEs. However, untreated depression was associated with higher outpatient MME use through 6 weeks postpartum (adjusted median difference 16.7 MMEs/d [95% CI, 8.9-24.5]) and higher moderate-to-severe perceived pain at 1 week after discharge. Both treated depression and untreated depression were associated with higher perceived pain interference in daily activities (adjusted odds ratio 1.44 [95% CI, 1.2-1.8] and 1.37 [95% CI, 1.1-1.7], respectively).

Self-reported history of depression, regardless of treatment status, was not associated with increased post-cesarean delivery inpatient opioid use, but untreated depression was associated with increased opioid use through 6 weeks postpartum.