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Maternal Depression and Opioid Use After Cesarean Delivery.

Taylor L Pitt1, Trisha M Boekhoudt, Kara M Rood

  • 1Departments of Obstetrics and Gynecology, Denver Health and Hospital Authority, Denver, Colorado, The Ohio State University, Columbus, Ohio, the University of Pittsburgh, Pittsburgh, Pennsylvania, the University of Alabama at Birmingham, Birmingham, Alabama, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, Columbia University, New York, New York, Brown University Womens and Infants Hospital of Rhode Island, Providence, Rhode Island, the University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, Case Western Reserve University, Cleveland, Ohio, the University of Utah Health Sciences Center, Salt Lake City, Utah, the University of Texas Medical Branch, Galveston, and the University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston, Texas, Northwestern University, Chicago, Illinois; and the University of Pennsylvania, Philadelphia, Pennsylvania; and the George Washington University Biostatistics Center, Washington, DC.

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Maternal depression history, treated or untreated, did not increase inpatient opioid use after cesarean delivery. However, untreated depression was linked to higher outpatient opioid use up to six weeks postpartum.

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Area of Science:

  • Obstetrics and Gynecology
  • Psychiatry
  • Pain Management

Background:

  • Maternal depression is a significant concern, potentially influencing postpartum recovery and treatment adherence.
  • Opioid use following cesarean delivery requires careful management to balance pain control and reduce risks of misuse.
  • Understanding the impact of depression on postpartum pain and opioid consumption is crucial for optimizing patient care.

Purpose of the Study:

  • To investigate the association between maternal depression history, by treatment status, and opioid use after cesarean delivery.
  • To examine the relationship between depression and postpartum pain perception and functional interference.

Main Methods:

  • Secondary analysis of a multicenter randomized trial involving patients undergoing cesarean delivery.
  • Evaluation of self-reported depression history (treated vs. untreated) as exposure.
  • Primary outcome: inpatient oral opioid use (morphine milligram equivalents per day). Secondary outcomes: outpatient opioid use, perceived pain, and pain interference using the Brief Pain Inventory (BPI).

Main Results:

  • Of 5,504 participants, 27.4% reported depression, with 44.0% receiving treatment.
  • Neither treated nor untreated depression was associated with increased inpatient opioid use.
  • Untreated depression correlated with higher outpatient opioid use (16.7 MMEs/d) and increased pain at 1 week postpartum. Both depression groups reported higher pain interference.

Conclusions:

  • Maternal depression history, irrespective of treatment, did not elevate inpatient opioid consumption post-cesarean delivery.
  • Untreated maternal depression was associated with increased outpatient opioid use up to six weeks postpartum.
  • Depression, treated or untreated, was linked to greater pain interference with daily activities.