Maternal Depression and Opioid Use After Cesarean Delivery

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.