Association of General Anesthesia and Neuraxial Anesthesia in Caesarean Section with Maternal Postpartum Depression: A Retrospective Nationwide Population-Based Cohort Study.
Level 3 - non-randomized controlled study
Retrospective propensity score-matched cohort study using nationwide health registry data.
PubMed 35743754 · doi:10.3390/jpm12060970
What was done
Researchers conducted a retrospective cohort study using three linked nationwide databases in Taiwan (National Health Insurance Research Database, National Birth Reporting Database, and National Death Index Database). Using propensity score matching on baseline depressive disorders, maternal demographics, delivery status, infant health, maternal comorbidities, and partner age, they compared three groups of 15,706 women each (total n = 47,118): vaginal births, cesarean sections (CS) under general anesthesia (GA), and CS under neuraxial anesthesia (NA). Conditional logistic regression was used to estimate odds ratios for postpartum depression outcomes, including clinical depression, sleep disorders, and prescription of hypnotics or antidepressants.
What was found
The prevalence of combined postpartum depressive disorders was 26.66% in natural births, 36.30% in CS with NA, and 43.87% in CS with GA. Postpartum use of hypnotics or antidepressants occurred in 21.70%, 31.84%, and 39.77% of women, respectively. Compared with natural births, CS with GA was associated with significantly higher odds of combined depressive disorders (aOR 2.15, 95% CI 2.05–2.25), clinical depression (aOR 1.10, 95% CI 1.00–1.21), and hypnotic/antidepressant use (aOR 2.38, 95% CI 2.27–2.50), but not sleep disorders alone (aOR 1.03, 95% CI 0.96–1.11). Women undergoing CS with GA also had higher depressive disorder risks and medication needs than those receiving CS with NA.
Why it matters
This study provides large-scale population evidence that general anesthesia during cesarean delivery is associated with an increased risk of postpartum psychiatric morbidity and psychotropic drug use compared to neuraxial anesthesia. It supports prioritizing neuraxial anesthesia when clinically feasible.
Limits
The retrospective observational design cannot fully rule out residual confounding, such as the acute emergency severity or obstetric indications that necessitated GA instead of NA. Outcomes relied on administrative diagnostic and prescription billing codes rather than structured psychiatric clinical assessments, and non-pharmacologic postpartum mental health variables were not captured.
Cited by
- context Approximately 45% to 50% of women who receive general anesthesia for a C-section develop postpartum depression, compared to roughly 28% to 30% with an epidural and 10% to 12% with unmedicated birth.