Anesthesia for cesarean delivery and subsequent depression: A nationwide retrospective cohort study.
Level 3 - non-randomized controlled study
Non-randomized retrospective cohort study with propensity score matching.
PubMed 39111347 · doi:10.1016/j.jad.2024.07.147
What was done
Researchers conducted a nationwide retrospective cohort study using Taiwan's National Health Insurance Research Database (2014–2018). They evaluated women undergoing cesarean delivery under general anesthesia compared to those under neuraxial anesthesia. Following 1:4 propensity score matching, the cohort included 4,544 women in the general anesthesia group and 18,176 in the neuraxial anesthesia group to evaluate new-onset postpartum depression using Cox regression models.
What was found
Within 1 year after delivery, the rate of new-onset depression was 1.10% (50/4,488) in the general anesthesia group versus 0.86% (157/18,176) in the neuraxial anesthesia group. For depression diagnosed within 90 days of delivery, the rate was significantly higher with general anesthesia (0.51% vs. 0.30%, P = 0.031). In time-to-event analysis, general anesthesia was associated with an increased risk of depression within 90 days (HR 1.71; 95% CI, 1.05–2.79).
Why it matters
The findings identify general anesthesia for cesarean delivery as a potential risk marker for early postpartum depression, suggesting that clinical context or anesthetic mode may warrant early psychiatric screening.
Limits
The observational design cannot establish causality. Confounding by indication (such as maternal or fetal emergencies prompting general anesthesia) remains a major limitation. The analysis relied on administrative insurance diagnostic codes, which may miss subclinical or undiagnosed depression.
Cited by
- contradicts 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.