Increased chances of severe severe postpartum depression, with the possible need of hospitalisation, and thoughts of self-inflicted injury or suicide, is linked to the administration of general anaesthesia during cesarean delivery, a study claims.
The study by researchers from the Columbia University Irving Medical Center and Columbia University Mailman School of Public Health was published in the journal of the International Anesthesia Research Society, Anesthesia and Analgesia.
First to examine the effect
The study is the first to examine the effect of the mode of anaesthesia for cesarean delivery on the risk of postpartum depression (PPD) and the possible protective effect of having regional anaesthesia for cesarean delivery on maternal mental health compared with general anaesthesia. Postpartum depression in the US has increased seven-fold in the past 15 years, and it now affects up to 1 in 7 women, yielding about 550,000 annual new cases.
"General anaesthesia for cesarean delivery may increase the risk of postpartum depression because it delays the initiation of mother to infant skin-to-skin interaction and breastfeeding, and often results in more acute and persistent postpartum pain," said Jean Guglielminotti, MD, PhD, in the Department of Anesthesiology and the Department of Epidemiology at Columbia Mailman School, and first author. "These situations are often coupled with a new mother's dissatisfaction with anaesthesia in general, and can lead to negative mental health outcomes."
Used hospital discharge records
The researchers used hospital discharge records of cesarean delivery cases performed in New York State hospitals between 2006 and 2013. Of the 428,204 cesarean delivery cases included in the analysis, 34,356 or 8 percent of the women had general anaesthesia. Severe postpartum depression requiring hospitalization was recorded in 1,158 women (3 percent); of which 60 percent were identified during readmission to the hospital, after approximately 164 days post-discharge.
Compared to regional anaesthesia in cesarean delivery, general anaesthesia was associated with a 54 percent increased odds of postpartum depression. The odds increased to 91 percent for suicidal thoughts or self-inflicting injury.
Mounting evidence
While general anaesthesia is associated with the shortest decision-to-delivery interval in case of an emergency delivery, there is no evidence that it improves outcomes for the baby but there is mounting evidence that there can be adverse consequences for mothers, noted Dr Guglielminotti.
"Our findings underscore the need to avoid using general anaesthesia for cesarean delivery whenever possible, and to provide mental health screening, counselling, and other follow-up services to obstetric patients exposed to general anaesthesia," said co-author Guohua Li, MD, DrPH, Finster Professor of Epidemiology and Anesthesiology.
(With inputs from agencies)
