General Anesthesia Increases Postpartum Depression Odds After Cesarean Deliveries

Jean Guglielminotti, MD, PhD

New data points to general anesthesia as a major cause of increased odds of mothers developing postpartum depression (PPD) following a cesarean delivery.

Jean Guglielminotti, MD, PhD, Department of Anesthesiology, Columbia University College of Physicians and Surgeons, examined whether general anesthesia for cesarean delivery is linked with increased odds of severe postpartum depression requiring hospitalization compared to neuraxial anesthesia.

Previously, investigators found general anesthesia increases the odds of postoperative depressive disorders when compared to regional anesthesia. However, there has not been a study evaluating the possible protective effect of neuraxial anesthesia for cesarean delivery on maternal mental health compared with general anesthesia.

In the retrospective cohort study, the investigators examined cesarean delivery cases performed in New York State hospitals between January 2006 and December 2013.

The investigators used several exclusions, including patients having more than 1 cesarean delivery during the study period, residing outside of New York, and having a general anesthetic for other surgery or delivery in the previous year or in the year after the index case.

The team also sought a primary outcome of the occurrence of postpartum depression, with secondary outcomes were the composite of suicidal ideation or self-inflicted injury, anxiety disorders and post-traumatic stress disorders.

They identified the primary and secondary outcomes during the delivery hospitalization, as well as up to 1 year following delivery.

The investigators examined data from 428,204 cesarean delivery cases, including 34,356 cases involving general anesthesia. A total of 1158 women required hospitalization from severe postpartum depression (95% CI, 2.5—2.9), of which, 60% were identified during readmission with a median of 164 days following discharge.

Relative to neuraxial anesthesia, general anesthesia in cesarean delivery was linked to a 54% increased odds of postpartum depression (aOR, 1.54; 95% CI, 1.21—1.95), as well as a 91% increased odds of suicidal ideation or self-inflicted injury (aOR, 1.91; 95% CI, 1.12–3.25).

However, due to insufficiency evidence in the data, general anesthesia was linked with anxiety disorders (aOR, 1.37; 95% CI, .97—1.95) or PTSD (aOR, 1.50; 95% CI, .50–4.47).

“General anesthesia for cesarean delivery is associated with increased odds of severe PPD requiring hospitalization, suicidal ideation, and self-inflicted injury,” the authors wrote. “If confirmed, these preliminary findings underscore the need to avoid the use of general anesthesia for cesarean delivery whenever possible, and to provide mental health screening, counseling, and other follow-up services to obstetric patients exposed to general anesthesia.”

Guglielminotti said general anesthesia for cesarean deliveries could increase the risk of postpartum depression because it delays the initiation of mother to infant skin-to-skin interaction and breastfeeding, resulting in more acute and persistent postpartum pain.

He explained that these situations are usually coupled with a new mother’s dissatisfaction with anesthesia in general, leading to negative mental health outcomes.

Postpartum depression, which currently affects up to 1 in 7 women, has increased seven-fold in the US in the past 15 years. There are currently approximately 550,000 new cases of PPD annually in the US.

The study, “Exposure to General Anesthesia for Cesarean Delivery and Odds of Severe Postpartum Depression Requiring Hospitalization,” was published online in Anesthesia & Analgesia.