Trajectories of pain during pregnancy predict symptoms of postpartum depression

Association Between Pain During Pregnancy and Postpartum Depressive Symptoms in Adolescent and Adult Women

ISSUE

Postpartum depressive symptoms may be more prevalent and/or severe in vulnerable populations.

BACKGROUND

Postpartum depression represents a serious mental health problem associated with maternal suffering. Despite the relevance and clinical implications of investigating pain during pregnancy and the association with postpartum depression, there is limited research on this topic.

AIM

We evaluated the association between pain during pregnancy and postpartum depression symptoms in adolescent and adult women.

METHODS

This study included 86 pregnant women (42 adolescents aged 13 to 18 years and 44 adults aged 23 to 28 years) from Trairi region, Northeastern Brazil. The evaluation of pain intensity and postpartum depression symptoms was conducted using the validated instruments of the Pelvic Pain Assessment Form and Edinburgh Postnatal Depression Scale (EPDS), respectively. Mann-Whitney and Kruskal-Wallis tests compared depressive symptoms in relation to pain status.

FINDINGS

Overall, pregnant women reporting moderate to intense pain presented more depressive symptoms, with emphasis to "deep pain with intercourse" (p = .09), "burning vaginal pain after sex" (p = .01), "pelvic pain lasting hours or days after intercourse" (p = .06), and "pain with urination" (p = .09). When stratified by age group, significant associations were found only for the adolescents.

DISCUSSION

Our results suggest that women reporting pain in different daily situations have higher EPDS scores.

CONCLUSION

Pain during pregnancy is associated with postpartum depression symptoms, mainly among adolescents. Adequate screening and pain management during pregnancy may improve women's quality of life.

Epidural injection of hydromorphone for postoperative pain after episiotomy: a randomized controlled trial

Perineal incision resulting in post-partum pain and impact on puerperal life was the focus of our study. We recruited postpartum mothers who had undergone vaginal delivery to receive labor analgesia and episiotomy with an epidural injection of 0.5 mg hydromorphone to assess the therapeutic effects of postpartum analgesia. The participants were randomly allocated into two groups: the control group (Group NS) received an epidural injection of an equal amount of saline, while the study group (Group HY) received an epidural injection of 0.5 mg hydromorphone. We collected relevant data from electronic medical records to compare the differences between the two groups. The intervention group demonstrated lower pain scores at 4, 8, 12, 16, and 24 h compared to the control group (p < 0.001). Additionally, a higher number of patients in the control group required pain medication (7 (15.9%) compared to 2 (4.7%)). The time to first analgesia request in group NS was earlier than that in group HY (8.94 ± 1.27 h compared to 16.96 ± 3.38 h). The study group experienced higher rates of vomiting (P = 0.002) and itching (P < 0.001). However, there were no differences between the two groups in terms of urinary retention, dyskinesia, respiratory depression, dizziness, or neonatal feeding. The epidural injection of 0.5 mg hydromorphone proved to be effective in alleviating pain caused by maternal episiotomy and did not negatively affect neonatal feeding.Clinical trial registration: http://www.chictr.org.cn/usercenter.aspx identifier: ChiCTR2200064687.

Investigating Factors Associated with the Development of Postnatal Depression After Cesarean Delivery: A Validation Cohort Study

Purpose

This study aimed to validate a proposed association model previously published to determine the clinical relevance of pre-operative determinants in the development of PND after Cesarean delivery (CD).

Patients and Methods

Parturients undergoing elective CD under neuraxial anesthesia were recruited for a prospective cohort study between Oct 2021 and Oct 2022 at KK Women's and Children's Hospital, Singapore. Predelivery pain, psychological and mechanical temporal summation, and demographic data were recorded. A follow-up survey was conducted at 6 to 10 weeks after CD. The primary outcome was the incidence of PND, defined as an Edinburgh Postnatal Depression Scale (EPDS) score ≥ 10.

Results

A total of 180 patients were recruited for validation. PND 6 to 10 weeks post-delivery occurred in 18.9% of recruited parturients. Multivariate regression analyses showed that higher pre-operative CSI scores (p=0.0156), higher anxiety levels about upcoming surgery (p=0.0429), increased pre-operative pain scores on movement (p=0.0110), and higher pre-operative HADS subscale scores on anxiety (p=0.0041) were independently associated with the development of PND weeks post-CD. Lower anticipation of pain medication needs (p=0.0038) was independently associated with the development of PND post-CD. The area under curve (AUC) of this multivariable model (training cohort), internal cross validation (training cohort) and external cross validation (validation cohort) were 0.818 (95% CI, 0.746 to 0.889), 0.785 (95% CI, 0.707 to 0.864) and 0.604 (95% CI, 0.497 to 0.710) respectively.

Conclusion

The proposed model performed well in a local population. Further refinement is necessary to test the proposed model in populations with social and cultural differences.

Persistent Postpartum Pain - A Somatic and Psychologic Perfect Storm

Persistent postpartum pain is common and has a complex etiology. It has both somatic and psychosocial provoking factors and has both functional and psychological ramifications following childbirth. Pain that limits the functional capacity of a person who has the daunting task to take care of all the demands of managing a growing newborn and infant can have debilitating consequences for several people simultaneously. We will review the incidence of persistent postpartum pain, analyze the risk factors, and discuss obstetric, anesthetic, and psychological tools for prevention and management. Based on the current knowledge, early antenatal screening and management is described as the most likely measure to identify patients at risk for persistent postpartum pain. Such antenatal management should be based on the close collaboration between obstetricians, anesthesiologists, and psychologists to tailor peripartum pain management and psychological support-based individual needs.

Trajectories and Predictors of Symptoms of Depression in Chinese Women From Early Pregnancy to the Early Postpartum Period

OBJECTIVE

To explore the trajectories and predictors of symptoms of depression in Chinese women from early pregnancy to 3 months after birth.

DESIGN

Prospective cohort study.

SETTING

Several maternal and child health care institutions and obstetric departments of general hospitals in Beijing, Jiangsu, Hunan, Sichuan, Shandong, Guangdong, and Shanxi provinces in China.

PARTICIPANTS

Chinese women (N = 667) during pregnancy and the postpartum period.

METHODS

From August 2019 to June 2020, participants from several tertiary hospitals in China who completed at least three measurements during early pregnancy to 3 months after birth (from time point 1 to time point 5) were included for data analysis. We used the self-administered basic information questionnaire and the Edinburgh Postnatal Depression Scale for follow-up. We used Mplus version 8.3 to construct the growth mixture modeling and SPSS version 25.0 to carry out logistic regression analysis.

RESULTS

We found three potential trajectories of symptoms of depression during pregnancy and the postpartum period: the down-then-up healthy group (Class 1, 68.5%), steady-growth moderate-risk group (Class 2, 27.5%), and up-then-down high-risk group (Class 3, 4.0%). Multinomial logistic regression analysis showed that being pregnant for the first time, being a company employee, being less satisfied with the living environment, and the occurrence of negative life events were significant predictors of the Class 2 trajectory, whereas younger age, being less satisfied with food, and the occurrence of negative life events were predictors of the Class 3 trajectory.

CONCLUSION

The trajectories of symptoms of depression during pregnancy and the postpartum period among Chinese women showed significant group heterogeneity. The trajectory categories were influenced not only by demographics and pregnancy-related factors but also by maternal subjective feelings.

Maternal pain during pregnancy dose-dependently predicts postpartum depression: The Japan Environment and Children's Study

BACKGROUND

Postpartum depression (PPD) affects women during the first year after delivery. This study investigated the association between prenatal pain (maternal pain during pregnancy) and PPD.

METHODS

Data were analyzed from the Japan Environment and Children's Study (JECS), a nationwide prospective birth cohort study. Information on prenatal pain was collected twice during pregnancy through self-administered questionnaires. PPD symptoms were assessed using the Edinburgh Postnatal Depression Scale at one month postpartum. Poisson regression analyses were performed to investigate the association between prenatal pain and PPD, with other putative risk factors adjusted in the model.

RESULTS

Among 84,801 study subjects, 11,535 (13.6%) were screened as positive for PPD. In the present study, the occurrence of prenatal pain was 69.6 and 84.0% at the first trimester and the second/third trimester, respectively. A positive relationship between any degree of pain and PPD in both the first and the second/third trimester was observed. A significant linear dose-dependent association was also found (Ptrend < 0.001) when the subjects were divided by the severity of pain. Using participants without any pain at either point as a reference, those with persistent pain both at the first and the second/third trimesters showed the highest risk for PPD: aRR = 1.95 (95%CI: 1.76-2.15; p < 0.001).

LIMITATIONS

No detailed information regarding the type or site of prenatal pain was available in the JECS questionnaires, neither did data concerning delivery and postpartum pain.

CONCLUSIONS

The study results suggest that prenatal pain is a dose-dependent risk factor for the development of PPD.