General anesthesia for C-section may increase risk of postpartum depression: Study
New York: The use of general anesthesia for cesarean delivery increases the risk of severe postpartum depression (PPD), self-inflicted injury, and suicidal thoughts, according to a recent study in the journal Anesthesia & Analgesia. These preliminary findings stress the need for avoiding general anesthesia for cesarean delivery whenever possible and the importance of providing mental health screening, counseling, and other required measures to the patients exposed to general anesthesia.
Previous studies have suggested general anesthesia to be associated with an increased risk of postoperative depressive disorders as compared to regional anesthesia. No study in specific has evaluated the possible protective effect of neuraxial anesthesia for cesarean delivery on maternal mental health compared with general anesthesia. The study by Jean Guglielminotti and Guohu Li from New York was designed to test the hypothesis that general anesthesia for cesarean delivery increases risk of severe PPD requiring hospitalization compared to neuraxial anesthesia.
The study included the 428,204 cases of cesarean delivery performed in New York State hospitals between January 2006 and December 2013. Patients with the following criteria were excluded 1) having more than 1 cesarean delivery during the study period; 2) having a general anesthetic for other surgery or delivery in the previous year or in the year after the index case; 3) residing outside of New York State.
The primary outcome was PPD occurrence. Secondary outcomes include suicidal ideation, self-inflicted injury, anxiety disorders, and posttraumatic stress disorders. The outcomes were identified during the delivery hospitalization and up to 1 year after delivery.
Key findings of the study include:
- Of the 428,204 cesarean delivery cases included, 8% had general anesthesia (8.0%).
- Severe PPD requiring hospitalization was recorded in 1158 women (2.7/1000); of them, 60% were identified during readmission, with a median of 164 days after discharge.
- Relative to neuraxial anesthesia, general anesthesia in cesarean delivery was associated with a 54% increased odds of PPD and a 91% increased odds of suicidal ideation or self-inflicted injury.
- There was insufficient evidence in these data that general anesthesia was associated with anxiety disorders or PTSD.
"General anesthesia for cesarean delivery increases the risk of severe PPD requiring hospitalization, self-inflicted injury, and suicidal ideation. The preliminary findings if confirmed 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," concluded the authors.
The study, "Exposure to General Anesthesia for Cesarean Delivery and Odds of Severe Postpartum Depression Requiring Hospitalization," is published in the journal Anesthesia & Analgesia.