Download PDF
Am J Perinatol 2022; 39(01): 106-112
DOI: 10.1055/s-0040-1714392
Original Article

The Effects of Antepartum Depressive Symptoms on Postcesarean Opioid Consumption

Zachary Walker
1   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
2   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Callie Perkins
1   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
2   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Lorie Harper
1   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
2   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
,
Victoria Jauk
1   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
3   Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
,
Jeff M. Szychowski
1   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
3   Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
,
Sara Mazzoni
1   Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama
2   Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Objective The study aimed to test the hypothesis that higher Edinburgh Postnatal Depression Scale (EPDS) scores are associated with increased pain scores and opioid use during postpartum hospitalization following cesarean section.

Study Design We conducted a retrospective cohort of English or Spanish-speaking women ≥18 years who had prenatal care for a singleton gestation and delivered by cesarean at ≥36 weeks within a tertiary center during 2017. Exclusions included women with fetal anomalies, intrauterine fetal demise, sickle cell disease, previously diagnosed pain disorders (e.g., chronic pain or fibromyalgia), substance use disorder (based on documented prescription or use of methadone or buprenorphine), or reoperation during hospital stay. Women without an EPDS recorded antenatally were also excluded. Major depressive symptoms (MDS) were defined as a documented antenatal EPDS ≥12. Women with and without MDS were compared, and multivariable linear regression models were generated to evaluate associations between MDS status and both pain scores and opioid use.

Results Of the 891 women meeting other inclusion criteria, 676 (76%) had documented antenatal EPDS scores, and 104 (15.4%) of those had MDS. Women with MDS were more likely to be use tobacco and have general anesthesia for cesarean delivery, but groups were otherwise similar. Women with MDS reported higher daily and average pain scores postpartum (2.4 vs. 1.7 average; p < 0.001). Women with MDS used more morphine milligram equivalents (MME) each day during their postpartum hospitalization, leading to a higher total MME use (121 mg [60.5–214.5] vs. 75 mg [28.5–133.5], p < 0.001).

Conclusion We found an association between antepartum depressive symptoms and acute pain after cesarean delivery leading to increased opioid use. Given the current focus on opioid stewardship, further research into this association, exploration of tailored pain control, and determining whether treatment of antepartum MDS reduces postpartum pain, and therefore opioid use, will be of the utmost priority.

Key Points

  • Women with MDS report higher pain scores postcesarean.

  • Women with MDS use more opioids postcesarean.

  • Future studies are needed for the treatment of MDS.

Keywords

depression - opioid - antepartum - postpartum - pain score

Note

The study was conducted in Birmingham, AL and presented at the 40th Annual Pregnancy Meeting of the Society for Maternal–Fetal Medicine, Grapevine, Texas, February 3 to 8, 2020.




Publication History

Received: 12 March 2020

Accepted: 13 June 2020

Article published online:
18 July 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Brandsborg B, Nikolajsen L, Hansen CT, Kehlet H, Jensen TS. Risk factors for chronic pain after hysterectomy: a nationwide questionnaire and database study. Anesthesiology 2007; 106 (05) 1003-1012
    CrossrefPubMedGoogle Scholar
  • 2 Young Casey C, Greenberg MA, Nicassio PM, Harpin RE, Hubbard D. Transition from acute to chronic pain and disability: a model including cognitive, affective, and trauma factors. Pain 2008; 134 (1-2): 69-79
    CrossrefPubMedGoogle Scholar
  • 3 Peters ML, Sommer M, de Rijke JM. et al. Somatic and psychologic predictors of long-term unfavorable outcome after surgical intervention. Ann Surg 2007; 245 (03) 487-494
    CrossrefPubMedGoogle Scholar
  • 4 Hinrichs-Rocker A, Schulz K, Järvinen I, Lefering R, Simanski C, Neugebauer EAM. Psychosocial predictors and correlates for chronic post-surgical pain (CPSP) - a systematic review. Eur J Pain 2009; 13 (07) 719-730
    CrossrefPubMedGoogle Scholar
  • 5 Jin J, Peng L, Chen Q. et al. Prevalence and risk factors for chronic pain following cesarean section: a prospective study. BMC Anesthesiol 2016; 16 (01) 99
    CrossrefPubMedGoogle Scholar
  • 6 Masselin-Dubois A, Attal N, Fletcher D. et al. Are psychological predictors of chronic postsurgical pain dependent on the surgical model? A comparison of total knee arthroplasty and breast surgery for cancer. J Pain 2013; 14 (08) 854-864
    CrossrefPubMedGoogle Scholar
  • 7 Hegarty D, Shorten G. Multivariate prognostic modeling of persistent pain following lumbar discectomy. Pain Physician 2012; 15 (05) 421-434
    CrossrefPubMedGoogle Scholar
  • 8 Bruce J, Thornton AJ, Powell R. et al; Recovery Study Group. Psychological, surgical, and sociodemographic predictors of pain outcomes after breast cancer surgery: a population-based cohort study. Pain 2014; 155 (02) 232-243
    CrossrefPubMedGoogle Scholar
  • 9 Macones GA, Caughey AB, Wood SL. et al. Guidelines for postoperative care in cesarean delivery: Enhanced Recovery After Surgery (ERAS) Society recommendations (part 3). Am J Obstet Gynecol 2019; 221 (03) 247.e1-247.e9
    CrossrefPubMedGoogle Scholar
  • 10 Meltzer-Brody S. New insights into perinatal depression: pathogenesis and treatment during pregnancy and postpartum. Dialogues Clin Neurosci 2011; 13 (01) 89-100
    CrossrefPubMedGoogle Scholar
  • 11 CDC. Prescription Painkiller Overdoses: A Growing Epidemic, Especially Among Women. Vital Signs (NY NY) 2013; (July): 4-7
    PubMedGoogle Scholar
  • 12 Walker ZW, Vinson AR, Babcock D, Benjamin T, Haas DM. Determining the Initiation of Opiate Misuse Resulting in Opioid Use Disorder in Pregnant Women. J Psychoactive Drugs 2018; 50 (04) 331-338
    CrossrefPubMedGoogle Scholar
  • 13 Peavy KM, Banta-Green CJ, Kingston S, Hanrahan M, Merrill JO, Coffin PO. “Hooked on” prescription-type opiates prior to using heroin: results from a survey of syringe exchange clients. J Psychoactive Drugs 2012; 44 (03) 259-265
    CrossrefPubMedGoogle Scholar
  • 14 Peahl AF, Dalton VK, Montgomery JR, Lai Y-L, Hu HM, Waljee JF. Rates of new persistent opioid use after vaginal or cesarean birth among US women. JAMA Netw Open 2019; 2 (07) e197863
    CrossrefPubMedGoogle Scholar
  • 15 Menacker F, Hamilton BE. Recent trends in cesarean delivery in the United States. NCHS Data Brief 2010; (35) 1-8
    PubMedGoogle Scholar
  • 16 Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry 1987; 150: 782-786
    CrossrefPubMedGoogle Scholar
  • 17 Daly B, Young S, Marla R. et al. Persistent pain after caesarean section and its association with maternal anxiety and socioeconomic background. Int J Obstet Anesth 2017; 29: 57-63
    CrossrefPubMedGoogle Scholar
  • 18 Hobson JA, Slade P, Wrench IJ, Power L. Preoperative anxiety and postoperative satisfaction in women undergoing elective caesarean section. Int J Obstet Anesth 2006; 15 (01) 18-23
    CrossrefPubMedGoogle Scholar
  • 19 Taenzer P, Melzack R, Jeans ME. Influence of psychological factors on postoperative pain, mood and analgesic requirements. Pain 1986; 24 (03) 331-342
    CrossrefPubMedGoogle Scholar
  • 20 De Cosmo G, Congedo E, Lai C, Primieri P, Dottarelli A, Aceto P. Preoperative psychologic and demographic predictors of pain perception and tramadol consumption using intravenous patient-controlled analgesia. Clin J Pain 2008; 24 (05) 399-405
    CrossrefPubMedGoogle Scholar
  • 21 Ozcan H, Ustundag MF, Yilmaz M, Aydinoglu U, Ersoy AO, Eyi EGY. The relationships between prenatal attachment, basic personality traits, styles of coping with stress, depression, and anxiety, and marital adjustment among women in the third trimester of pregnancy. Eurasian J Med 2019; 51 (03) 232-236
    CrossrefPubMedGoogle Scholar