Association between epidural labor analgesia and postpartum depressive symptoms at 6 weeks in primiparous women: a prospective preference-based cohort study

Abstract Objective To evaluate the association between epidural labor analgesia (ELA) and postpartum depression (PPD) at 6 weeks postpartum, and to identify independent predictors of PPD in primiparous women planning vaginal delivery. Methods This prospective preference-based controlled cohort study enrolled 200 singleton primiparous women scheduled for vaginal delivery (July–December 2021). Participants chose whether to receive ELA and were grouped accordingly. Pain intensity was assessed using the numerical rating scale (NRS) at predefined intrapartum time points and on postpartum day 1. PPD at postpartum day 42 was assessed using the Edinburgh Postnatal Depression Scale (EPDS), with PPD defined as EPDS ≥ 9. Group comparisons used appropriate parametric/non-parametric tests. Multivariable logistic regression and a propensity score–based inverse probability of treatment weighting (IPTW) sensitivity analysis were performed to assess robustness to confounding. Results A total of 184 women completed follow-up (ELA group, n = 93; non-ELA group, n = 91). The overall incidence of PPD was 20.65% (38/184). Women in the ELA group reported significantly lower NRS scores at full cervical dilatation (T4) and on postpartum day 1, and higher satisfaction scores on postpartum day 1 (all P < 0.05). The incidence of PPD at 6 weeks was lower in the ELA group than in the non-ELA group (14.0% vs 27.5%, P = 0.008). After adjustment for potential confounders, ELA remained independently associated with a reduced risk of PPD (OR = 0.276, 95% CI 0.082–0.928, P = 0.038). Education ≤ 12 years, cesarean delivery, and antenatal fear of labor pain were independent risk factors. Conclusion Among singleton primiparous women planning vaginal delivery, receipt of epidural labor analgesia was associated with a lower risk of postpartum depression at 6 weeks postpartum.