Association between intrapartum epidural use and maternal postpartum depression presenting for medical care: a population-based, matched cohort study

Purpose: To evaluate whether intrapartum epidural use is associated with maternal postpartum depression presenting for medical care. Methods: Population-based, matched cohort study including all adult nulliparous women in Ontario, Canada from 2006 to 2012 without a history of depression, who had a term vaginal delivery. Seventy covariates including maternal demographics, medical and psychiatric conditions, prenatal and perinatal complications, and healthcare utilization were measured. Primary exposure was intrapartum epidural use. Primary outcome was the onset of depression requiring medical care within 12 months postpartum; and the secondary outcome was self-harm. Results: A total of 40303 women who received an intrapartum epidural were matched 1:1 on age, year of cohort entry, and propensity score to an equal number of women who did not receive an intrapartum epidural. Overall rate of new onset depression presenting to the healthcare system was 0.88% within 12 months postpartum. Intrapartum epidural use was not associated with maternal postpartum physician or hospital visits (adjusted HR 1.05 [95% CI 0.87 to 1.28]) or self-harm (unadjusted HR 0.91 [95% CI 0.57 to 1.48]). Conclusions: Intrapartum epidural use was not associated with maternal postpartum depression presenting to the healthcare system in term nulliparous women who had a vaginal delivery. Further research is needed to determine if intrapartum epidural use is associated with postpartum depression among women who don't seek care from a physician. (C) 2018 Elsevier Ltd. All rights reserved.