Preoperative Higher Depression Scores are Associated With Risk of Hypotension Following Spinal Anesthesia for Cesarean Delivery

Objective: During pregnancy, depression is linked to altered autonomic functions, including reduced heart rate variability (HRV). Reduced HRV is associated with an increased risk of hypotensive episodes following spinal anesthesia for cesarean delivery (CD). This study aimed to evaluate whether antenatal depression is associated with post-spinal hypotension during CD. Methods: This secondary analysis utilized data from a previously conducted trial involving 290 full-term singleton pregnant women with American Society of Anesthesiologists (ASA) physical status II, undergoing elective CD under spinal anesthesia. Patients were randomized to receive either 100 µg of intrathecal morphine or normal saline, in addition to the standard spinal mixture of 0.5% bupivacaine (2.2 mL) with 10 µg fentanyl. The primary outcome of the present study was the incidence of post-spinal hypotension, defined as systolic blood pressure <80% of baseline. We performed multivariable logistic regression to examine the association between antenatal depression scores (assessed with Hospital Anxiety and Depression Scale) and post-spinal hypotension. Results: Of the 290 participants, 164 (56%) developed post-spinal hypotension. The median (interquartile range) antenatal depression scores were higher in the hypotensive group compared to the non-hypotensive group (4 [3–5] vs. 3 [2–4], P = 0.003). Multivariable logistic regression revealed that higher depression scores (OR 1.15, 95% CI 1.009–1.31, P = 0.036) and sensory block height ≥ T4 (OR 1.84, 95% CI 1.03–3.30, P = 0.039) were significantly associated with post-spinal hypotension. Conclusion: Higher antenatal depression scores are associated with an increased risk of post-spinal hypotension in women undergoing elective CD.