Investigating the association between pain and psychological vulnerabilities and postpartum depression

Pain and psychological vulnerabilities may be associated with the development of postpartum depression (PPD) in women undergoing Cesarean delivery. However, there is limited information regarding women undergoing labor and delivery. We investigated whether pre-delivery pain and psychological vulnerabilities, and other risk factors were associated with an increased risk of PPD among laboring women. This was a secondary analysis of a clinical trial conducted between June 2017 and July 2021. The risk of PPD was assessed using an online survey on Edinburgh Postnatal Depression Scale (EPDS) administered at 6–10 weeks postpartum with a cut-off score of 10. Of the 819 parturients who completed the follow-up survey, 301 (36.8%) had an EPDS score ≥ 10 at 6–10 weeks postpartum. Univariate analysis was performed to identify potential risk factors. The multivariable model for the risk of PPD demonstrated an area under the receiver operating characteristics curve (AUROC) of 0.79 (95%CI 0.76–0.82). Independent risk factors included greater pre-delivery pain and psychological vulnerabilities (EPDS: adjusted odds ratio (aOR) 1.24, 95%CI 1.17–1.31; central sensitization: aOR 1.02, 95%CI 1.01–1.04; fear avoidance (pain-related fear/anxiety): aOR 1.03, 95%CI 1.01–1.06), irregular menstrual cycles (aOR 1.58, 95%CI 1.03–2.43), previous pregnancy complications (aOR 2.33, 95%CI 1.22–4.43), emergency Cesarean delivery due to failed induction of labor (aOR 3.04, 95%CI 1.25–7.41), and light meconium-stained amniotic fluid during delivery (aOR 3.93, 95%CI 1.55–9.97). Greater placental weight was associated with decreased risk of PPD (aOR 0.86, 95%CI 0.74–0.99 per 100 g increase). Further research is warranted to validate this model, and clarification of the clinical utility of these risk factors may facilitate early identification and intervention to reduce the risk of PPD and improve maternal outcomes. Trial registration: This study was registered on Clinicaltrials.gov NCT03167905 on 30 May 2017.