| Background:As the pace of life accelerates,women face increased workplace and childcare pressures,postnatal depression(PPD)is on the rise year by year,seriously endangering the health of mothers and infants.PPD is one of the common serious complications after childbirth,characterized by symptoms such as low mood,behavioral changes,and mental depression,which seriously damage the physical and mental health of pregnant women and even endanger their lives,there are behaviors such as excessive worry about infants and refusal to breastfeed,affecting children’s development,and bringing serious impacts to society and families.Many studies have confirmed that severe labor pain is one of the important risk factors for inducing PPD,and is the only controllable factor in the medical process.Various types of labor analgesia can alleviate labor pain in pregnant women,the World Health Organization(WHO)recommends the use of epidural labor analgesia(ELA)as the gold standard for relieving labor pain,which is the most reliable and feasible analgesic method with the most effective results.Some previous studies have found that ELA can reduce the incidence of PPD in pregnant women,while others have found that ELA is not associated with reducing PPD.This conclusion is controversial in existing research and deserves further study.Objective:The purpose of this study is to observe the impact of ELA on PPD,analyze the risk factors of PPD,and provide theoretical support for subsequent mechanism research.Methods:1.This study is a prospective cohort study.Four hundred and six full-term primiparous women who met the inclusion and exclusion criteria at the First Affiliated Hospital of Shandong First Medical University from November 2020 to January 2022 and underwent vaginal delivery were included in the study,they were divided into an analgesic group of 303 cases and a non analgesic group of 103 cases based on their willingness to undergo ELA.2.General information,visual analogue scale(VAS)score at different time points,labor outcome,labor time,intrapartum blood loss,lateral perineal incision and cervical injury,1min,5min Apgar score of newborn,feeding mode and so on were recorded in the two groups.3.The incidence of PPD at different stages of postpartum in the two groups was evaluated using the Edinburgh Postnatal Depression Scale(EPDS)at 1,4,and 6 weeks after delivery,with EPDS≥10 as the threshold.4.SPSS 27 statistical software was used for data analysis,the correlation between ELA and PPD was evaluated,and risk factors for PPD were found.ResultsIn this study,a total of 793 pregnant women were screened,and 406 full-term primiparous women who met the inclusion and exclusion criteria were included in the study,among them,seventy-two were lost in follow-up,a total of 334 pregnant women completed the study,with 251 in the analgesic group and 83 in the non analgesic group.1.The incidence of PPD in the 1,4,and 6 week postpartum analgesia group was 17.9%,22.3%,and 17.1%,respectively,and the incidence of postpartum depression in the non analgesia group was 20.5%,26.5%,and 30.1%,respectively.The incidence of PPD in the analgesia group at different stages of postpartum was lower than that in the non analgesia group.There was no statistically significant difference in the incidence of PPD between the two groups at 1 and 4 weeks postpartum,but there was a statistically significant difference in the incidence of PPD at 6 weeks postpartum(P<0.05).2.When PPD at 6 weeks postpartum was used as the dependent variable,univariate analysis showed that ELA(P=0.012)and pregnancy complications(P=0.015)were associated with PPD at 6 weeks postpartum.Incorporating univariate P<0.1 related factors into a logistic regression analysis showed that ELA could reduce the incidence of PPD at 6 weeks after delivery(OR 0.52,95%CI,0.29-0.93,P=0.027),and pregnancy complications could increase the incidence of PPD at 6 weeks after delivery(OR 3.24,95%CI,1.12-9.38,P=0.031).There was a significant correlation between the EPDS score at 1 week postpartum and the EPDS score at 4 weeks postpartum and the EPDS score at 6 weeks postpartum(Spearman correlation coefficient at 1 week postpartum=0.551,P<0.001;Spearman at 4 weeks postpartum=0.689,P<0.001).3.There was no statistically significant difference in VAS score between the two groups before labor analgesia,and the VAS score in the full-time analgesia group with uterine opening was significantly lower than that in the non-analgesic group,and the difference was statistically significant(P<0.001).4.The analgesia group had a statistically significant difference in the time to first stage of labour,second stage of labour and total duration of labour than in the nonanalgesic group(P<0.05).Compared with the non-analgesic group,the incidence of urinary retention,lethargy,episiotomy,and cervical laceration was higher in the analgesic group(P<0.05).There were no significant differences in the rate of intermediate caesarean section,neonatal Apgar scores at 1min and 5min,intrapartum bleeding,and feeding mode between the two groups.Conclusion:1.ELA can effectively relieve maternal labor pain and reduce the incidence of PPD,which is a protective factor for full-term primipara PPD at 6 weeks postpartum.Pregnancy complications increase the incidence of PPD and are risk factors for PPD at 6 weeks postpartum in full-term primipara women.2.ELA can prolong the first and second stages of labor,and increase the incidence of lateral perineal incision and cervical laceration.3.ELA has no significant adverse effect on maternal and infant outcomes. |
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