Maternal Fetal Medicine Fellow University of Utah Salt Lake City, UT, United States
Objective: To evaluate whether there is an association between treated or untreated maternal depression and opioid use after cesarean delivery (CD).
Study Design: Secondary analysis of a multicenter randomized trial of individuals who underwent CD at 31 U.S. hospitals (2020-22).
We evaluated two primary exposures: self-reported treated depression (pharmacologic or non-pharmacologic therapy during pregnancy) or self-reported untreated depression. The primary outcome was inpatient oral opioid use in morphine milligram equivalents (MME) per day between 12 hours after surgery through hospital discharge. Secondary outcomes included outpatient opioid use (MME of opioid prescriptions through 6 weeks postpartum) and moderate-severe perceived pain (≥4) and interference in daily activities (≥4) on the Brief Pain Inventory (BPI, 1-10) at 1-week postpartum. Multivariable modeling evaluated the association between untreated or treated depression compared with no depression and the selected outcomes.
Results: Of 5,478 study participants, 1,508 (28%) had depression of whom 663 (44%) were treated. Those with depression were more likely to have a chronic pain condition, use tobacco, and experience disordered sleep. In adjusted modeling, neither treated nor untreated depression was associated with inpatient postpartum MME (Table). Untreated depression, but not treated, was associated with higher MME use through 6 weeks postpartum (adjusted median difference 19.2, 95% CI 11.5-26.8) and higher patient perceived pain severity (Table). Both treated and untreated depression were associated with higher patient perceived pain interference in daily activities.
Conclusion: Inpatient postpartum opioid use did not differ by depression (treated or not). However, untreated (but not treated) depression was associated with increased outpatient opioid use and worse perceived pain. This information can inform clinicians when counseling patients. Further, it is notable that only 44% of gravidae in this cohort who reported depression received treatment for it.
