Women with prenatal depression who received an infusion of the sedative dexmedetomidine shortly after a cesarean delivery (C-section) had lower incidences of postpartum depression at one and six weeks postpartum compared with women who received a saline infusion after delivery. These findings were published in JAMA Network Open. The study was funded by grants from the Natural Science Foundation of Hunan Province.
Yingyong Zhou, Ph.D., of the Third Xiangya Hospital of Central South University and colleagues conducted the study at two hospitals in China from March 2022 to April 2023. Women 18 years or older with prenatal depression (defined as higher than 9 on the Edinburgh Postnatal Depression Scale, or EPDS) who underwent elective cesarean delivery and required postoperative patient-controlled intravenous analgesia were recruited for the trial. The researchers randomized 338 women (average age 31.5 years) to the dexmedetomidine group (n = 169) or the control group (n = 169).
After delivery, study participants in the dexmedetomidine group received 0.5 μg/kg of dexmedetomidine in 20 mL of 0.9% saline for 10 minutes. Those in the control group received 20 mL of 0.9% saline for 10 minutes. Following this infusion, women in the study were administered one of two infusions of the narcotic sufentanil, which were set for continuous infusion at a rate of 2 mL/h for 48 hours: The dexmedetomidine group received dexmedetomidine (2.0 μg/kg) + sufentanil (2.2 μg/kg); the control group received sufentanil (2.2 μg/kg).
Zhou and colleagues followed up with the study participants by telephone at 7 and 42 days after their C-section, again administering the EPDS. The participants were also asked about insomnia, pain, and other adverse events.
At 7 days, 12.6% of women in the dexmedetomidine group screened positive for postpartum depression versus 32.1% of women in the control group. At 42 days, 11.4% of the dexmedetomidine group versus 30.3% of the control group screened positive. Other findings included the following:
- The median insomnia scores of the dexmedetomidine group were significantly decreased from baseline to 1 and 2 days postpartum compared with the control group. However, there was no difference in insomnia scores between the groups at 7 and 42 days postpartum.
- Women who had received dexmedetomidine reported less pain while at rest at 6, 24, and 48 hours after delivery than women who received saline.
- The groups experienced similar adverse events, but those in the dexmedetomidine had a higher incidence of hypotension (systolic blood pressure less than 90 mm Hg or 20% lower than baseline).
“Given the serious negative consequences for mothers, young children, family members, and society, strategies to improve prevention [of postpartum depression] and treatment are a public health priority,” Zhou and colleagues wrote.
For related information, see the Psychiatric News article “Special Report: Women’s Reproductive Mental Health—A Clinical Framework.”
(Image: Getty Images/iStock/FatCamera)
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