General Anesthesia for C-Sections: A Mental Health Risk?

TOPLINE:

The use of general anesthesia during cesarean deliveries is associated with an increased risk for postpartum depression (PPD) that necessitates hospitalization as well as a risk for suicidality, regardless of obstetric complications.

METHODOLOGY:

• Researchers conducted a retrospective cohort study to assess the association of the use of general anesthesia for cesarean delivery with the risk for PPD and suicidality.
• They analyzed discharge records for New York State from three databases and included 325,840 women (age, 10-44 years) who underwent cesarean delivery from 2009 to 2017, of whom 19,513 received general anesthesia.
• The primary outcome was PPD, defined as a diagnosis of depression recorded during a readmission, outpatient visit, or emergency department visit within 1 year after discharge.
• The secondary outcomes included PPD requiring hospitalization and suicidality, encompassing suicidal ideation, a suicide attempt, self-harm, and suicide.
• The analysis accounted for obstetric complications; 13,528 women who received general anesthesia were propensity score matched to 54,112 women who received neuraxial anesthesia.

TAKEAWAY:

• The use of general anesthesia for cesarean delivery was not associated with a significant overall increase in risk for PPD (adjusted hazard ratio [aHR], 1.12; 95% CI, 0.97-1.30).
• However, general anesthesia was associated with a 38% increased risk for PPD requiring hospitalization (95% CI, 1.07-1.77), with the increased risk being significant only for Black women (aHR, 1.77; 95% CI, 1.15-2.72).
• The use of general anesthesia was associated with a 45% increased risk for suicidality (95% CI, 1.02-2.05).

IN PRACTICE:

“Use of GA [general anesthesia] for cesarean delivery is independently associated with a significantly increased risk of PPD requiring hospitalization and suicidality. It underscores the need to avoid using GA whenever appropriate and to address the potential mental health issues of patients after GA use, specifically by screening for PPD and providing referrals to accessible mental health providers as needed,” the authors of the study wrote.

“Mechanisms accounting for increased risk of PPD associated with GA are multifactorial and may include a delayed first interaction between the mother and her child, delayed first breastfeeding attempt, postpartum pain, and discordance between women’s expectations for childbirth and care pro­vided and/or anticipated birth experience and what ensued, contributing to maternal dissatisfaction, dis­appointment, sense of loss, and self-blame,” the researchers added.

SOURCE:

The study was led by Jean Guglielminotti, MD, PhD, Columbia University Vagelos College of Physicians and Surgeons in New York City. It was published online on December 4, 2024, in Anesthesia & Analgesia.

LIMITATIONS:

Residual confounding may have influenced the observed associations between the use of general anesthesia and postpartum mood disorders. Data on mechanisms such as delayed first mother-child interaction that could explain the increased risk for PPD associated with the use of general anesthesia were lacking. No specific International Classification of Diseases code for PPD existed before October 2015, which may have affected the identification of cases. The study was conducted in New York State, limiting the generalizability of the results to other regions. 

DISCLOSURES:

This study was supported by the National Institute of Mental Health, the National Institutes of Health. No relevant conflicts of interest were disclosed by the authors.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.