Obstetric Anesthesia and Postpartum Depression

产科麻醉与产后抑郁症

基本信息

批准号：
10370162
负责人：
Jean R Guglielminotti
金额：
$ 20.54万
依托单位：
COLUMBIA UNIVERSITY HEALTH SCIENCES
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-06-10 至 2024-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10370162
关键词：
Absence of pain sensation Accident and Emergency department Affect Analgesics Anesthesia procedures Anesthetics COVID-19 pandemic Caring Cesarean section Childbirth Data Epidemiologic Methods Ethnic Origin Evidence based intervention General Anesthesia Health Health Care Costs Hospitalization Improve Access Incidence Inpatients Link Maternal Health Maternal complication Mediation Medical Medical History Mental Health Methods Minority Women Neonatal New York Not Hispanic or Latino Obstetrical Anesthesia Outcome Outpatients Pain Pain intensity Pain management Patient Self-Report Patients Perinatal Postpartum Depression Postpartum Period Premature Birth Publishing Race Records Reporting Research Risk Risk Estimate Risk Factors Spinal Statistical Methods Techniques Testing United States United States Agency for Healthcare Research and Quality Vaginal delivery procedure Woman depressive symptoms disparity reduction effective intervention ethnic minority health care service utilization improved postpartum care preventive intervention racial minority screening severe maternal morbidity socioeconomics stillbirth

项目摘要

The broad, long-term objective of the proposed project is to improve maternal health outcomes by providing access to quality obstetric anesthesia care during delivery hospitalization. Postpartum depression is a serious maternal health problem in the United States, affecting one in seven parturient, especially racial and ethnic minority women. Severe postpartum pain is associated with an increased risk of postpartum depression. Pain intensity and the risk of postpartum depression could be reduced through the use of neuraxial analgesia for vaginal delivery (i.e., epidural or spinal analgesia) or neuraxial anesthesia for cesarean delivery. Neuraxial analgesic or anesthetic techniques are the most effective evidence-based interventions to relieve postpartum pain but are underutilized in racial and ethnic minority women. Results of previous research are inconsistent on the association between the use of neuraxial analgesia or anesthesia for childbirth and the risk of postpartum depression. Inconsistency of previous research might be due to the non-consideration of newly identified strong risk factors for postpartum depression, when estimating the risk of postpartum depression. Indeed, serious maternal complications during delivery hospitalizations (i.e., severe maternal morbidity) and severe neonatal complications (e.g., preterm birth, stillbirth) have been recently linked to a significantly increased risk of PPD. The hypothesized decreased risk of postpartum depression associated with neuraxial analgesia or anesthesia for childbirth could be modified when severe maternal or neonatal complications occur. To untangle the interrelationships among neuraxial analgesia or anesthesia, maternal or neonatal complications, and postpartum depression, we will analyze data from inpatient, outpatient, and emergency department discharge records in New York State from 2006 to 2018 provided by the Healthcare Cost and Utilization Project (HCUP) of the Agency for Healthcare Research and Quality. We will use sophisticated statistical and epidemiologic methods, including causal inference techniques such as interaction and mediation analysis, and stratify our analyses according to race and ethnicity. The proposed project could provide scientific evidence for improving access to obstetric anesthesia care, especially for racial and ethnic minority women, to reduce the risk of postpartum depression and disparities in maternal mental health outcomes.

拟议项目的广泛、长期目标是通过以下方式改善孕产妇健康结果：在分娩住院期间提供优质产科麻醉护理。产后抑郁症在美国是一个严重的孕产妇健康问题，影响着一七、产妇，尤其是少数民族妇女。严重的产后疼痛与产后抑郁症的风险增加。疼痛强度和产后抑郁症的风险可能是通过使用椎管内分娩镇痛（即硬膜外镇痛或脊髓镇痛）来减少或剖宫产时椎管内麻醉。椎管内镇痛或麻醉技术是最有效的以证据为基础的干预措施可缓解产后疼痛，但在少数种族和族裔中并未得到充分利用女性。先前的研究结果对于椎管内使用之间的关联性并不一致。分娩镇痛或麻醉以及产后抑郁症的风险。与之前的不一致研究可能是由于没有考虑新发现的产后强风险因素抑郁症，在估计产后抑郁症的风险时。事实上，严重的孕产妇并发症分娩住院（即严重的产妇发病率）和严重的新生儿并发症（例如早产）最近已发现与产后抑郁症风险显着增加有关。假设减少与椎管内镇痛或分娩麻醉相关的产后抑郁症的风险可能是当发生严重的孕产妇或新生儿并发症时进行修改。理清孕产妇或新生儿椎管内镇痛或麻醉之间的相互关系并发症和产后抑郁症，我们将分析住院、门诊和急诊的数据纽约州 2006 年至 2018 年各部门出院记录由医疗保健费用和医疗保健研究和质量局的利用项目 (HCUP)。我们将使用先进的统计和流行病学方法，包括因果推理技术，例如相互作用和调解分析，并根据种族和民族对我们的分析进行分层。拟议的项目可以为改善产科麻醉的可及性提供科学证据护理，特别是针对少数族裔妇女，以减少产后抑郁症和孕产妇心理健康结果的差异。