# The impact of combined spinal-epidural analgesia (CSEA) on postpartum depression: A Mendelian randomization study

## TL;DR

This study investigates whether using spinal-epidural analgesia during childbirth causes postpartum depression, finding no causal link.

## Contribution

The study uses Mendelian randomization to explore a potential causal relationship between CSEA and PPD for the first time.

## Key findings

- No significant causal relationship was found between CSEA and PPD using multiple MR methods.
- Results from IVW, weighted median, and other models consistently showed no strong link.
- Findings suggest CSEA does not cause PPD, aiding clinical understanding of postpartum mental health.

## Abstract

Postpartum depression (PPD) develops within the first few weeks or months following delivery and causes severe emotional and psychological problems. Pain has been closely linked to the occurrence of depression. Observational studies have suggested that effective pain relief during childbirth can reduce the incidence of PPD. However, these studies are fraught with numerous confounding factor. Combined spinal-epidural analgesia (CSEA) is a commonly used pain relief method during childbirth. It is currently unclear whether a causal relationship exists between CSEA and PPD.

An analysis was conducted using five methods in Mendelian randomization (MR) to study the use of CSEA during childbirth and PPD. The data were obtained from the United Kingdom Biobank database for CSEA and from FinnGen for PPD. The analysis included MR-Egger, weighted median, inverse variance weighted (IVW), simple mode, and weighted mode. We then conducted exposure heterogeneity testing using Cochran’s Q statistics and assessed the pleiotropy of exposure single nucleotide polymorphisms (SNPs) using MR-Egger.

IVW odds ratio (OR) = 0.978; 95% confidence interval (CI) 0.407, 1.031; P = 0.408. The results of the weighted median (OR = 1.035; 95% CI 0.995; 1.118, P = 0.377), simple mode (OR = 0.929; 95% CI 0.773, 1.116; P = 0.435), and weighted mode (OR = 0.995; 95% CI 0.930, 1.065; P = 0.888) suggest that there is no significant link between CSEA and PPD.

We have concluded that there is no causal link between CSEA and PPD. This information can assist clinical professionals in gaining a better understanding of this condition.