Dexmedetomidine early after delivery reduced incidence of postpartum depression

Key takeaways:

• At 7 and 42 days postpartum, women who received dexmedetomidine had lower positive postpartum depression rates.
• The dexmedetomidine group had more than twofold incidence of hypotension vs. the control group.

Dexmedetomidine administration early in the postpartum period was associated with significantly lower positive postpartum depression incidence compared with placebo, researchers reported in JAMA Network Open.

“Prenatal depression is a postpartum depression risk factor, allowing prenatal depression screening to better focus preventive intervention to limit postpartum depression emergence,” Yingyong Zhou, PhD, from the department of anesthesiology at The Third Xiangya Hospital of Central South University, Changsha, China, and colleagues wrote. “In a previous exploratory study, dexmedetomidine administration in the early postpartum period reduced postpartum depression incidence and was well tolerated.”

Zhou and colleagues conducted a randomized, double-blind, placebo-controlled clinical trial with data from 338 women (mean age, 31.5 years) with positive screening for prenatal depression from two hospitals in Hunan, China, from March 2022 to April 2023. All women had an Edinburgh Postnatal Depression Scale (EPDS) score of more than nine and were scheduled for elective cesarean section delivery. Each participant was randomly assigned dexmedetomidine 0.5 µg/kg in 20 mL of 0.9% saline (n = 169) or 20 mL of 0.9% saline alone (n = 169). Each intervention was administered intravenously for 10 minutes after delivery.

After infusion, the dexmedetomidine group received dexmedetomidine 2 µg/kg plus sufentanil 2.2 µg/kg diluted in saline 100 mL, and the control group received sufentanil 2.2 µg/kg diluted in saline 100 mL through patient-controlled IV analgesia for 48 hours.

The primary outcome was a positive postpartum depression screening at 7 and 42 days postpartum as measured by an EPDS score of more than nine.

Researchers observed decreased positive postpartum depression screening incidence in the dexmedetomidine group compared with the control group at 7 (12.6% vs. 32.1%; RR = 0.39; 95% CI, 0.25-0.62; P < .001) and 42 (11.4% vs. 30.3%; RR = 0.38; 95% CI, 0.23-0.61; P < .001) days postpartum.

Regarding adverse events, the dexmedetomidine group demonstrated no significant differences compared with the control group (27.2% vs. 19.5%). However, hypotension incidence increased for women who received dexmedetomidine (18.3% vs. 9.5%; RR = 2.15; 95% CI, 1.13-4.1; P = .02).

“Dexmedetomidine has central antisympathetic, antianxiety and sedative effects similar to natural sleep and has certain analgesic effects,” the researchers wrote. “This study indicated that preventive dexmedetomidine administration may decrease positive postpartum depression screening incidence and reduce the postpartum EPDS score among women at high risk for postpartum depression.”