{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T17:46:50Z","timestamp":1791654410140,"version":"4.3.4"},"reference-count":21,"publisher":"Georg Thieme Verlag KG","issue":"01","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Perinatol"],"published-print":{"date-parts":[[2022,1]]},"abstract":"<jats:p>\n            Objective\u2003The study aimed to test the hypothesis that higher Edinburgh Postnatal Depression Scale (EPDS) scores are associated with increased pain scores and opioid use during postpartum hospitalization following cesarean section.<\/jats:p><jats:p>\n            Study Design\u2003We conducted a retrospective cohort of English or Spanish-speaking women \u226518 years who had prenatal care for a singleton gestation and delivered by cesarean at \u226536 weeks within a tertiary center during 2017. Exclusions included women with fetal anomalies, intrauterine fetal demise, sickle cell disease, previously diagnosed pain disorders (e.g., chronic pain or fibromyalgia), substance use disorder (based on documented prescription or use of methadone or buprenorphine), or reoperation during hospital stay. Women without an EPDS recorded antenatally were also excluded. Major depressive symptoms (MDS) were defined as a documented antenatal EPDS \u226512. Women with and without MDS were compared, and multivariable linear regression models were generated to evaluate associations between MDS status and both pain scores and opioid use.<\/jats:p><jats:p>\n            Results\u2003Of the 891 women meeting other inclusion criteria, 676 (76%) had documented antenatal EPDS scores, and 104 (15.4%) of those had MDS. Women with MDS were more likely to be use tobacco and have general anesthesia for cesarean delivery, but groups were otherwise similar. Women with MDS reported higher daily and average pain scores postpartum (2.4 vs. 1.7 average; p\u2009&lt;\u20090.001). Women with MDS used more morphine milligram equivalents (MME) each day during their postpartum hospitalization, leading to a higher total MME use (121\u2009mg [60.5\u2013214.5] vs. 75\u2009mg [28.5\u2013133.5], p\u2009&lt;\u20090.001).<\/jats:p><jats:p>\n            Conclusion\u2003We found an association between antepartum depressive symptoms and acute pain after cesarean delivery leading to increased opioid use. Given the current focus on opioid stewardship, further research into this association, exploration of tailored pain control, and determining whether treatment of antepartum MDS reduces postpartum pain, and therefore opioid use, will be of the utmost priority.<\/jats:p><jats:p>\n            Key Points\n          <\/jats:p>","DOI":"10.1055\/s-0040-1714392","type":"journal-article","created":{"date-parts":[[2020,7,18]],"date-time":"2020-07-18T22:31:42Z","timestamp":1595111502000},"page":"106-112","source":"Crossref","is-referenced-by-count":9,"title":["The Effects of Antepartum Depressive Symptoms on Postcesarean Opioid Consumption"],"prefix":"10.1055","volume":"39","author":[{"given":"Zachary","family":"Walker","sequence":"additional","affiliation":[{"name":"Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama"},{"name":"Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Callie","family":"Perkins","sequence":"additional","affiliation":[{"name":"Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama"},{"name":"Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorie","family":"Harper","sequence":"additional","affiliation":[{"name":"Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama"},{"name":"Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria","family":"Jauk","sequence":"additional","affiliation":[{"name":"Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama"},{"name":"Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeff M.","family":"Szychowski","sequence":"additional","affiliation":[{"name":"Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama"},{"name":"Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Mazzoni","sequence":"additional","affiliation":[{"name":"Center for Women's Reproductive Health, University of Alabama at Birmingham, Birmingham, Alabama"},{"name":"Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2020,7,18]]},"reference":[{"issue":"05","key":"ref1","doi-asserted-by":"crossref","first-page":"1003","DOI":"10.1097\/01.anes.0000265161.39932.e8","article-title":"Risk factors for chronic pain after hysterectomy: a nationwide questionnaire and database study","volume":"106","author":"B Brandsborg","year":"2007","journal-title":"Anesthesiology"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.pain.2007.03.032","article-title":"Transition from acute to chronic pain and disability: a model including cognitive, affective, and trauma factors","volume":"134","author":"C Young Casey","year":"2008","journal-title":"Pain"},{"issue":"03","key":"ref3","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1097\/01.sla.0000245495.79781.65","article-title":"Somatic and psychologic predictors of long-term unfavorable outcome after surgical intervention","volume":"245","author":"M L Peters","year":"2007","journal-title":"Ann Surg"},{"issue":"07","key":"ref4","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1016\/j.ejpain.2008.07.015","article-title":"Psychosocial predictors and correlates for chronic post-surgical pain (CPSP) - a systematic review","volume":"13","author":"A Hinrichs-Rocker","year":"2009","journal-title":"Eur J Pain"},{"issue":"01","key":"ref5","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1186\/s12871-016-0270-6","article-title":"Prevalence and risk factors for chronic pain following cesarean section: a prospective study","volume":"16","author":"J Jin","year":"2016","journal-title":"BMC Anesthesiol"},{"issue":"08","key":"ref6","doi-asserted-by":"crossref","first-page":"854","DOI":"10.1016\/j.jpain.2013.02.013","article-title":"Are psychological predictors of chronic postsurgical pain dependent on the surgical model? 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