{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T06:15:25Z","timestamp":1789539325401,"version":"build-2803163510"},"reference-count":66,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,5,27]],"date-time":"2021-05-27T00:00:00Z","timestamp":1622073600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> Postpartum depression (PPD) is a severe psychiatric disorder. Its risk is associated with the cesarean section (CS). Currently, there are few early intervention strategies for these women with PPD who underwent CS.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> This was a parallel-group randomized controlled trial of singleton pregnant women who underwent elective CS in a tertiary referral hospital in China from October, 2017 to September, 2019. After operation, patients received randomly tramadol patient-controlled intravenous analgesia (PCIA; 4 mg\/ml; TRA group), hydromorphone PCIA (0.04 mg\/ml; HYD group), or ropivacaine patient-controlled epidural analgesia (PCEA; 1.5 mg\/ml; ROP group) for 48 h in a 1:1:1 ratio. Total blinding during hospitalization was not feasible due to differences between the PCEA and PCIA treatments. All investigators who performed the follow-up were blinded to the group assignment.<\/jats:p><jats:p><jats:bold>Outcomes:<\/jats:bold> A total of 1,230 patients were enrolled for eligibility. Intention-to-treat analysis showed reduced incidence of PPD in the TRA group (<jats:italic>n<\/jats:italic> = 27 [6.6%]) than that in the HYD (10.2%, OR 1.62, 95% CI 0.98~2.68; <jats:italic>p<\/jats:italic> = 0.059) and ROP groups (10.5%, OR 1.66, 95% CI 1.01~2.75; <jats:italic>p<\/jats:italic> = 0.046) at 4 weeks post-operation, however, the difference was not statistically significant (Bonferroni corrected <jats:italic>p<\/jats:italic> = 0.118, <jats:italic>p<\/jats:italic> = 0.098, respectively). Subgroup analysis in high-risk women (preoperative Edinburgh Postpartum Depression Scale [EPDS] \u226510) showed a significantly lower incidence of PPD in the TRA group (16.5%) than in the HYD (32.6%) and ROP groups (30.9%) (Bonferroni corrected <jats:italic>p<\/jats:italic> = 0.022 and <jats:italic>p<\/jats:italic> = 0.038, respectively). The per-protocol analysis yielded similar results. Reported adverse events (AEs) were mostly mild. None of the women or infant discontinued treatment due to AEs.<\/jats:p><jats:p><jats:bold>Conclusions:<\/jats:bold> Tramadol PCIA after CS in high-risk women can help to reduce the risk of PPD at 4 weeks after elective CS.<\/jats:p><jats:p><jats:bold>Clinical Trial Registration:<\/jats:bold><jats:ext-link>https:\/\/clinicaltrials.gov\/ct2\/show\/NCT03309163?term=ETPPD&amp;amp;draw=2&amp;amp;rank=1<\/jats:ext-link>; <jats:ext-link>ClinicalTrials.gov<\/jats:ext-link> (NCT03309163).<\/jats:p>","DOI":"10.3389\/fmed.2021.679159","type":"journal-article","created":{"date-parts":[[2021,5,27]],"date-time":"2021-05-27T14:08:07Z","timestamp":1622124487000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":13,"title":["A Patient-Controlled Intravenous Analgesia With Tramadol Ameliorates Postpartum Depression in High-Risk Woman After Cesarean Section: A Randomized Controlled Trial"],"prefix":"10.3389","volume":"8","author":[{"given":"Zhuoxi","family":"Wu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Peng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liang","family":"Fang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinping","family":"Ding","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guangming","family":"Yan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dongting","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhengqiong","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingling","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiangting","family":"Deng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guangyou","family":"Duan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhiyi","family":"Zuo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,5,27]]},"reference":[{"key":"B1","volume-title":"Diagnostic and Statistical Manual of Mental Disorders","year":"2013"},{"key":"B2","doi-asserted-by":"publisher","first-page":"2582","DOI":"10.1001\/jama.296.21.2582","article-title":"New parents and mental disorders: a population-based register study","volume":"296","author":"Munk-Olsen","year":"2006","journal-title":"JAMA."},{"key":"B3","doi-asserted-by":"publisher","first-page":"e151","DOI":"10.1016\/j.wombi.2019.04.004","article-title":"\u201cDoing the month\u201d and postpartum depression among Chinese women: a Shanghai prospective cohort study","volume":"33","author":"Ding","year":"2020","journal-title":"Women Birth"},{"key":"B4","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1186\/1471-244X-12-22","article-title":"Antenatal risk factors for postnatal depression: a prospective study of Chinese women at maternal and child health centres","volume":"12","author":"Siu","year":"2012","journal-title":"BMC Psychiatry."},{"key":"B5","doi-asserted-by":"publisher","first-page":"645","DOI":"10.1111\/j.1365-2702.2010.03542.x","article-title":"A comparison of postnatal depression and related factors between Chinese new mothers and fathers","volume":"20","author":"Mao","year":"2011","journal-title":"J Clin Nurs."},{"key":"B6","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1001\/jama.2019.17595","article-title":"Trends in cesarean delivery rates in China, 2008-2018","volume":"323","author":"Li","year":"2020","journal-title":"JAMA."},{"key":"B7","doi-asserted-by":"publisher","first-page":"2263","DOI":"10.1001\/jama.2015.15553","article-title":"Relationship between cesarean delivery rate and maternal and neonatal mortality","volume":"314","author":"Molina","year":"2015","journal-title":"JAMA."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1881","DOI":"10.1089\/jwh.2011.2842","article-title":"Cesarean section and postpartum depression in a cohort of Chinese women with a high cesarean delivery rate","volume":"20","author":"Xie","year":"2011","journal-title":"J Womens Health."},{"key":"B9","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1016\/j.jpsychores.2017.04.016","article-title":"Cesarean section and risk of postpartum depression: a meta-analysis","volume":"97","author":"Xu","year":"2017","journal-title":"J Psychosom Res."},{"key":"B10","doi-asserted-by":"publisher","first-page":"410","DOI":"10.1177\/0884217504266915","article-title":"Postpartum depression beyond the early postpartum period","volume":"33","author":"Goodman","year":"2004","journal-title":"J Obstet Gynecol Neonatal Nurs."},{"key":"B11","doi-asserted-by":"publisher","first-page":"h3190","DOI":"10.1136\/bmj.h3190","article-title":"Specific SSRIs and birth defects: Bayesian analysis to interpret new data in the context of previous reports","volume":"351","author":"Reefhuis","year":"2015","journal-title":"BMJ."},{"key":"B12","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1007\/s11920-016-0664-7","article-title":"Depression during pregnancy and postpartum","volume":"18","author":"Becker","year":"2016","journal-title":"Curr Psychiatry Rep."},{"key":"B13","doi-asserted-by":"publisher","first-page":"839","DOI":"10.1016\/j.cpr.2011.03.009","article-title":"A meta-analysis of treatments for perinatal depression","volume":"31","author":"Sockol","year":"2011","journal-title":"Clin Psychol Rev."},{"key":"B14","doi-asserted-by":"publisher","first-page":"1058","DOI":"10.1016\/S0140-6736(18)31551-4","article-title":"Brexanolone injection in post-partum depression: two multicentre, double-blind, randomised, placebo-controlled, phase 3 trials","volume":"392","author":"Meltzer-Brody","year":"2018","journal-title":"Lancet."},{"key":"B15","doi-asserted-by":"publisher","first-page":"1775","DOI":"10.1016\/S0140-6736(14)61276-9","article-title":"Non-psychotic mental disorders in the perinatal period","volume":"384","author":"Howard","year":"2014","journal-title":"Lancet."},{"key":"B16","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1016\/j.pain.2008.07.011","article-title":"Severity of acute pain after childbirth, but not type of delivery, predicts persistent pain and postpartum depression","volume":"140","author":"Eisenach","year":"2008","journal-title":"Pain."},{"key":"B17","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1016\/j.anclin.2016.09.010","article-title":"Optimal pain management after cesarean delivery","volume":"35","author":"Sutton","year":"2017","journal-title":"Anesthesiol Clin."},{"key":"B18","doi-asserted-by":"publisher","first-page":"139","DOI":"10.2165\/00003495-200060010-00008","article-title":"Tramadol: a review of its use in perioperative pain","volume":"60","author":"Scott","year":"2000","journal-title":"Drugs."},{"key":"B19","doi-asserted-by":"publisher","first-page":"49","DOI":"10.2147\/JPR.S184782","article-title":"Patient-controlled intravenous tramadol versus patient-controlled intravenous hydromorphone for analgesia after secondary cesarean delivery: a randomized controlled trial to compare analgesic, anti-anxiety and anti-depression effects","volume":"12","author":"Duan","year":"2019","journal-title":"J Pain Res."},{"key":"B20","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1016\/j.ejphar.2004.08.011","article-title":"Long-term exposure of rats to tramadol alters brain dopamine and alpha 1-adrenoceptor function that may be related to antidepressant potency","volume":"501","author":"Faron-Gorecka","year":"2004","journal-title":"Eur J Pharmacol."},{"key":"B21","doi-asserted-by":"publisher","first-page":"352","DOI":"10.1093\/bja\/79.3.352","article-title":"Actions of tramadol, its enantiomers and principal metabolite, O-desmethyltramadol, on serotonin (5-HT) efflux and uptake in the rat dorsal raphe nucleus","volume":"79","author":"Bamigbade","year":"1997","journal-title":"Br J Anaesth."},{"key":"B22","doi-asserted-by":"publisher","first-page":"909","DOI":"10.1093\/bja\/83.6.909","article-title":"Effects of tramadol stereoisomers on norepinephrine efflux and uptake in the rat locus coeruleus measured by real time voltammetry","volume":"83","author":"Halfpenny","year":"1999","journal-title":"Br J Anaesth."},{"key":"B23","doi-asserted-by":"publisher","first-page":"661","DOI":"10.1111\/j.1365-2125.2008.03117.x","article-title":"Use of a sparse sampling study design to assess transfer of tramadol and its O-desmethyl metabolite into transitional breast milk","volume":"65","author":"Ilett","year":"2008","journal-title":"Br J Clin Pharmacol."},{"key":"B24","doi-asserted-by":"publisher","first-page":"118","DOI":"10.1056\/NEJM200007133430208","article-title":"Drug therapy for breast-feeding women","volume":"343","author":"Ito","year":"2000","journal-title":"N Engl J Med."},{"key":"B25","doi-asserted-by":"publisher","first-page":"290","DOI":"10.1016\/j.pbb.2014.06.018","article-title":"Tramadol reduces anxiety-related and depression-associated behaviors presumably induced by pain in the chronic constriction injury model of neuropathic pain in rats","volume":"124","author":"Caspani","year":"2014","journal-title":"Pharmacol Biochem Behav."},{"key":"B26","doi-asserted-by":"publisher","first-page":"136","DOI":"10.1016\/j.brainresbull.2017.07.016","article-title":"Involvement of NMDA receptors in the antidepressant-like effect of tramadol in the mouse forced swimming test","volume":"134","author":"Ostadhadi","year":"2017","journal-title":"Brain Res Bull."},{"key":"B27","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1037\/a0022721","article-title":"Examining the use of tramadol hydrochloride as an antidepressant","volume":"19","author":"Barber","year":"2011","journal-title":"Exp Clin Psychopharmacol."},{"key":"B28","doi-asserted-by":"publisher","first-page":"e022538","DOI":"10.1136\/bmjopen-2018-022538","article-title":"Protocol for a randomised, double-blind, placebo-controlled trial to explore the effect of tramadol in the prevention of postpartum depression (ETPPD)","volume":"8","author":"Duan","year":"2018","journal-title":"BMJ Open."},{"key":"B29","doi-asserted-by":"publisher","first-page":"875","DOI":"10.1016\/S0140-6736(14)62248-0","article-title":"Prediction of perinatal depression from adolescence and before conception (VIHCS):20-year prospective cohort study","volume":"386","author":"Patton","year":"2015","journal-title":"Lancet."},{"key":"B30","doi-asserted-by":"publisher","first-page":"433","DOI":"10.1192\/bjp.172.5.433","article-title":"Detecting postnatal depression in Chinese women. Validation of the Chinese version of the Edinburgh Postnatal Depression Scale","volume":"172","author":"Lee","year":"1998","journal-title":"Br J Psychiatry."},{"key":"B31","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1016\/j.eplepsyres.2015.11.019","article-title":"Validation of the Generalized Anxiety Disorder-7 (GAD-7) among Chinese people with epilepsy","volume":"120","author":"Tong","year":"2016","journal-title":"Epilepsy Res."},{"key":"B32","doi-asserted-by":"publisher","first-page":"200","DOI":"10.3969\/j.issn.1002-0829.2010.04.002","article-title":"Reliability and validity of a generalized anxiety disorder scale in general hospital outpatients","volume":"2010","author":"He","year":"2010","journal-title":"Shanghai Arch Psychiatry."},{"key":"B33","doi-asserted-by":"publisher","first-page":"490","DOI":"10.1001\/jamapsychiatry.2013.87","article-title":"Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings","volume":"70","author":"Wisner","year":"2013","journal-title":"JAMA Psychiatry."},{"key":"B34","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1016\/S2215-0366(14)00055-8","article-title":"Action towards C, treatment C: heterogeneity of postpartum depression: a latent class analysis","volume":"2","author":"Postpartum","year":"2015","journal-title":"Lancet Psychiatry"},{"key":"B35","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1016\/j.jad.2008.07.008","article-title":"CSF and plasma cytokines at delivery and postpartum mood disturbances","volume":"115","author":"Boufidou","year":"2009","journal-title":"J Affect Disord."},{"key":"B36","doi-asserted-by":"publisher","first-page":"1073","DOI":"10.1016\/j.jpainsymman.2010.08.016","article-title":"Studies comparing numerical rating scales, verbal rating scales, and visual analogue scales for assessment of pain intensity in adults: a systematic literature review","volume":"41","author":"Hjermstad","year":"2011","journal-title":"J Pain Symptom Manage."},{"key":"B37","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1007\/s001340051150","article-title":"Using and understanding sedation scoring systems: a systematic review","volume":"26","author":"De Jonghe","year":"2000","journal-title":"Intensive Care Med."},{"key":"B38","doi-asserted-by":"publisher","first-page":"1332","DOI":"10.1097\/ALN.0b013e318289b84b","article-title":"Development and psychometric evaluation of a postoperative quality of recovery score: the QoR-15","volume":"118","author":"Stark","year":"2013","journal-title":"Anesthesiology."},{"key":"B39","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1007\/s40271-015-0148-6","article-title":"Validation of the Chinese version of the quality of recovery-15 score and its comparison with the post-operative quality recovery scale","volume":"9","author":"Bu","year":"2016","journal-title":"Patient."},{"key":"B40","volume-title":"Antenatal and Postnatal Mental Health: The NICE Guideline on Clinical Management and Service Guidance","year":"2014"},{"key":"B41","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1016\/j.jad.2017.03.023","article-title":"Genetic variants of the kynurenine-3-monooxygenase and postpartum depressive symptoms after cesarean section in Chinese women","volume":"215","author":"Wang","year":"2017","journal-title":"J Affect Disord."},{"key":"B42","doi-asserted-by":"publisher","first-page":"136","DOI":"10.21037\/atm.2016.03.35","article-title":"Variable selection with stepwise and best subset approaches","volume":"4","author":"Zhang","year":"2016","journal-title":"Ann Transl Med."},{"key":"B43","doi-asserted-by":"crossref","first-page":"1800","DOI":"10.1016\/S0140-6736(14)61277-0","article-title":"Effects of perinatal mental disorders on the fetus and child","volume":"384","author":"Stein","year":"2014","journal-title":"Lancet."},{"key":"B44","doi-asserted-by":"publisher","first-page":"208","DOI":"10.1016\/j.jchromb.2016.11.015","article-title":"Detection of dexmedetomidine in human breast milk using liquid chromatography-tandem mass spectrometry: application to a study of drug safety in breastfeeding after Cesarean section","volume":"1040","author":"Nakanishi","year":"2017","journal-title":"J Chromatogr B Analyt Technol Biomed Life Sci."},{"key":"B45","doi-asserted-by":"publisher","first-page":"524","DOI":"10.1016\/j.jad.2018.10.361","article-title":"A placebo controlled treatment trial of sertraline and interpersonal psychotherapy for postpartum depression","volume":"245","author":"O'Hara","year":"2019","journal-title":"J Affect Disord."},{"key":"B46","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1016\/j.brainres.2004.05.026","article-title":"Effects of tramadol on alpha2-adrenergic receptors in the rat brain","volume":"1016","author":"Faron-Gorecka","year":"2004","journal-title":"Brain Res."},{"key":"B47","doi-asserted-by":"publisher","first-page":"256","DOI":"10.1046\/j.1471-4159.1994.63010256.x","article-title":"Autoradiographic demonstration of increased alpha 2-adrenoceptor agonist binding sites in the hippocampus and frontal cortex of depressed suicide victims","volume":"63","author":"Gonzalez","year":"1994","journal-title":"J Neurochem."},{"key":"B48","doi-asserted-by":"publisher","first-page":"617","DOI":"10.1046\/j.1471-4159.1994.63020617.x","article-title":"Agonist binding to alpha 2-adrenoceptors is elevated in the locus coeruleus from victims of suicide","volume":"63","author":"Ordway","year":"1994","journal-title":"J Neurochem."},{"key":"B49","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1016\/j.pain.2011.11.001","article-title":"Impact of pain on the course of depressive and anxiety disorders","volume":"153","author":"Gerrits","year":"2012","journal-title":"Pain."},{"key":"B50","doi-asserted-by":"publisher","first-page":"504691","DOI":"10.1155\/2015\/504691","article-title":"Neuroplasticity underlying the comorbidity of pain and depression","volume":"2015","author":"Doan","year":"2015","journal-title":"Neural Plast."},{"key":"B51","doi-asserted-by":"publisher","first-page":"857","DOI":"10.1097\/00000539-199904000-00033","article-title":"A comparison of epidural ropivacaine infusion alone and in combination with 1, 2, and 4 microg\/mL fentanyl for seventy-two hours of postoperative analgesia after major abdominal surgery","volume":"88","author":"Scott","year":"1999","journal-title":"Anesth Analg."},{"key":"B52","doi-asserted-by":"publisher","first-page":"105","DOI":"10.1016\/j.smrv.2019.03.005","article-title":"The effect of opioid therapy on sleep quality in patients with chronic non-malignant pain. A systematic review and exploratory meta-analysis","volume":"45","author":"Tang","year":"2019","journal-title":"Sleep Med Rev."},{"key":"B53","doi-asserted-by":"publisher","first-page":"1045","DOI":"10.1185\/03007990902797790","article-title":"Sleep disturbances in patients with chronic pain: effectively managing opioid analgesia to improve outcomes","volume":"25","author":"Brennan","year":"2009","journal-title":"Curr Med Res Opin."},{"key":"B54","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1007\/s007260170064","article-title":"Influence of exercise on serotonergic neuromodulation in the brain","volume":"20","author":"Weicker","year":"2001","journal-title":"Amino Acids."},{"key":"B55","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1016\/0304-3959(84)90061-7","article-title":"Pain sensitivity, mood and plasma endocrine levels in man following long-distance running: effects of naloxone","volume":"19","author":"Janal","year":"1984","journal-title":"Pain."},{"key":"B56","doi-asserted-by":"publisher","first-page":"33","DOI":"10.1016\/S0272-7358(99)00032-X","article-title":"Effects of physical exercise on anxiety, depression, and sensitivity to stress: a unifying theory","volume":"21","author":"Salmon","year":"2001","journal-title":"Clin Psychol Rev."},{"key":"B57","doi-asserted-by":"publisher","first-page":"1789","DOI":"10.1016\/S0140-6736(14)61278-2","article-title":"Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period","volume":"384","author":"Jones","year":"2014","journal-title":"Lancet."},{"key":"B58","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1016\/j.jad.2003.08.004","article-title":"The course of anxiety and depression through pregnancy and the postpartum in a community sample","volume":"80","author":"Heron","year":"2004","journal-title":"J Affect Disord."},{"key":"B59","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/S0376-8716(99)00041-1","article-title":"A postmarketing surveillance program to monitor Ultram (tramadol hydrochloride) abuse in the United States","volume":"57","author":"Cicero","year":"1999","journal-title":"Drug Alcohol Depend"},{"key":"B60","doi-asserted-by":"publisher","first-page":"39","DOI":"10.2165\/00003495-199400471-00007","article-title":"Acute effects of tramadol in methadone-maintained volunteers","volume":"47","author":"Cami","year":"1994","journal-title":"Drugs."},{"key":"B61","doi-asserted-by":"publisher","first-page":"830","DOI":"10.1089\/jwh.2011.3466","article-title":"Depression and treatment among U.S. pregnant and nonpregnant women of reproductive age, 2005-2009.","volume":"21","author":"Ko","year":"2012","journal-title":"J Womens Health."},{"key":"B62","doi-asserted-by":"publisher","first-page":"1080","DOI":"10.1067\/mob.2000.105409","article-title":"Postpartum depression: a comparison of screening and routine clinical evaluation","volume":"182","author":"Evins","year":"2000","journal-title":"Am J Obstet Gynecol."},{"key":"B63","doi-asserted-by":"publisher","first-page":"899","DOI":"10.1067\/mob.2002.123404","article-title":"Diagnosing postpartum depression: can we do better?","volume":"186","author":"Fergerson","year":"2002","journal-title":"Am J Obstet Gynecol."},{"key":"B64","doi-asserted-by":"publisher","first-page":"879","DOI":"10.2165\/00003088-200443130-00004","article-title":"Clinical pharmacology of tramadol","volume":"43","author":"Grond","year":"2004","journal-title":"Clin Pharmacokinet."},{"key":"B65","doi-asserted-by":"publisher","first-page":"1110","DOI":"10.1136\/archdischild-2017-313786","article-title":"Tramadol, breast feeding, and safety in the newborn","volume":"103","author":"Palmer","year":"2018","journal-title":"Arch Dis Child."},{"key":"B66","doi-asserted-by":"publisher","first-page":"266","DOI":"10.1111\/j.1460-9592.2010.03389.x","article-title":"Developmental pharmacology of tramadol during infancy: ontogeny, pharmacogenetics, and elimination clearance","volume":"21","author":"Allegaert","year":"2011","journal-title":"Paediatr Anaesth."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2021.679159\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,5,27]],"date-time":"2021-05-27T14:08:14Z","timestamp":1622124494000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2021.679159\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,27]]},"references-count":66,"alternative-id":["10.3389\/fmed.2021.679159"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2021.679159","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,27]]},"article-number":"679159"}}