{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T06:38:14Z","timestamp":1777012694737,"version":"3.51.4"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000},"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. Pharmacol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Postpartum depression (PPD) is a significant concern in obstetrics. This study aimed to investigate the effects of hydromorphone in patient-controlled intravenous analgesia (PCIA) on PPD and sleep disorders following cesarean section.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 140 parturients undergoing elective cesarean section under combined spinal-epidural anesthesia, with singleton full-term pregnancy and aged 22\u201335\u00a0years, were enrolled from July to December 2025 at Jiangning Hospital Affiliated to Nanjing Medical University. Using a random number table, participants were allocated to two groups based on PCIA formulation: the sufentanil group (Group S) received sufentanil (3\u00a0\u03bcg\/kg) + tropisetron (0.1\u00a0mg\/kg) diluted to 150\u00a0mL with normal saline; the hydromorphone group (Group H) received hydromorphone (0.15\u00a0mg\/kg) + tropisetron (0.1\u00a0mg\/kg) diluted to 150\u00a0mL with normal saline. The primary outcome was the incidence of PPD at 6\u00a0weeks postoperatively. Secondary outcomes included PPD incidence at 1\u00a0week, Ramsay sedation scores at 24 and 48\u00a0h, Pittsburgh Sleep Quality Index (PSQI) scores preoperatively and at 24\/48\u00a0h, resting Visual Analog Scale (VAS) pain scores at 6, 12, 24, and 48\u00a0h, PCIA button presses and rescue analgesia within 48\u00a0h, cumulative 48-hour opioid consumption, bowel function recovery time, first lactation time, neonatal behavioral neurological assessment (NBNA) scores at 48\u00a0h postoperatively and adverse reactions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The incidence of PPD at 6\u00a0weeks was significantly lower in Group H compared to Group S [5.8% vs. 20.6%, relative risk (RR) = 0.28, 95% confidence interval (CI) 0.10 to 0.78,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.004]. The absolute risk reduction was 14.8% (95% CI 4.2%\u201325.4%), corresponding to a number needed to treat (NNT) of 7 (95% CI 4\u201324). Ramsay and PSQI scores at 24 and 48\u00a0h were also significantly lower in Group H (\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.01 for all), as was the incidence of dizziness and drowsiness within 48\u00a0h (\n                      <jats:italic>P<\/jats:italic>\n                      &amp;lt; 0.01). No significant intergroup differences were found in analgesia-related outcomes or other adverse reactions.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Hydromorphone for PCIA after cesarean section can reduce the incidence of PPD at 6\u00a0weeks, improve early postoperative sleep quality, and decrease dizziness and drowsiness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Trial Registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link>https:\/\/www.chictr.org.cn\/bin\/home<\/jats:ext-link>\n                      , identifier ChiCTR2500105264.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fphar.2026.1802702","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T05:42:59Z","timestamp":1777009379000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Effects of hydromorphone for patient-controlled intravenous analgesia on postpartum depression and sleep disorders after cesarean section: a randomized, double-blind controlled trial"],"prefix":"10.3389","volume":"17","author":[{"given":"Yun","family":"Zhu","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Nanjing Jiangning Hospital of Traditional Chinese Medicine","place":["Nanjing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chao","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Nanjing Jiangning Hospital of Traditional Chinese Medicine","place":["Nanjing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiangxiang","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, The Affiliated Jiangning Hospital of Nanjing Medical University","place":["Nanjing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuanyuan","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Huainan First People\u2019s Hospital, The First Affiliated Hospital of Anhui University of Science and Technology","place":["Huainan, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lei","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, The Affiliated Jiangning Hospital of Nanjing Medical University","place":["Nanjing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qi","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, The Affiliated Jiangning Hospital of Nanjing Medical University","place":["Nanjing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jie","family":"Lv","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, The Affiliated Jiangning Hospital of Nanjing Medical University","place":["Nanjing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, The Affiliated Jiangning Hospital of Nanjing Medical University","place":["Nanjing, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e77376","DOI":"10.2196\/77376","article-title":"AI for detecting and predicting postpartum depression: scoping review","volume":"28","author":"Alkhateeb","year":"2026","journal-title":"J. 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