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Perioperative Esketamine Administration for Prevention of Postpartum Depression After the Cesarean Section: A Systematic Review and Meta-Analysis Publisher Pubmed



Parsaei M1, 2 ; Hasehmi SM3 ; Seyedmirzaei H4 ; Cattarinussi G5 ; Sambataro F5 ; Brambilla P7, 8 ; Barone Y8 ; Delvecchio G8
Authors
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Authors Affiliations
  1. 1. Breastfeeding Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
  2. 2. Maternal, Fetal, and Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
  3. 3. School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
  4. 4. Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
  5. 5. Department of Neuroscience (DNS), Padua Neuroscience Center, University of Padova, Padua, Italy
  6. 6. Padua Neuroscience Center, University of Padova, Padua, Italy
  7. 7. Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
  8. 8. Department of Neurosciences and Mental Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy

Source: Journal of Affective Disorders Published:2024


Abstract

Background: Postpartum Depression (PPD) exerts a substantial negative effect on maternal well-being post-delivery, particularly among Cesarean Section (C/S) recipients. In this study, we aimed to review the efficacy of perioperative esketamine, the S-enantiomer of ketamine, in preventing PPD incidence and depressive symptoms as measured with the Edinburgh Postnatal Depression Scale (EPDS) after C/S. Methods: A systematic search for relevant articles was conducted in Scopus, PubMed, Web of Sciences, and PsycINFO until April 6, 2024. Meta-analyses were conducted using random-effect models to compare the PPD incidence and EPDS scores via log odds ratio and Hedge's g, respectively, during the first week post-C/S and at 42 days post-C/S in the esketamine and control group. Results: Fourteen studies, including 12 randomized controlled trials and 2 retrospective cohorts, were reviewed. Our meta-analyses found lower PPD incidence during the first week (log odds ratio: −0.956 [95 % confidence interval: −1.420, −0.491]) and at day 42 post-C/S (log odds ratio: −0.989 [95 % confidence interval: −1.707, −0.272]) among patients administered esketamine compared to controls. Additionally, EPDS scores for the esketamine group were significantly lower than controls during the first week (Hedge's g: −0.682 [95 % confidence interval: −1.088, −0.276]) and at day 42 post-C/S (Hedge's g: −0.614 [95 % confidence interval: −1.098, −0.129]). Limitations: Presence of various concomitant medications and heterogeneous study designs. Conclusion: Our review highlights the potential impact of esketamine in PPD prevention, as well as in alleviating depressive symptoms post-C/S, regardless of PPD occurrence, therefore suggesting the benefits of adding esketamine to peri-C/S analgesic regimen. © 2024 Elsevier B.V.
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