The Relationship Between Perioperative Use of Esketamine and Postpartum Depression Risk: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

Yuansheng Cao,1 Lijuan Fu,1 Xianjie Zhang,1 Leqiang Xia,1 Rui Zhou2 1Department of Anesthesiology, Deyang People’s Hospital, Deyang, People’s Republic of China; 2Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation, Translational Research Institute of Brain and Brain-Like Intelligence, Clinical Research Center for Anesthesiology and Perioperative Medicine, Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, People’s Republic of ChinaCorrespondence: Rui Zhou, Shanghai Fourth People’s Hospital, No. 1279, Sanmen Road, Hongkou District, Shanghai, 200434, People’s Republic of China, Email [email protected]: To determine whether perioperative esketamine use decreases the risk of postpartum depression (PPD).Methods: Online search of PubMed, Web of Science, and Embase was conducted to identify relevant studies. Key words for search included, but were not limited to, postpartum depression, esketamine, and clinical trials. The mean and standard deviation of the Edinburgh Postnatal Depression Scale (EPDS) scores were extracted from the studies as primary parameters.Results: The literature search identified 226 articles, of which 5 met the criteria and were enrolled in the study. In total, 886 patients in the studies were taken into analysis. The EPDS scores in the esketamine group were lower than those of the control group at the early stage of puerperium (WMD=− 2.05, 95% CI: − 3.77, − 0.34, p=0.019), whereas there was no significant difference at the middle and later stages (WMD=− 1.41, 95% CI: − 2.86, 0.04, p=0.056). The sensitivity analyses indicated that the result for the early stage was stable, whereas it was unreliable for the middle and later stages. The results of the Egger’s test indicated no publication bias.Conclusion: Perioperative use of esketamine contributes to a lower risk of PPD at the early stage of puerperium but not at the middle and later stages. To further verify this conclusion, more high-quality studies are required.Keywords: esketamine, postpartum depression, pregnant women, mental health

Keywords

• esketamine
• postpartum depression
• pregnant women
• mental health.