Effects of perioperative application of esketamine on postpartum depression in cesarean section: A systematic review and meta-analysis

Abstract

Background: To evaluate the effect of perioperative esketamine administration on postpartum depression in pregnant women undergoing cesarean section. Methods: Data sources was PubMed, Embase, Web of Science, and Cochrane Library from inception to February 1, 2024. Randomized controlled trials in pregnant women undergoing cesarean section were selected and compared to the use of esketamine in the perioperative period. The primary outcome measure was the incidence of postpartum maternal depression. Preferred reporting items for systematic reviews and meta-analyses were used. Data pooled by random-effects models are presented as risk ratios (RR) (95% confidence intervals, 95% CI) or mean differences (95% CI). This review was registered in PROSPERO (ID: CRD42023431197). Results: We included 8 studies with a total of 1655 participants. The quality of the studies was rated high or unclear. Seven studies involving 1485 participants reported the incidence of postpartum depression. Compared with pregnant women undergoing cesarean section without the use of esketamine, those using esketamine in the perioperative period showed a 48% decreased risk of developing postpartum depression (RR: 0.52, 95% CI: 0.35–0.79) and a 1.43-point reduction in EPDS (Edinburgh Postnatal Depression Scale) (mean difference: −1.43, 95% CI: −2.32 to −0.54). For immediate intraoperative adverse reactions, the application of esketamine caused maternal nausea and vomiting (RR: 2.16, 95% CI: 1.22–3.81), dizziness (RR: 6.11, 95% CI: 1.49–24.98), and hallucinations (RR: 6.83, 95% CI: 1.57–29.68) compared to no esketamine use. Conclusions: Perioperative use of esketamine in pregnant women undergoing cesarean section may reduce postpartum depression and increase intraoperative adverse reactions, but has no significant effect on postoperative adverse reactions.