Dexmedetomidine in PPD
Trial question
What is the effect of dexmedetomidine on postpartum depression in women with prenatal depression?
Study design
Multi-center
Open label
RCT
Population
338 female patients.
Inclusion criteria: adult women with prenatal depression undergoing Cesarean delivery.
Interventions
N=169 dexmedetomidine (loading dose of intravenous infusion of 0.5 mcg/kg for 10 minutes after delivery, followed by dexmedetomidine plus sufentanil via patient-controlled intravenous analgesia for 48 hours).
N=169 normal saline (loading dose of intravenous infusion of 0.9% saline for 10 minutes after delivery, followed by sufentanil via patient-controlled intravenous analgesia for 48 hours).
Primary outcome
Positive postpartum depression screening incidence at 7 days postpartum
12.6%
32.1%
32.1 %
24.1 %
16.1 %
8.0 %
0.0 %
Dexmedetomidine
Normal
saline
Significant
decrease ▼
NNT = 5
Significant decrease in positive postpartum depression screening incidence at 7 days postpartum (12.6% vs. 32.1%; RR 0.39, 95% CI 0.25 to 0.62).
Secondary outcomes
Significant decrease in positive postpartum depression screening incidence at 42 days post partum (11.4% vs. 30.3%; RR 0.38, 95% CI 0.23 to 0.61).
Significant decrease in the rate of suicidal ideation postpartum day 7 (1.2% vs. 5.5%; RR 0.22, 95% CI 0.05 to 1).
No significant difference in the rate of suicidal ideation postpartum day 42 (2.4% vs. 4.2%; RR 0.57, 95% CI 0.17 to 1.89).
Safety outcomes
Significant difference in hypotension (18.3% vs. 9.5%).
Conclusion
In adult women with prenatal depression undergoing Cesarean delivery, dexmedetomidine was superior to normal saline with respect to positive postpartum depression screening incidence at 7 days postpartum.
Reference
Yingyong Zhou, Zhihong Bai, Wenchao Zhang et al. Effect of Dexmedetomidine on Postpartum Depression in Women With Prenatal Depression: A Randomized Clinical Trial. JAMA Netw Open. 2024 Jan 2;7(1):e2353252.
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