Scholars@Duke publication: Cerebrospinal fluid proteome of patients with persistent pain and/or postpartum depression after elective cesarean delivery: An exploratory prospective cohort study.

Cerebrospinal fluid proteome of patients with persistent pain and/or postpartum depression after elective cesarean delivery: An exploratory prospective cohort study.

Publication , Journal Article

Yurashevich, M; Devinney, M; Foster, MW; Myers, R; O'Grady, N; Ji, R-R; Habib, AS; Berger, M

Published in: J Clin Anesth

June 2025

BACKGROUND: Persistent pain (>2 months) after cesarean delivery (CD) can affect up to 20 % of patients, and is associated with increased risk for postpartum depression (PPD). Preoperative identification of patients at risk for persistent pain and PPD remains a challenge due to poorly understood underlying mechanisms. To better understand these potential mechanisms, here, we examined the preoperative cerebrospinal (CSF) proteome for changes associated with persistent pain or PPD at 3 months post-CD. METHODS: Eighty patients undergoing elective CD under neuraxial anesthesia were recruited. We collected baseline demographics, obstetric data, and Edinburgh Postnatal Depression Scale (EPDS) scores. EPDS and pain scores were also obtained at 3 months post-CD. CSF was collected before spinal anesthetic placement. Liquid chromatography coupled with tandem mass spectrometry was used to study the CSF proteome. RESULTS: 63 patients completed clinical follow-up, however only 61 of the patients had adequate preoperative CSF sample for analysis. Of these 61 patients, 21 developed pain or PPD at 3 months post-CD (14 had persistent pain alone and 7 had PPD alone). Over 1600 proteins were quantified in each CSF sample. Forty-three of these proteins were nominally differentially expressed in patients with persistent pain and/or PPD vs those with neither disorder. Pathway analysis showed a downregulation of the complement and coagulation cascades in the preoperative CSF of patients who later developed persistent pain or PPD 3 months after CD. CONCLUSIONS: These results suggest that the CSF complement and coagulation cascades may play a role in patients who develop postpartum pain or PPD 3 months later.