Cerebrospinal Fluid Proteome of Patients With Persistent Pain and/or Postpartum Depression After Elective Cesarean Delivery: An Exploratory Prospective Cohort Study

( J Clin Anesth . 2025:104:111855. doi: 10.1016/j.jclinane.2025.111855) Cesarean delivery (CD) accounts for approximately one-third of deliveries in the United States and up to 21% of deliveries globally every year. Persistent pain after CD can lead to poor recovery and an increased risk for postpartum depression (PPD); PPD is a leading cause of maternal mortality, and there have been recent studies showing a correlation between chronic pain after CD and PPD. Expected recovery for CD is 8 weeks, but pain that lasts beyond this timeline is estimated to occur in more than 10% of cases; there are no predictive tools that currently are able to identify patients at risk of prolonged pain, meaning there is little to be done by practitioners to limit the occurrence of this outcome. One possibility that could result in identification of these patients is cerebrospinal fluid (CSF) biomarkers that have previously been used to assess patients with chronic pain conditions in nonobstetric populations. This study was designed to assess unbiased proteomics in CSF for the identification of patients with the potential to have chronic pain after CD and/or PPD.