Neurological

Maternal Epidural Anesthesia and Autism Risk in Children: Is There a Link?

The use of maternal epidural analgesia during labor and delivery is associated with a slightly increased risk of autism spectrum disorder (ASD) in the offspring. However, the interpretation of these results is likely to be constrained by residual mix-ups with study data that do not provide strong evidence for the association. These are the results of a Canadian study published in JAMA.

Epidural analgesia has a good safety and efficacy profile at reducing labor pain more effectively than opioids, but data on the long-term outcomes associated with epidural analgesia are limited. Previous research into the use of epidural analgesics during labor and delivery and the risk of ASA in children has produced conflicting results. The aim of the current study was to evaluate detailed data on prenatal care and on birth and birth dates in connection with ASA diagnoses in a population-based study in order to determine whether maternal epidural anesthesia is associated with a risk of ASA in offspring.

The retrospective cohort study included women who gave birth to a living native child from April 1, 2000 to December 31, 2014 in British Columbia, Canada. All children were followed up until a clinical diagnosis of ASD, death, graduation on December 31, 2016, or until they left the province. The British Columbia Autism Assessment Network and the British Columbia Ministry of Education were used to obtain ASD clinical diagnostic data.

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The total cohort comprised 599,527 single births from 386,192 women. After exclusions, the main cohort included 388,254 vaginal deliveries to 258,472 women, of which 111,480 infants (28.71%) were born to women who used epidural analgesia during labor and delivery. The mean (SD) age for women exposed to epidural analgesia was 29.9 (5.5) compared with 30.1 (5.5) for those not exposed. The children were followed up for a mean of 9.05 years (4.3 years).

After the follow-up examination on December 31, 2016, 5,192 children (1.34%) were diagnosed with ASA. 1,710 children (1.53%) of the 111,480 deliveries exposed to epidural analgesia (94,157 women) were diagnosed with ASD, compared with an ASD diagnosis in 3,482 children (1.26%) from the 276,774 deliveries who were none Were exposed to epidural analgesia (192,510 women) (absolute risk difference 0.28%) [95% CI, 0.19%-0.36%]).

The hazard ratio (HR) was 1.32 (95% CI, 1.24-1.40) for the association between ASA and exposure to epidural analgesia in the unadjusted analysis. In the fully adjusted analysis, which also took into account induction, gestational age, gender, status small or large for gestational age at birth, and the congenital abnormality, a further weakening was observed (fully adjusted HR 1.09 [95% CI, 1.00-1.15]).

No statistically significant association with regard to the use of epidural analgesics during labor and delivery with ASA was observed for the conditional logistic regression (839/1659.) Adjusted within the woman [50.6%] in the exposed group vs 1905/4587 [41.5%] in the unexposed group; fully adjusted hazard ratio, 1.07 [95% CI, 0.87-1.30]).

The limitations of the study included the observational design and the important differences between births to which epidural analgesia was used and not, particularly for variables suggesting a poorer prognosis for women exposed to epidural analgesia. In addition, there was no detailed information on the dose of epidural analgesia in order to directly address the dose-response relationship.

“Given the likelihood of residual mix-ups that may be responsible for the results, these results do not provide strong evidence for this association,” said the researchers. “In addition, there was no statistically significant association between epidural analgesia and ASA in the maternal matched analysis or the sibling cohort.”

reference

Hanley GE, Bickford C, Ip A, et al. Association of epidural analgesia during labor and delivery with autism spectrum disorder in offspring. JAMA. Published online September 28, 2021. doi: 10.1001 / jama.2021.14986

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