Epidural analgesia during labor increases risk of neonatal infection: JAMA Study

China: A recent study in JAMA Network Open has found the use of epidural analgesia during labor to be associated with an increased risk of neonatal infection. The findings support efforts for further improvement of delivery care and safety and quality of labor for parturient women.

Management of the post parturition complications is crucial. Epidural analgesia during labor could help ease the pain for parturient women however it has its own consequences. 

Lijie Jia, Shanghai Jiao Tong University School of Medicine, Shanghai, China, and colleagues aimed to evaluate the association between epidural analgesia use during labor and neonatal infection in a large cohort of parturient women.

A cohort study was conducted at a university-affiliated hospital in Shanghai, China. Women at full-term pregnancy undergoing vaginal delivery between January 2013 and October 2018 were included in the study. Parturient women who were parous, experiencing premature delivery (gestational age <37 weeks), were pregnant with more than 1 fetus, or had experienced a stillbirth were excluded. Data were analyzed from October 2019 to June 2020.

The results of the study were primarily evaluated for the incidence of neonatal infection, including neonatal sepsis, neonatal uncharacterized infection, neonatal pneumonia, and neonatal necrotizing enterocolitis reported in the medical record. It included the incidence of maternal intrapartum fever and histologic chorioamnionitis.

• A total of 37 786 parturient women were included (mean [SD] age, 29.5 years), 19 968 (52.8%) received epidural analgesia during labor. In the propensity score-matched cohort (including 15 401 parturient women in each group).

• The use of epidural analgesia was associated with a higher incidence of neonatal infection (absolute risk difference, 2.6%; relative risk [RR], 2.43), including higher incidence of sepsis (absolute risk difference, 0.1%; RR, 3.50).

• The uncharacterized infection (absolute risk difference, 2.2%; RR, 2.69), compared with no epidural analgesia use.

• Use of epidural analgesia was also associated with a greater incidence of maternal intrapartum fever (RR, 4.12) and histologic chorioamnionitis (RR, 4.08) compared with no epidural analgesia use.

Dr. Jia and the team concluded that "This cohort study found that use of epidural analgesia in full-term nulliparous women undergoing vaginal delivery was associated with an increased risk of neonatal infection, pending further investigation. These findings support efforts to further improve safety and quality of labor and delivery care for parturient women."

"However, findings from this study should not be the reason for refusing epidural analgesia but should lead to more studies to improve the quality and safety of labor and delivery care, including epidural analgesia, in parturient women," they wrote. 

Reference:

Jia L, Cao H, Guo Y, et al. Evaluation of Epidural Analgesia Use During Labor and Infection in Full-term Neonates Delivered Vaginally. JAMA Netw Open. 2021;4(9):e2123757. doi:10.1001/jamanetworkopen.2021.23757