Epidural analgesia during vaginal delivery increases autism risk in children: JAMA
USA: The use of epidural analgesia for vaginal delivery in mothers may increase the risk of autism in children, suggests a recent study in the journal JAMA Pediatrics.
Epidural analgesia is being used commonly and is known to improve outcomes for both neonates and mothers but the recent findings from the study are of concern in the context of long-term neurodevelopmental disorders in offspring.
Chunyuan Qiu, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, California, and colleagues assess the association between maternal labor epidural analgesia (LEA) exposure and risk of autism spectrum disorders (ASDs) in offspring.
The researchers derived data for this study from electronic medical records from a population-based clinical birth cohort. It included a total of 147 895 singleton children born through vaginal delivery between January 1, 2008, and December 31, 2015, in a single integrated health care system. They were followed up from the age of 1 year until the first date of the following occurrences: clinical diagnosis of ASD, last date of health plan enrollment, death, or the study end date of December 31, 2018.
The main outcome was the clinical diagnosis of ASD.
Among the cohort of 147 895 singleton children, 74.2% were exposed to maternal LEA.
Key findings of the study include:
- Fever during labor was observed in 11.9% of mothers in the LEA group and 1.3% mothers in the non-LEA group.
- Autism spectrum disorders were diagnosed in 1.9% of children in the LEA group and 1.3% children in the non-LEA group.
- After adjusting for potential confounders, including birth year, medical center, maternal age at delivery, parity, race/ethnicity, educational level, household income, history of comorbidity, diabetes during pregnancy, smoking during pregnancy, preeclampsia or eclampsia, prepregnancy body mass index, gestational weight gain, gestational age at delivery, and birth weight, the HR associated with LEA vs non-LEA exposure was 1.37.
- Relative to the unexposed group, the adjusted HR associated with LEA exposure of less than 4 hours was 1.33, with LEA exposure of 4 to 8 hours was 1.35, and with LEA exposure of more than 8 hours was 1.46.
- Within the LEA group, there was a significant trend of ASD risk associated with increasing duration of LEA exposure after adjusting for covariates (HR for linear trend, 1.05).
- Adding fever to the model did not change the HR estimate associated with LEA exposure (adjusted HR for LEA vs non-LEA, 1.37).
"This study suggests that maternal LEA may be associated with increased risk of autism in children. The risk appears to not be directly associated with epidural-related maternal fever. Further research is warranted to confirm the study findings and understand the potential mechanisms," concluded the authors.
The study, "Association Between Epidural Analgesia During Labor and Risk of Autism Spectrum Disorders in Offspring," is published in the journal JAMA Pediatrics.