Epidural Analgesia During Labor Might Increase Autism Risk

Epidural analgesia during labor (LEA) is associated with an increased risk of autism-spectrum disorder in offspring, according to a retrospective study.

"Exposure to LEA during pregnancy may have long-term effects on neurodevelopment in children," Dr. Chunyuan Qiu of Kaiser Permanente Baldwin Park Medical Center, in California, told Reuters Health by email.

More than 70% of women receive epidural analgesia or some other form of neuraxial anesthesia during labor. This has been shown to be effective for the mother and safe for the fetus and newborn during the perinatal period, but the long-term effects of neuraxial anesthesia on offspring are largely unknown.

Dr. Qiu and colleagues used Kaiser Permanente electronic medical record data from 2008 through 2015 to assess whether LEA for routine vaginal delivery is associated with ASD risk in offspring.

Among more than 147,000 children born to nearly 120,000 women, 74.2% were born to women exposed to LEA.

Fever rates were higher in mothers in the LEA group (11.9%) than in the non-LEA group (1.3%); 1.1% of mothers in the LEA group had fever prior to LEA.

Overall, 1.9% of children in the LEA group and 1.3% of children in the non-LEA group received a diagnosis of ASD during follow-up, the researchers report in JAMA Pediatrics.

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In a bivariable analysis adjusted for birth year, LEA was associated with a significant 48% increased risk of ASD. In models estimated from the inverse probability of treatment weighting (IPTW) and covariate adjustment, LEA was associated with significant 38% and 37% increases in risk of ASD%, respectively.

There was a significant trend of increasing ASD risk with increased duration of LEA exposure amounting to a 5% increased risk per four hours of LEA.

Fever after LEA was not associated with ASD risk.

Analyses limited to one child per family, excluding children with preterm birth or children with birth defects at delivery, or excluding children born at less than 37 weeks' gestation, yielded similar but somewhat higher ASD risks associated with LEA.

Coauthor Dr. Anny H. Xiang of Kaiser Permanente Southern California, in Pasadena, told Reuters Health by email, "ASD is rare, with multi-complex etiologies which still requires more research; although we did see a relative risk increase of 37% associated with LEA, the absolute risk is still small (1.3% in non LEA group and 1.9% in LEA group)."

"We do not advise change of clinical practice or inclusion of this information as part of the informed consent, since this is the first observational study showing the associations," Dr. Qiu said. "No causal relationship can be drawn."

"More research is needed to confirm the study findings and to understand the potential mechanisms before making any recommendations, since LEA is still beneficial for labor pain control," he said.

Dr. Idan Menashe of Ben-Gurion University of the Negev and the National Autism Research Center of Israel, in Be'er Sheva, who recently reported a possible association between general anesthesia and ASD in offspring of women undergoing cesarean delivery, told Reuters Health by email, "This paper adds to increasing evidence about a range of pre- and perinatal factors associated with autism risk in the offspring. The findings of this paper are particularly important because they highlight a new factor which is not considered a medical necessity."

"While these results are based on an observational study and therefore do not necessarily suggest a causal link between EA and autism, they should be conveyed (with the necessary reservations) to women considering EA before delivery," he said.

—Will Boggs MD

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