Study finds no link between epidural labor analgesia and autism

April 22, 2021

2 min read

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Disclosures:
Hanley and Wall-Wieler do not report relevant financial information. See the study for all relevant financial disclosures from other authors.

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A Canadian study of more than 123,000 births found no association between exposure to labor epidural pain relief and an increased risk of autism spectrum disorder in children, according to findings published in JAMA Pediatrics.

Elizabeth Wall-Wieler, PhD, an assistant professor of community health services at the University of Manitoba, and colleagues conducted a longitudinal cohort study of vaginal deliveries of solitary babies born April 1, 2005 through March 31, 2016, based on a population-based dataset that linked information from healthcare databases in Manitoba.

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Wall-Wieler and colleagues cited a study published by Qui and colleagues last year that suggested that there may be a link between epidural analgesia for vaginal delivery and autism in children.

The current study included 123,175 births, the majority of which were male infants (50.9%; 62,647). Of the total, 80,459 babies had at least one sibling. Wall-Wieler and colleagues classified a diagnosis of autism spectrum disorder (ASD) by the presence of at least one diagnosis at 18 months of age. Of the total number of births, 47,011 infants (38.2%) were exposed to epidural labor analgesia (ELA).

On April 1, 2019, 2.1% (985 of 47,011) of infants exposed to ELA were diagnosed with ASD, compared to 1.7% (1272 of 76,164) of infants not exposed to ELA (HR = 1 , 25; 95% CI, 1.15-1.36), Wall-Wieler and colleagues reported. There was also no association after adjusting for perinatal covariates (inverse probability of treatment weighted HR = 1.08; 95% CI 0.97-1.2).

ELA-exposed offspring were at a slightly higher risk in a sibling cohort (HR = 1.25; 95% CI, 1.12-1.39).

“Our findings suggest that the use of ELA is not associated with an increased risk of ASD for the offspring,” the authors wrote.

In a related editorial, Gillian E. Hanley, PhD, a postdoctoral fellow at the University of British Columbia, and colleagues called for further research into the matter.

“Epidural labor pain relief is an extremely effective approach to obstetric analgesia, and we have a collective responsibility to understand whether it is a safe option that provides a healthy developmental pathway well into childhood,” Hanley and colleagues wrote. “Women have the right to make a truly informed choice about their pain relief during labor: for their health and that of her newborn.”

References:

Hanley GE, et al. JAMA Pediatr. 2021; doi: 10.1001 / jamapediatrics.2021.0382.

Qui C, et al. JAMA Pediatr. 2020; doi: 10.1001 / jamapediatrics.2020.3231.

Wall-Wieler E, et al. JAMA Pediatr. 2021; doi: 10.1001 / jamapediatrics.2021.0376.

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