According to a longitudinal cohort study from Canada, babies born to mothers who used epidural analgesia during labor were not at an increased risk of developing autism spectrum disorder (ASD).
About 2.1% of children exposed to epidural pain relief (ELA) developed ASD, compared to 1.7% who were not exposed (HR 1.25, 95% CI 1.15-1.36), Elizabeth reported Wall-Wieler, PhD, from the University of Manitoba in Winnipeg and colleagues.
But after adjusting for maternal sociodemographic factors, pre-pregnancy, pregnancy, and perinatal factors, the researchers found no association between epidural analgesia and ASD risk in children (HR 1.08, 95% CI 0.97-1.20), wrote them in JAMA Pediatrics.
“This finding is of clinical importance in the context of pregnant women and their obstetric and anesthesia care professionals considering ELA during labor,” noted Wall-Wieler and colleagues.
The group’s results contradict a recent study by Qiu et al. Who found a 37% increased risk of autism in children whose mothers were on epidural pain relief. This previous study did not take into account key perinatal factors, including induction of labor, contraction dysticks and fetal distress, and was criticized by five medical associations for possible residual disturbances.
Wall-Wieler and colleagues said ELA is recognized as the most effective method of delivering pain relief in labor, adding that future qualitative research should assess how their findings – as well as the earlier ones – have changed perceptions about perceived risk. . of ASD in offspring among both pregnant women and caregivers.
In an accompanying editorial, Gillian Hanley, PhD, of the University of British Columbia in Vancouver, and colleagues said that given the concerns arising from previous findings, “It is therefore with some relief that Wall-Wieler et al. controlling major socio-demographic and perinatal factors in the mother. “
However, they speculated whether the lack of evidence for a link between epidural analgesia and childhood autism should put clinicians at ease.
“Taken together, the articles by Qiu et al. And Wall-Wieler et al. Provide an important opportunity to examine critical questions about the plausibility of associations between obstetric care during labor and delivery and ASD risk,” the editors wrote. These studies allow researchers to further explore methodological approaches, they added, recognizing that the amount of anesthetic entering the newborn brain, the biological plausibility of risk with specific neonatal factors, and how ASD is diagnosed, all affect can be on these results.
“Epidural pain relief in childbirth is an extremely effective approach to obstetric pain relief,” noted Hanley’s group. “We have a collective responsibility to understand whether it is a safe option that provides a healthy development path well into childhood.”
Dimitri Christakis, MD, MPH, editor-in-chief of JAMA Pediatrics, wrote in an editor’s note that the journal’s publication of two similar studies with conflicting results in such a short period of time is evidence of the imperfect and iterative nature of the scientific process .
“For the time being, my personal estimate is that the association should not be definitively established yet,” wrote Christakis. “If a more definitive study is done, JAMA Pediatrics will publish it.”
Epidural analgesia is used by 73% of pregnant women in the US for pain during labor. As the incidence of ASD in the US increased from 0.66% in 2002 to 1.85% in 2016, there has been more focus on identifying potential environmental factors that put children at risk, Wall-Wieler and colleagues said.
This longitudinal cohort study included vaginal deliveries of loner babies born in Canada from 2005 to 2016. The group followed children from birth to 2019. Information was obtained from a population-based dataset linking care information from four health care providers.
More than 123,000 infants were enrolled in the study; approximately 38% were exposed to epidural analgesia during labor and approximately 80,000 had a sibling in the study cohort. Mothers were on average 28 years old.
Births with epidural analgesia were previously nulliparous, had premature rupture of membranes, antepartum haemorrhage, induction of contractions, increased contractions and fetal distress.
Most children with ASD were diagnosed in the outpatient setting, with about 75% receiving the initial diagnosis from a pediatrician. The mean age of children at first diagnosis was 4 years.
The researchers observed an association between ELA and autism risk before taking confounding factors into account; but after adjustment for all maternal sociodemographic factors, pre-pregnancy, pregnancy and perinatal factors, there was no association.
In a sibling analysis, researchers again saw a zero association after adjusting for all confounding factors (HR 1.14, 95% CI 0.99-1.30) and family fixative effects (inverse probability of treatment-weighted HR 0.97, 95% BI 0.78-1.22). Siblings exposed to epidural analgesia had a 2% cumulative risk of developing autism, and unexposed siblings had a 1.6% risk.
Wall-Wieler and colleagues noted that their findings may have been limited by the accuracy of inpatient and outpatient diagnostic codes for ASD, as well as coding for ELA. They also had no data describing the dosing regimens for epidural analgesia or the duration of exposure.
Last updated April 19, 2021
Amanda D’Ambrosio is a reporter on MedPage Today’s Enterprise & Research team. She covers obstetrics-gynecology and other clinical news, and writes articles about the US health care system. To follow
This research was funded in part by the Canadian Institutes of Health Research.
Wall-Wieler’s group reported financial relationships with Aetion, Inc., Alosa Foundation, Lilly, GlaxoSmithKline, Pacira and Takeda.
Hanley and colleagues reported no relevant industry relationships.