Effects of epidural and systemic maternal analgesia in term infants the NoPiL study

Abstract

The aim of the No Pain in Labour (NoPiL) study was to evaluate the stress and clinical outcome of infants vaginally born without maternal analgesia and after maternal epidural or systemic analgesia. We studied 120 healthy term infants, 41 in the no analgesia group, 38 in the epidural analgesia group, and 41 in the systemic analgesia group. Cortisol, beta-endorphin, oxidative stress markers (ie: total hydroperoxide (TH) and advanced oxidation protein products (AOPP)), interleukin-1beta (IL-1beta), and interleukin-8 (IL-8) cytokines were measured in arterial cord blood samples. Infants in the 3 groups had similar Apgar score, cord blood pH and occurrence of hypoglycaemia, hyperbilirubinemia, and respiratory depression. Cortisol and endorphin plasma levels did not differ in the groups, nor did TH and AOPP values. IL-1beta and IL-8 cytokine were higher in infants born after maternal epidural analgesia than in other groups. Short-term outcome and stress were similar in infants vaginally born without maternal analgesia and after epidural and systemic analgesia. The possible implications of the highest interleukin levels in the epidural analgesia group deserve further study.

Cord blood 8-isoprostane in the preterm infant

“…26-29 These studies also show marked variability that appears to be influenced by obstetrical intervention and mode of delivery. 30-32 Consistent with these findings in our preterm population, covariates of medical intervention (e.g., artificial ROM, tocolysis, c-section delivery) all had odds ratios <1.0 with elevated 8-IP, suggesting a protective effect. Conversely, covariates related to ongoing labor (preterm labor, spontaneous ROM and prolonged ROM) were positively associated with elevated 8-IP (OR>1, data not shown).…”

The Effect of Epidural Analgesia Alone and in Association With Other Variables on the Risk of Cesarean Section

“…Previous researchers have reported that EA affects not only the process of labor but also the newborn, detecting an increase in the percentage of newborns requiring resuscitation and hospitalization in the neonatal intensive care unit that was associated with EA administration (Herrera-Gómez et al, 2015). Investigators have also reported that EA affects the biochemical profile of newborns, increasing their cytokine levels (Dani et al, 2010). Also, Bell, White-Traut, Wang, and Schwertz (2012) explored relationships between exposure to EA and maternal and umbilical cortisol.…”

Pain-reducing anesthesia prevents oxidative stress in human term placenta

“…According to a previous report, anesthesia and analgesia do not affect the health state of the newborn, as indicated by Apgar score; cord blood pH; the occurrence of hypoglycemia, hyperbilirubinemia, and respiratory depression; the lack of changes in the levels of cortisol, beta-endorphin, and two oxidative stress markers (total hydroperoxide and advanced oxidation protein products) in the cord arterial blood and extremely high levels of 2 cytokines (IL-1 beta and IL-8) in the epidural analgesia group. ( 18 ) Although numerous previous studies have examined the association between pregnancy and oxidative stress, evidence that maternal anesthesia affects the condition of the fetus or neonate is lacking. ( 19 ) While a certain amount of reactive oxygen species (ROS) is necessary for normal embryonic and fetal development, an excess of ROS or oxidative stress is associated with maternal obesity, smoking and hypertension.…”