Evidence Mounts Refuting an Association Between Epidural Use and Neurodevelopmental Adverse Outcomes in Children

Abstract

Neuraxial analgesia-more commonly described as epidural pain relief-is the most effective means of managing pain during labor. 1 In 2015, nearly 3 out of 4 US women used epidural pain relief during labor. 2 Despite its popularity, flawed or misleading research has linked epidural pain relief to several unfavorable perinatal and postnatal outcomes, such as an increased risk of cesarean delivery or longterm back pain. 3 In response, anesthesia researchers have invested considerable time and effort to assuage these claims. 3 A recent population-based study of 147 895 live births in Kaiser Permanente Southern California hospitals reported that epidural pain relief is associated with a 37% increased risk of autism spectrum disorder in offspring. 4 However, residual confounding likely explains these findings, as a subsequent population-based study of 123 175 live births in Manitoba, Canada, did not confirm this association after accounting for a larger set of confounders. 5 Therefore, there is a need for more research that addresses selection and confounding bias to clarify the presence and extent of an association.Because assigning women to receive epidural pain relief or placebo in a randomized trial is unethical and immoral, high-quality longitudinal studies remain the only viable option for evaluating potential Open Access. This is an open access article distributed under the terms of the CC-BY License.

Association of labor epidural analgesia exposure with long-term risk of autism spectrum disorder in offspring: A meta-analysis of observational studies

“…reduced uteroplacental perfusion) (Minnich et al, 1990; Rooth, 1982; Shnider et al, 1979). Neuraxial analgesia, which is technically simple with the requirement of only an indwelling epidural catheter, is the most common and effective means of peripartum pain relief because of its association with only transient side effects such as pruritus and hypotension and rare life-threatening complications (Halliday et al, 2022) as well as its ability to allow unplanned intrapartum CS when necessary (A. J. Butwick & Wall-Wieler, 2021).…”

“…J. Butwick & Wall-Wieler, 2021). Its popularity is also boosted by the possibility of avoiding general anesthesia, which is known to be related to an increased risk of maternal and perinatal morbidities, including failed intubation, intraoperative hemorrhage, postoperative pain, nausea, and vomiting as well as fetal exposure to general anesthesia (A. J. Butwick & Wall-Wieler, 2021).…”

“…selection bias) and uncontrolled confounders may contribute to an overestimation of the association (A. J. Butwick et al, 2022; A. J. Butwick & Wall-Wieler, 2021 ; McKeen & Zaphiratos, 2021; Saito et al, 2021).…”

“…genetic and environmental factors) (A. J. Butwick et al, 2022; A. J. Butwick & Wall-Wieler, 2021; McKeen & Zaphiratos, 2021; Saito et al, 2021), a possible link could not be ruled out.…”