Is There an Association between the Use of Epidural Analgesia during Labor and the Development of Autism Spectrum Disorder in the Offspring?—A Review of the Literature

Abstract

Autism spectrum disorders (ASDs) are multifactorial and complex neurodevelopmental conditions usually diagnosed in the early childhood. The etiology of ASDs is commonly described as a genetic predisposition combined with an environmental impact. As a result of broadening of the diagnostic criteria the prevalence of ASDs has been increasing worldwide and the search for the modifiable factors is still on-going. Epidural analgesia (ELA) provides effective pain relief during labor and is currently the most preferred method of anesthesia during the delivery. The safety of the procedure is well-discussed and documented; nonetheless, in 2020 a single population-based study indicated an association between the use of ELA during labor and newborn risk of ASD development, which led to widespread concern. To explore the possible association between the ELA and ASD occurrence in the offspring several studies in different countries have been conducted to date. In this review we aimed to summarize the current state of knowledge concerning the association between the use of epidural analgesia during labor and risk of ASD. In conclusion, the literature review indicates that there is no significant association.

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“…In a retrospective longitudinal study, Qiu et al observed that epidural analgesia in labour (LEA) is associated with a significantly higher rate of ASD risk along with the increase in the duration of exposure to the medication used in LEA, which caused a series of controversies regarding the methodology of the study [80]. Other studies based on robust epidemiological data and sibling matching analysis claim no significant association between LEA and ASD [81][82][83]. However, in a meta-analysis by Wang et al, it has been mentioned that LEA during birth can associate offspring with more chances of developing ASD [84].…”

Examining the relationship between autism spectrum disorder in children whose mother had labour epidural analgesia for their birth

“…21 Several publications have recently addressed a potential association between ASD in a child and its mother's use of epidural analgesia during labour, with conflicting results. 22 A large population study by Qiu et al published in 2020, including approximately 148 000 children, found a 37% increased risk for ASD after a child's exposure to maternal labour epidural analgesia, mainly when used for longer times (adjusted hazard ratio 1.37, 95% CI, 1.23 to 1.53). 23 However, this study may not have accounted for several medical risk factors for autism more common among patients who use epidural analgesia, nor does it provided a plausible mechanism to support a link.…”