Autism spectrum disorders, Medical News, Neurodevelopmental disorders, Pediatrics, Pharmaceuticals, Women's health

No association found between epidural analgesia during labor and risk of autism spectrum disorders

The researchers found that after assessing 388,254 children and mothers included in the cohort, no relationship between epidural use and autism spectrum disorders (ASD) was found.

According to a recently published research study which assessed the risk of autism in close to 480,000 Danish children, pregnant women who have an epidural to relieve pain during birth are no more likely than others to have children with autism.

Back in October of 2020, a group of researchers published a paper which they claim demonstrated a significant association between epidural use for vaginal deliveries and autism spectrum disorders (ASD) in offspring. These conclusions were met with a great deal of backlash from the medical community. In a statement made by the American College of Obstetricians and Gynecologists (ACOG), they stated, “Current clinical practice guidance recognizes that there are many medical indications for analgesia and anesthesia during labor and delivery and that in the absence of a medical contraindication, maternal request is a sufficient medical indication for pain relief during labor. Obstetricians, anesthesiologists and other clinicians providing care to patients during labor and delivery should not change practice due to this study, which has severe limitations. The study does not demonstrate a causal link between epidural analgesia and autism and should not alter current clinical practice.”

Since the publishing of the paper, few studies have been published using large population-based data sets to address the controversial claims.

The new study led by Gillian E. Hanley, PhD, of Vancouver General Hospital Research Pavilion, shows that the use of maternal epidural analgesia during labor and delivery did produce a modest increase in the risk of ASD in children. However, the importance of this was diminished due to the likelihood of residual confounding, and researchers concluded that their findings did not give strong support for any connection.

Epidural needle insertion between the spinous processes of the lumbar vertebrae.

The paper’s results state, “Of the 388,254 children included in the cohort (49.8% female; mean gestational age, 39.2 [SD, 1.2] weeks; mean follow-up, 9.05 [SD, 4.3] years), 5192 were diagnosed with ASD (1.34%) and 111,480 (28.7%) were exposed to epidural analgesia. A diagnosis of ASD was made for 1710 children (1.53%) among the 111,480 deliveries exposed to epidural analgesia (94,157 women) vs a diagnosis of ASD in 3482 children (1.26%) among the 276,774 deliveries not exposed to epidural analgesia (192,510 women).”

“This is very complex observational research to conduct, and replication in different datasets and different settings is important,” Hanley told BreakingMed. “However, we were primarily motivated by some data-related advantages. First, British Columbia has very high quality ASD diagnostic data, as were were able to link with a clinical dataset where children are assessed in a standardized way by clinicians who are specifically trained to diagnose ASD (through the BC Autism Assessment Network). Thus, we had high confidence in our ASD data. We also had high quality data on the use of pain relief in labor and other important intrapartum and perinatal care. Thus, we could account for many ways in which the group of women who use epidurals during labor and delivery are different from the group of women who do not. Finally, our data are population-based and date back to 2000, so we could take advantage of mothers who delivered more than one child during our study period to examine whether a mother was more likely to have used an epidural during a labor and delivery when her child was diagnosed with ASD, compared to when her child was not diagnosed with ASD. This controls for other important factors that are likely to remain constant within a woman over time (e.g., genetics, propensity to use medical care, etc). We found no relationship between epidural use and ASD in that analysis.”

In an editorial that was published soon after the release of the paper, Dr. Cynthia Wong from the University of Iowa explains that although research into a suspected link between epidural analgesia during birth and ASD is necessary, the findings of this research show that no such link exists.

Dr. Wong concluded her thoughts in the editorial by stating, “Because of the recent publications, patients and clinicians will legitimately ask whether a risk of ASD should be included in this benefit-risk analysis. Based on these studies and the current knowledge of ASD, it appears that concern for ASD should not carry weight in this decision. Current evidence does not justify considering risk of ASD when deciding whether to use (patients) or recommend (health care professionals) neuraxial labor analgesia.”

The study was published in JAMA, on September 28th, 2021.

Abstract. In this population-based study, maternal epidural analgesia use during labor and delivery was associated with a small increase in the risk of autism spectrum disorder in offspring that met the threshold for statistical significance. However, given the likelihood of residual confounding that may account for the results, these findings do not provide strong supporting evidence for this association.

Hanley GE, Bickford C, Ip A, et al. Association of Epidural Analgesia During Labor and Delivery With Autism Spectrum Disorder in Offspring. JAMA. 2021;326(12):1178–1185. doi:10.1001/jama.2021.14986

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