Study finds no link between epidural labor analgesia and autism

A Canadian study of more than 123,000 births found no association between epidural labor analgesia exposure and an increased risk for autism spectrum disorder in children, according to findings published in JAMA Pediatrics.

Elizabeth Wall-Wieler, PhD, an assistant professor of community health services at the University of Manitoba, and colleagues conducted a longitudinal cohort study of vaginal deliveries of singleton live infants born from April 1, 2005, through March 31, 2016, from a population-based data set linking information from health care databases in Manitoba.

Wall-Wieler and colleagues cited a study published last year by Qui and colleagues that suggested there may be an association between epidural analgesia for vaginal delivery and autism in children.

The current study included 123,175 births, a majority of which were male infants (50.9%; 62,647). Of the total, 80,459 infants had at least one sibling. Wall-Wieler and colleagues classified a diagnoses of autism spectrum disorder (ASD) by the presence of at least one diagnosis by age 18 months. Of the total births, 47,011 infants (38.2%) were exposed to epidural labor analgesia (ELA).

By April 1, 2019, 2.1% (985 of 47,011) of infants exposed to ELA were diagnosed with ASD compared with 1.7% (1,272 of 76,164) of infants not exposed to ELA (HR = 1.25; 95% CI, 1.15-1.36), Wall-Wieler and colleagues reported. There also was no association after adjustment for perinatal covariates (inverse probability of treatment-weighted HR = 1.08; 95% CI, 0.97-1.2).

ELA-exposed offspring faced a slightly higher risk in a sibling cohort (HR = 1.25; 95% CI, 1.12-1.39).

“Our findings suggest that ELA use is not associated with an increased offspring risk of ASD,” the authors wrote.

In a related editorial, Gillian E. Hanley, PhD, a postdoctoral fellow at the University of British Columbia, and colleagues called for further research into the issue.

“Epidural labor analgesia is an extremely effective approach to obstetric analgesia, and we have a collective responsibility to understand whether it is a safe option that sets a healthy developmental pathway well into childhood,” Hanley and colleagues wrote. “Women have the right to make a truly informed choice about their pain relief during labor: for their health and that of her newborn.”

References:

Hanley GE, et al. JAMA Pediatr. 2021;doi:10.1001/jamapediatrics.2021.0382.

Qui C, et al. JAMA Pediatr. 2020;doi:10.1001/jamapediatrics.2020.3231.

Wall-Wieler E, et al. JAMA Pediatr. 2021;doi:10.1001/jamapediatrics.2021.0376.