Does exposure to an epidural during delivery increase autism risk?

Many chemical exposures during pregnancy can have an impact on the offspring’s health. An investigation in JAMA Pediatrics examines whether exposure to maternal labor epidural analgesia during a vaginal delivery is linked to the risk of autism spectrum disorder in children.¹

The investigators ran a retrospective longitudinal birth cohort study. The data were taken from electronic medical records from a population-based clinical birth cohort. Children who were delivered vaginally between January 2008 and December 2015 in a single integrated health care system were included in the study. Each child was followed up from 1 year of age until one of the following occurred: a clinical diagnosis of autism spectrum disorder, last date of health plan enrollment, death, or the study’s end date of December 31, 2018.

The cohort had 147,895 singleton children and 109,719 of the children had been exposed to maternal labor epidural analgesia. Fever during the course of labor was seen in 13,055 of the mothers who received a labor epidural analgesia and 510 of the mothers who did not receive an epidural. A diagnosis of autism spectrum disorder was given to 2039 children in the labor epidural analgesia group and 485 children who were not exposed to a labor epidural analgesia. Following an adjustment for a number of confounders including maternal age at delivery, parity, gestational age at delivery, and history of comorbidity, the hazard ratio linked to labor epidural analgesia exposure versus no exposure was 1.37 (95% CI, 1.23-1.53). In the group exposed to labor epidural analgesia, a significant trend of risk for autism spectrum disorder was linked with an increasing duration of exposure to labor epidural analgesia, following adjustment for covariates (HR for linear trend, 1.05 [95% CI, 1.01-1.09] per 4 hours). Including fever did not change the HR estimate linked with exposure to labor epidural analgesia (adjusted HR for labor epidural analgesia vs non- labor epidural analgesia, 1.37 [95% CI, 1.22-1.53]).

The researchers concluded that exposure to labor epidural analgesia appears to be linked to an increased risk of autism spectrum disorder in children and that risk is not directly tied to maternal fever linked to the epidural. They urged further research to confirm the findings and to begin understanding the mechanism behind the association.

Reference

1. Qiu C, Lin J, Shi J, et al. Association between epidural analgesia during labor and risk of autism spectrum disorders in offspring. JAMA Pediatr. October 12, 2020. Epub ahead of print. doi:10.1001/jamapediatrics.2020.3231