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April 20, 2021 – Using an epidural during labor did not show a link with a later diagnosis of autism spectrum disorder in a study published on April 19 in Pediatrics JAMA.
Although the first analysis showed an association, adjusting for a wide range of demographic, medical, and birth factors eliminated the link. The authors note that their results are different from those reported in a California study published in the same journal last year.
Researchers looked at data from all infants born from 2005 to 2016 at a hospital in Manitoba, Canada, to compare the use of epidurals at birth with autism diagnoses before the age of 18 months. The researchers excluded women who gave birth by cesarean section because it was not possible to differentiate between scheduled and unscheduled cesarean deliveries.
The study involved 123,175 children born to mothers with an average age of 28. Among mothers, 38.2% used an epidural during labor. Autism diagnoses occurred in 2.1% of children exposed to epidurals and 1.7% of those who were not. After the researchers controlled for a range of potential factors, the difference was insignificant.
The results are significant but not surprisingly, said Scott M. Myers, MD, neurodevelopmental pediatrician and associate professor in the Institute of Developmental and Autism Medicine at the Geisinger Commonwealth School of Medicine in Scranton, PA. Myers, who was not involved in the study, said it was strengthened by the inclusion of a wide range of variables.
“This confirms the suspicion of many experts who were skeptical of the previously reported association that the small increase in ASDs in offspring of mothers who had labor epidural analgesia was likely due to other factors,” said Myers in an interview. “The plausibility of exposure to epidural analgesia during labor having a significant effect on the risk of ASD and explaining changes in the prevalence of ASD over time is low.”
Myers said epidurals can lead to longer labor. If prolonged labor were a significant risk factor for autism, one would expect there to be evidence that prolonged labor leads to increased risk of autism. “But it has been reviewed and it is not,” he said.
Clay Jones, MD, who specializes in neonatal medicine at Newton Wellesley Hospital in Newton, MA, was not involved in the research and offered a similar assessment of the results.
“Our understanding of autism is that it is more of a genetic disease that interferes with the organization of brain architecture, so the evidence for any environmental cause should be strong for this to change the medical practice or our recommendations to the general public ”. Jones said in an interview. Compared to the previous California study, “this new research is larger and better takes into account confounding variables that could increase the risk that a child will ultimately be diagnosed with autism,” he said.
The study authors also noted the benefits of using an epidural during labor.
“It is recognized as the most effective method of providing labor analgesia,” they write.
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