Having an epidural during childbirth is not associated with a greater risk
of autism in the child, according to a study led by researchers at the Stanford
University School of Medicine and the University of Manitoba.
The study, which was published online April 19 in JAMA Pediatrics, helps resolve questions raised by an
earlier, widely criticized report on the topic.
“We did not find evidence for any genuine link between
having an epidural and putting your baby at increased risk of autism spectrum
disorder,” said the study’s senior author, Alexander Butwick, MD, associate
professor of anesthesiology, perioperative and pain medicine at Stanford.
The study should help reassure both physicians and pregnant women about the
favorable safety profile of epidurals, he added.
Epidurals are the most common form of pain relief for
childbirth, used by about three-quarters of women in labor in the United
States. Autism is a developmental disorder that affects one in every 54
children nationwide.
“The vast majority of evidence around epidurals,
including that from our new study, shows that they are the most effective means
of providing pain relief to women during labor and that serious complications
are rare.”
Questions raised by prior study
During an epidural, anesthetic is given by catheter
into the space around the woman’s spinal cord. Epidurals relieve pain from
labor contractions while allowing women to stay alert and push during birth.
They also have other important, yet underappreciated,
advantages. For example, epidurals can provide anesthesia to laboring women who
require unplanned, and often urgent, cesarean sections.
They also pose a lower risk to the mother and baby
than general anesthesia, which may be necessary if a woman who has not already
had an epidural needs an emergency C-section.
In October 2020, a study of California
births said epidural use was associated with a 37% greater risk of later autism
diagnosis for children. But the study was widely criticized for failing to
account for many socioeconomic, genetic and medical risk factors for autism —
separate from the epidural — that could be more common among women who choose
epidurals.
Experts also noted that it was biologically
implausible for epidurals to raise autism risk. Shortly after that study’s
release, several professional societies issued a statement saying that
the study did not provide credible scientific evidence that epidurals cause
autism.
The new research examined epidural use during
childbirth and later diagnoses of autism in Manitoba, Canada. It included
123,175 children who were born between 2005 and 2016 and were followed until
2019.“Manitoba has these wonderful, linked data sets that are population-wide,”
Butwick said, noting that the research team was able to access information that
linked individuals’ medical records, prescriptions, other health-related data,
socioeconomic information and information about children’s academic achievements.
“It’s extraordinary information that is super rich,” he said.
All of the children in the study were born via vaginal
delivery and were single births — not twins or other multiples. Of those
studied, 38.2% of the children were exposed to epidural anesthesia during
labor; the rest were not. Of children exposed to epidurals during labor, 2.1%
were later diagnosed with autism spectrum disorder, compared with 1.7% of
children not exposed to epidurals.
Controlling for social, medical and family factors
But then the researchers controlled for factors
thought to potentially influence autism risk — many more such factors than in
the prior study.
Those included socioeconomic factors (mothers’
education, marital status, neighborhood socioeconomic level and receipt of
welfare during pregnancy); mothers’ pre-pregnancy medical history (including
diabetes, hypertension, anxiety and depression); medical conditions during
pregnancy; mothers’ smoking, alcohol and recreational drug use; mothers’
hospitalization for mental illness during pregnancy; mothers’ use of several
types of prescription medications (benzodiazepines, antidepressants and
antiepileptics); medical complications of delivery; and factors related to the
mothers’ pregnancy and labor, including the length of the pregnancy, whether
labor was induced or augmented, and whether the fetus was large or in distress
during labor.
The researchers also analyzed pairs of siblings in
which the mother received an epidural during one child’s birth but not the
other. This comparison gave a way to account for genetic and familial factors,
which influence autism risk.
Once the researchers had adjusted for all the
confounding factors, there was no statistically significant difference in
autism risk between children whose mothers received epidurals during their
birth and those who did not. Accounting for genetic and family-related factors
reduced the difference between the groups even more.
The team conducted many different analyses, said
Wall-Wieler, and repeatedly found a lack of association between epidurals and
autism. “That makes us really confident in how robust our results were,” she
said.
“Our study has a stronger finding because we accounted
for limitations the first study had,” Butwick said. “An epidural remains a
well-established and effective means of providing pain relief during labor,
with several benefits associated with it.”
Source: http://med.stanford.edu/news/all-news/2021/04/Epidural-use-at-birth-not-linked-to-autism-risk-study-finds.html
Journal article: https://jamanetwork.com/journals/jamapediatrics/article-abstract/2778776
Source: Epidural
Use At Birth Not Linked to Autism Risk – Scents of Science (myfusimotors.com)
