Gillian E Hanley1,2, Celeste Bickford3, Angie Ip2,4, Nancy Lanphear2,4, Bruce Lanphear2,5, Whitney Weikum2,4, Lonnie Zwaigenbaum6, Tim F Oberlander2,4,3. 1. Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, Canada. 2. British Columbia Children's Hospital Research Institute, University of British Columbia, Vancouver, Canada. 3. School of Population and Public Health, University of British Columbia, Vancouver, Canada. 4. Division of Developmental Pediatrics, Department of Pediatrics, University of British Columbia, Vancouver, Canada. 5. Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada. 6. Department of Pediatrics, University of Alberta, Edmonton, Canada.
Abstract
Importance: Evidence from studies investigating the association of epidural analgesia use during labor and delivery with risk of autism spectrum disorder (ASD) in offspring is conflicting. Objective: To assess the association of maternal use of epidural analgesia during labor and delivery with ASD in offspring using a large population-based data set with clinical data on ASD case status. Design, Setting, and Participants: This population-based retrospective cohort study included term singleton children born in British Columbia, Canada, between April 1, 2000, and December 31, 2014. Stillbirths and cesarean deliveries were excluded. Clinical ASD diagnostic data were obtained from the British Columbia Autism Assessment Network and the British Columbia Ministry of Education. All children were followed up until clinical diagnosis of ASD, death, or the study end date of December 31, 2016. Exposures: Use of epidural analgesia during labor and delivery. Main Outcomes and Measures: A clinical diagnosis of ASD made by pediatricians, psychiatrists, and psychologists with specialty training to assess ASD. Cox proportional hazards models were used to estimate the hazard ratio of epidural analgesia use and ASD. Models were adjusted for maternal sociodemographics; maternal conditions during pregnancy; labor, delivery, and antenatal care characteristics; infant sex; gestational age; and status of small or large for gestational age. A conditional logistic regression model matching women with 2 births or more and discordance in ASD status of the offspring also was performed. Results: 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) (absolute risk difference, 0.28% [95% CI, 0.19%-0.36%]). The unadjusted hazard ratio was 1.32 (95% CI, 1.24-1.40) and the fully adjusted hazard ratio was 1.09 (95% CI, 1.00-1.15). There was no statistically significant association of epidural analgesia use during labor and delivery with ASD in the within-woman matched conditional logistic regression (839/1659 [50.6%] in the exposed group vs 1905/4587 [41.5%] in the unexposed group; fully adjusted hazard ratio, 1.07 [95% CI, 0.87-1.30]). Conclusions and Relevance: 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.
Importance: Evidence from studies investigating the association of epidural analgesia use during labor and delivery with risk of autism spectrum disorder (ASD) in offspring is conflicting. Objective: To assess the association of maternal use of epidural analgesia during labor and delivery with ASD in offspring using a large population-based data set with clinical data on ASD case status. Design, Setting, and Participants: This population-based retrospective cohort study included term singleton children born in British Columbia, Canada, between April 1, 2000, and December 31, 2014. Stillbirths and cesarean deliveries were excluded. Clinical ASD diagnostic data were obtained from the British Columbia Autism Assessment Network and the British Columbia Ministry of Education. All children were followed up until clinical diagnosis of ASD, death, or the study end date of December 31, 2016. Exposures: Use of epidural analgesia during labor and delivery. Main Outcomes and Measures: A clinical diagnosis of ASD made by pediatricians, psychiatrists, and psychologists with specialty training to assess ASD. Cox proportional hazards models were used to estimate the hazard ratio of epidural analgesia use and ASD. Models were adjusted for maternal sociodemographics; maternal conditions during pregnancy; labor, delivery, and antenatal care characteristics; infant sex; gestational age; and status of small or large for gestational age. A conditional logistic regression model matching women with 2 births or more and discordance in ASD status of the offspring also was performed. Results: 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) (absolute risk difference, 0.28% [95% CI, 0.19%-0.36%]). The unadjusted hazard ratio was 1.32 (95% CI, 1.24-1.40) and the fully adjusted hazard ratio was 1.09 (95% CI, 1.00-1.15). There was no statistically significant association of epidural analgesia use during labor and delivery with ASD in the within-woman matched conditional logistic regression (839/1659 [50.6%] in the exposed group vs 1905/4587 [41.5%] in the unexposed group; fully adjusted hazard ratio, 1.07 [95% CI, 0.87-1.30]). Conclusions and Relevance: 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.
Authors: Gillian M Maher; Gerard W O'Keeffe; Patricia M Kearney; Louise C Kenny; Timothy G Dinan; Molly Mattsson; Ali S Khashan Journal: JAMA Psychiatry Date: 2018-08-01 Impact factor: 21.596
Authors: Celeste D Bickford; Tim F Oberlander; Nancy E Lanphear; Whitney M Weikum; Patricia A Janssen; Helene Ouellette-Kuntz; Gillian E Hanley Journal: Autism Res Date: 2019-12-04 Impact factor: 5.216
Authors: Elizabeth Wall-Wieler; Brian T Bateman; Ana Hanlon-Dearman; Leslie L Roos; Alexander J Butwick Journal: JAMA Pediatr Date: 2021-07-01 Impact factor: 16.193
Authors: Chunyuan Qiu; Jane C Lin; Jiaxiao M Shi; Ting Chow; Vimal N Desai; Vu T Nguyen; Robert J Riewerts; R Klara Feldman; Scott Segal; Anny H Xiang Journal: JAMA Pediatr Date: 2020-12-01 Impact factor: 26.796
Authors: Joanna Weronika Król; Paweł Jan Stanirowski; Natalia Mazanowska; Agata Majewska; Mirosław Wielgoś; Dorota Bomba-Opoń Journal: Int J Environ Res Public Health Date: 2022-06-12 Impact factor: 4.614
Authors: Malia S Q Murphy; Robin Ducharme; Steven Hawken; Daniel J Corsi; William Petrcich; Darine El-Chaâr; Lise Bisnaire; Daniel I McIsaac; Deshayne B Fell; Shi Wu Wen; Mark C Walker Journal: JAMA Netw Open Date: 2022-05-02