1. This large, nationwide, Danish cohort study found no increased risk of autism spectrum disorder in children exposed to labour epidural analgesia compared to those without exposure.
Evidence Rating Level: 2 (Good)
Study Rundown: A recent study observed an increased incidence of autism in children born from mothers who received labour epidural analgesia compared to those born without epidural analgesia. This nationwide Danish cohort study, including all live-born children from January 1, 2006, until December 31, 2013, investigated whether there was an increased risk of autism spectrum disorder (ASD) in children following administration of labour epidural analgesia. The primary outcome was the incidence of ASD. Follow-up began after the child-first birthday. Among 479 178 eligible children, 92 900 (19.4%) were exposed to labour epidural analgesia. The median follow-up was 7.0 years (IQR: 4.9-9.0). Some baseline characteristics differed between mothers who received labour epidural versus no labour epidural analgesia; therefore, adjusted analyses were presented. The incidence rate of ASD was 23.1 per 10 000 person-years in children exposed to labour epidural analgesia compared to 18.5 per 10 000 person-years in those without exposure (adjusted hazard ratio [HR]: 1.05 [95% CI: 0.98-1.11]). Furthermore, a within-mother analysis design was explored using children of mothers with more than one delivery who had both exposure and no exposure to labour epidural analgesia. There were 59 154 children included in this analysis and similarly found no association of ASD from exposure to labour epidural analgesia (exposed incidence rate: 20.8 per 10 000 person-years; unexposed incidence rate: 17.1 per 10 000 person-years; adjusted HR: 1.05 [95% CI: 0.90-1.21]). Overall, in contrast to a recent study, the incidence of ASD was not increased among children exposed to labour epidural analgesia. One limitation of this study, however, is that ASD can be misclassified or diagnosed later in life. Follow-up for this study was adequate (median: 7 years); however, it is critical to consider that some children can be diagnosed later in their adolescent years.
Click to read the study in JAMA
Click to read an accompanying editorial in JAMA
Relevant Reading: Association between epidural analgesia during labor and risk of autism spectrum disorders in offspring
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