Labor Epidurals and Autism
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tl;dr version: "Children whose mothers were given an epidural during labor may face a slightly heightened risk of autism, a large, new study suggests.
Researchers found that the rate of autism was a little higher among those kids, versus their peers whose mothers did not get epidural pain relief during childbirth: 1.9% versus 1.3%."
"Now look here, you Baltic gas passer... " - Mik, 6/14/08
The saying, "Lite is just one damn thing after another," is a gross understatement. The damn things overlap.
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@Klaus said in Labor Epidurals and Autism:
@George-K said in Labor Epidurals and Autism:
Children whose mothers were given an epidural during labor may face a slightly heightened risk of autism, a large, new study suggests.
Correlation does not imply causation.
And that's what the study says.
And it's a retrospective study.
"Now look here, you Baltic gas passer... " - Mik, 6/14/08
The saying, "Lite is just one damn thing after another," is a gross understatement. The damn things overlap.
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Here's where I heard of it first.
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Study Finds Association Between Labor Epidurals, Increased Risk for Autism
Exposure to labor epidural analgesia (LEA) is associated with a 37% increased risk for autism spectrum disorder (ASD) in children after controlling for multiple confounding factors, according to a large retrospective study.
The study’s abstract (BCPS-06) was accepted for presentation at the annual meeting of the Society for Obstetric Anesthesia and Perinatology (SOAP), in May, which was canceled due to the coronavirus pandemic. The study’s co-author, Scott Segal, MD, MHCM, a professor and the chair of anesthesiology at Wake Forest School of Medicine, in Winston-Salem, N.C., was the scheduled presenter. He had, for many years, researched the connection between epidural-related maternal fever and neonatal outcomes
“This phenomenon is very widely appreciated and documented,” Segal said. “We have known for over 30 years that women with epidurals tend to develop fever more often than women without epidurals.”
At first, this finding was viewed as a physiologic curiosity, according to Segal. “But increasingly, there is concern that maternal fever may be a risk to the fetus and newborn in animal models, including in some of my own animal research,” he said. “There is clearly evidence that the fetal brain is affected by processes that can cause maternal fever.”
The study article, titled “Labor Epidural Analgesia and Risk of Autism Spectrum Disorders in Offspring,” was published online in JAMA Pediatrics, in October 2020. The lead author is Chunyuan Qiu, MD, the chief of the Department of Anesthesiology at Kaiser Permanente Baldwin Park, in California. The senior author is Anny H. Xiang, PhD, an investigator with the Kaiser Permanente Southern California Department of Research and Evaluation, in Pasadena.
The investigators sought to determine whether there were observable adverse events in humans for the infant from maternal intrapartum fever. The risk does not appear directly linked to epidural-related maternal fever.
The study obtained data on 147,895 singleton vaginal deliveries among 119,973 mothers at Kaiser Southern California, which is a large multicenter, integrated health system, between January 2008 and December 2015. Overall, 74.2% of the patients received LEA.
All children were followed from 1 year of age in the Kaiser Permanente Southern California electronic health record system. ASD was identified with at least two clinical diagnostic codes recorded in the system.
A total of 2,524 children were diagnosed with ASD between 2009 and 2018: 1.9% among women who had epidurals and 1.3% among women who did not.
“It appears there was somewhat of a dose-response relationship; in other words, the longer the mother was exposed to an epidural, the higher the risk of ASD in the baby,” Segal said. “This finding tends to strengthen people’s feeling that the association between epidural and ASD is real. But we did not find a threshold for epidural duration.”
In addition, the investigators were unable to determine the specific drugs administered and their amounts from the data.
However, maternal fever was much more common with LEA than without it in this study: 11.9% versus 1.3%.
Despite the study’s finding of the modest association between LEA and infant ASD, Segal adamantly advises that clinicians continue to administer LEA.
“This is obviously a very emotional issue,” Segal said. “Clearly, on the basis of a single, retrospective association study, it would be irresponsible to recommend against LEA.”
However, Segal emphasizes that the study does not recommend that clinicians share the findings during patient counseling and cautions that the results would need to be replicated by other investigators before any conclusions can be made.
“I do think it is a call to action for the obstetric anesthesia community and autism community to study further the association between LEA and ASD,” he said.
Other adverse effects that have been linked to LEA in the past, such as increased risk for cesarean delivery or stopping breastfeeding earlier than planned, “turned out later not to be causally related,” Segal said.
Ruth Landau, MD, the president of SOAP, was shocked by the study results and is very skeptical. “Neuraxial analgesia is the gold standard for labor analgesia,” she said. “Absolutely, we should not stop doing epidurals; if anything, we know that babies born to mothers who received an epidural do well. Rather, we need to understand the mechanism—if there is one—that causes ASD and if that mechanism is related to LEA.”
Landau suspects the link between LEA and ASD may be due to the duration of labor and other factors causing neuroinflammation, not the epidural itself. “There may be a casual association rather than a causal association. A retrospective study cannot establish causality by study design.”
Landau, the Virginia Apgar Professor of Anesthesiology at Columbia University Vagelos College of Physicians and Surgeons, in New York City, said the link between LEA and ASD definitely needs to be explored further. “We also need to replicate these findings in another population. But I do not think the epidural itself is causing harm.”
Societies Issue Joint Statement
Several societies, concerned that news of the study might raise anxiety among women who are pregnant, issued a joint statement on Oct. 12, stressing that labor epidurals are safe for mothers and infants. The societies are SOAP, American Society of Anesthesiologists, Society for Pediatric Anesthesia, American College of Obstetricians and Gynecologists, and Society for Maternal-Fetal Medicine.
The societies, which together represent more than 100,000 physicians, said in the statement they “want to assure the public that an association between a mother’s use of epidural analgesia during childbirth and her infant’s risk of developing autism does not imply causation. In the scientific literature, the finding of an association between a treatment and an outcome does not prove the treatment caused the outcome.”
The statement noted: “Importantly, many of the details about the course of these deliveries are not available. There are multiple other possible causes of autism that the study does not address.” The statement went on to point out that epidural analgesia involves small amounts of diluted local anesthetics. “Very low levels of these drugs are transferred to the infant, and there is no evidence that these very low levels of drug exposure cause any harm to the infant’s brain.”
The study authors agree the study simply points out an association, not a causal relationship. They view the findings as a call to action to further research the long-term safety of epidurals, and do not recommend that clinicians take any action based on this study.
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@George-K said in Labor Epidurals and Autism:
@Klaus said in Labor Epidurals and Autism:
@George-K said in Labor Epidurals and Autism:
Children whose mothers were given an epidural during labor may face a slightly heightened risk of autism, a large, new study suggests.
Correlation does not imply causation.
And that's what the study says.
And it's a retrospective study.
True. I was judging the case by your "tl;dr" version, which uses the phrasing "may face", which sounds more like causality to me.
