Association Between Epidural Analgesia During Labor and Risk of Autism Spectrum Disorders in Offspring

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Abstract
Labor epidural analgesia (LEA) is the most commonly administered neuraxial anesthesia for labor pain.1 In the United States, more than 70% of women receive some form of a neuraxial procedure during labor. Although the effectiveness of neuraxial anesthesia for labor pain management and the safety of neuraxial anesthesia for the fetus and newborns during the perinatal period have been well documented, the long-term effects of neuraxial anesthesia on the offspring are largely unknown.2-4 Limited toxicology and animal studies have shown that standard clinical doses of local anesthetics (LAs) can produce neurotoxic effects and alter normal behavioral development in rhesus monkeys.5 Recent observational studies with humans found that general anesthesia for cesarean deliveries was associated with an approximately 50% increased risk for children to develop autism spectrum disorders (ASDs) compared with vaginal deliveries.6,7 A recent meta-analysis comprising 61 studies with 20 million deliveries concluded that birth by cesarean delivery was significantly associated with the risk of ASD.8 However, these studies did not address the potential risk associated with the common use of neuraxial anesthesia for routine vaginal delivery. Given that LEA is currently the criterion standard for labor pain management for routine vaginal delivery, it is critical to assess whether maternal LEA exposure has any long-term association with outcomes in offspring.

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