The following is a summary of “Labor epidural analgesia and subsequent risk of offspring autism spectrum disorder and attention-deficit/hyperactivity disorder: a cross-national cohort study of 4.5 million individuals and their siblings,” published in the FEBRUARY 2023 issue of Obstetrics and Gynecology by Hegvik, et al.

For a study, researchers sought to investigate whether there was an association between exposure to labor epidural analgesia and offspring autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD), after adjusting for unmeasured familial confounding. 

The study used data from the Medical Birth Registers in Finland (cohorts born from 1987-2005), Norway (1999-2015), and Sweden (1987-2011), and identified 4,498,462 singletons and their parents. The cohorts were followed from birth until they had the outcomes of interest, emigrated, died, or reached the end of the follow-up, whichever occurred first, with a mean age range of 13.6-16.8 years. Cox regression models were used to estimate the country-specific associations between labor epidural analgesia and outcomes (at least one secondary care diagnosis of ASD and ADHD or dispensed medication prescription for ADHD). The models were adjusted for sex, birth year, birth order, and unmeasured familial confounders via sibling comparisons. Pooled estimates across all three countries were estimated using inverse variance-weighted fixed-effects meta-analysis models.

Of the 4,498,462 individuals included in the study, 1,091,846 (24.3%) were exposed to labor epidural analgesia, 1.2% were diagnosed with ASD, and 4.0% with ADHD. On the population level, pooled estimates showed that labor epidural analgesia was associated with an increased risk of offspring ASD (adjusted hazard ratio [AHR] 1.12; 95% CI 1.10-1.14; absolute risks 1.20% vs 1.07%) and ADHD (AHR 1.20; 95% CI 1.19-1.21; absolute risks 3.95% vs 3.32%). However, when comparing full siblings who were differentially exposed to labor epidural analgesia, the associations were fully attenuated for both conditions, with narrow confidence intervals (AHR [ASD] 0.98; 95% CI 0.93-1.03; AHR [ADHD] 0.99; 95% CI 0.96-1.02).

In conclusion, the large cross-national study found no evidence to support the hypothesis that exposure to labor epidural analgesia causes either offspring ASD or ADHD, after adjusting for unmeasured familial confounding.

Reference: ajog.org/article/S0002-9378(22)00650-0/fulltext