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Can Use of Epidurals During Labour Increase Risk of Autism in Children?

Epidurals are the most common form of pain relief for childbirth.

Epidurals are considered the most effective means of providing pain relief to women during labour. But a previous study had linked its use to increased risk of autism spectrum disorder in children.

Written by Longjam Dineshwori |Updated : April 21, 2021 1:51 PM IST

An epidural is an injection used to lessen the pain of labour contractions during childbirth. While it creates a band of numbness from the waist down, the local anesthesia allows the mother to be awake and alert throughout labour, as well as to feel labour pressure, enabling her to push when it's time to give birth to the baby. But use of an epidural for pain relief during labour has been linked to various side effects, including increased risk of autism spectrum disorder in children. Is this true? No, says a new study, which has eliminated the link between epidural use during labour and a later diagnosis of autism spectrum disorder in children. The study published in JAMA Pediatrics was led by researchers at the Stanford University School of Medicine and the University of Manitoba.

"We did not find evidence for any genuine link between having an epidural and putting your baby at increased risk of autism spectrum disorder," said the study's senior author Alexander Butwick, MD, associate professor of anesthesiology, perioperative and pain medicine at Stanford in a press release. He noted that their finding would help reassure both physicians and pregnant women about the favourable safety profile of epidurals.

The study's lead author, Elizabeth Wall-Wieler, PhD, assistant professor at the University of Manitoba, pointed out that the epidural is the gold standard in labour pain management. "The vast majority of evidence around epidurals, including that from our new study, shows that they are the most effective means of providing pain relief to women during labour and that serious complications are rare," she added in their release.

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Earlier study failed to account for many risk factors for autism

A study in California published in the same journal in October 2020 had linked epidural use to a 37% greater risk of later autism diagnosis for children. However, the study was widely criticized by several professional societies for failing to provide credible scientific evidence that epidurals cause autism.

For the new study, the researchers examined data of 123,175 children who were born between 2005 and 2016 at a hospital in Manitoba, Canada. They were followed until 2019. The average age of the mothers was 28 years and all of them had vaginal delivery and single birth. Of these, 38.2% used an epidural during their labour, which means their children were exposed to epidural anesthesia during birth. About 2.1% of the children exposed to epidurals during labour were later diagnosed with autism spectrum disorder, compared with 1.7% of children who were not exposed to epidurals.

However, after they had adjusted for many social, medical, genetic and family-related risk factors for autism that the previous study had failed to account for, they found no statistically significant difference in autism risk between children whose mothers received epidurals during their birth and those who did not.

Conclusion

According to Wall-Wieler, they repeatedly found no association between epidurals and autism even after many different analyses, which proves how robust their results are. Butwick added that an epidural remains "a well-established and effective means of providing pain relief during labour, with several benefits associated with it."

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