Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Jan 12:17:227-240.
doi: 10.2147/JPR.S442298. eCollection 2024.

Association Between Epidural Labor Analgesia and Autism Spectrum Disorder in Offspring: A Systematic Review and Meta-Analysis

Xinyue Hu  1   2   3 , Beibei Wang  1   2   3 , Jing Chen  1   2   3 , Dong Han  1   2   3 , Jing Wu  1   2   3
Affiliations
Review

Association Between Epidural Labor Analgesia and Autism Spectrum Disorder in Offspring: A Systematic Review and Meta-Analysis

Xinyue Hu et al. J Pain Res. .

Abstract

Purpose: Many studies have focused on the association between Autism spectrum disorder (ASD) and epidural labor analgesia (ELA), which is the most effective way to manage labor pain. The purpose of this meta-analysis was to summarize the current state of the association between ELA and ASD.

Methods: A search of the literature yielded 201 relevant studies, of which 7 cohort studies met our inclusion criteria. Two independent reviewers screened the inclusion results, extracted data, and assessed the risk of bias and quality of evidence.

Results: Compared to parturient who did not receive ELA, parturient who received ELA had a slightly increased risk of ASD (adjusted hazard ratio [aHR], 1.12; 95% confidence interval [CI], 1.06-1.17; I2, 69%; P < 0.001; seven studies). After excluding one literature (aHR, 1.09; 95% CI, 1.06-1.12; I2, 4%; P < 0.001; six studies). The sensitivity analyses had consistent outcomes with the main analyses involving siblings (aHR 1.11; 95% CI 1.03-1.19), cesarean section and instrumental deliveries (aHR 1.07; 95% CI 1.03-1.10), non-overlapping populations (aHR 1.09; 95% CI 1.05-1.12), full-term birth populations (aHR 1.10; 95% CI 1.06-1.14), and studies assessed to have moderate risk of bias (aHR 1.09; 95% CI 1.02-1.16).

Conclusion: This meta-analysis revealed a modest positive association between ELA and ASD, acknowledging a slight potential risk. However, it is important to note that this risk cannot be completely dismissed due to the possibility of bias and this association is based on low-quality evidence. Future studies are required to assess and mitigate different confounding biases and investigate the time-dose-response relationship.

Keywords: Autism spectrum disorder; ELA; epidural analgesia; epidural labor analgesia; meta-analysis; neuraxial labor analgesia; pregnancy.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
PRISMA flowchart.
Figure 2
Figure 2
(A) Risk of bias assessment of each individual study. (B) Risk of bias assessment of included studies summary.
Figure 3
Figure 3
The GRADE quality of evidence for the primary outcomes.
Figure 4
Figure 4
Continued.
Figure 4
Figure 4
(A) All forest plots for this analysis. (B) All forest plots for this analysis.
Figure 5
Figure 5
The funnel plot.
See this image and copyright information in PMC

References

    1. First MB. Diagnostic and statistical manual of mental disorders, 5th edition, and clinical utility. J Nerv Ment Dis. 2013;201(9):727–729. doi: 10.1097/NMD.0b013e3182a2168a - DOI - PubMed
    1. Muhle RA, Reed HE, Stratigos KA, Veenstra-VanderWeele J. The emerging clinical neuroscience of autism spectrum disorder: a review. JAMA Psychiatry. 2018;75(5):514–523. doi: 10.1001/jamapsychiatry.2017.4685 - DOI - PubMed
    1. Ronald A, Hoekstra RA. Autism spectrum disorders and autistic traits: a decade of new twin studies. Am J Med Genet B Neuropsychiatr Genet. 2011;156B(3):255–274. doi: 10.1002/ajmg.b.31159 - DOI - PubMed
    1. Cheng J, Eskenazi B, Widjaja F, Cordero JF, Hendren RL. Improving autism perinatal risk factors: a systematic review. Med Hypotheses. 2019;127:26–33. doi: 10.1016/j.mehy.2019.03.012 - DOI - PubMed
    1. Chien LN, Lin HC, Shao YHJ, Chiou ST, Chiou HY. Risk of autism associated with general anesthesia during cesarean delivery: a population-based birth-cohort analysis. J Autism Develop Disorder. 2015;45(4):932–942. doi: 10.1007/s10803-014-2247-y - DOI - PubMed