Labour epidural analgesia not a risk factor for offspring ASD, ADHD

Children born to mothers who were exposed to labour epidural analgesia do not appear to be at greater risk of autism spectrum disorder (ASD) or attention-deficit/hyperactivity disorder (ADHD), according to a study.

The study assessed the extent to which exposure to labour epidural analgesia was related to the risk of offspring ASD and ADHD. They identified singleton-and-parent pairs using the Medical Birth Registers in Finland (cohorts born 1987-2005), Norway (1999-2015), and Sweden (1987-2011), linked with population and patient registries. These cohorts were followed from birth until they either had the outcomes of interest, emigrated, died, or reached the end of the follow-up (at mean ages 13.6‒16.8 years), whichever occurred first.

Researchers used Cox regression models to evaluate country-specific associations between labour epidural analgesia recorded at birth and outcomes (eg, at least one secondary care diagnosis of ASD and ADHD or at least one dispensed prescription of medication used for the treatment of ADHD).

Of the 4,498,462 individuals (48.7 percent women) included, 1,091,846 (24.3 percent) were exposed to labour epidural analgesia. A total of 1.2 percent of the offspring had ASD while 4.0 percent had ADHD.

On the population level, pooled estimates showed that labour epidural analgesia contributed to increased risks of offspring ASD (adjusted hazard ratio [aHR], 1.12, 95 percent confidence interval [CI], 1.10–1.14; absolute risks, 1.20 percent vs 1.07 percent) and ADHD (aHR, 1.20, 95 percent CI, 1.19–1.21; 3.95 percent vs 3.32 percent).

However, in an analysis that compared full siblings who were differentially exposed to labour epidural analgesia, the associations were fully attenuated for both risks, with narrow CIs (ASD: aHR, 0.98, 95 percent CI, 0.93–1.03; ADHD: aHR, 0.99, 95 percent CI, 0.96–1.02).