Neonatal and early childhood outcomes following maternal anesthesia for cesarean section: a population-based cohort study

Kearns, R. J. , Shaw, M., Gromski, P. S., Iliodromiti, S., Pell, J. P. , Lawlor, D. A. and Nelson, S. M. (2021) Neonatal and early childhood outcomes following maternal anesthesia for cesarean section: a population-based cohort study. Regional Anesthesia and Pain Medicine, 46(6), pp. 482-489. (doi: 10.1136/rapm-2020-102441) (PMID:33832987)

Abstract

Background: The fetus is vulnerable to maternal drug exposure. We determined associations of exposure to spinal, epidural, or general anesthesia on neonatal and childhood development outcomes during the first 1000 days of life. Methods: Population-based study of all singleton, cesarean livebirths of 24+0 to 43+6 weeks gestation between January 2007 and December 2016 in Scotland, stratified by urgency with follow-up to age 2 years. Models were adjusted for: maternal age, weight, ethnicity, socioeconomic status, smoking, drug-use, induction, parity, previous cesarean or abortion, pre-eclampsia, gestation, birth weight, and sex. Results: 140 866 mothers underwent cesarean section (41.2% (57,971/140,866) elective, 58.8% (82,895/140,866) emergency) with general anesthesia used in 3.2% (1877/57,971) elective and 9.8% (8158/82,895) of emergency cases. In elective cases, general anesthesia versus spinal was associated with: neonatal resuscitation (crude event rate 16.2% vs 1.9% (adjusted RR 8.20, 95% CI 7.20 to 9.33), Apgar <7 at 5 min (4.6% vs 0.4% (adjRR 11.44, 95% CI 8.88 to 14.75)), and neonatal admission (8.6% vs 4.9% (adjRR 1.65, 95% CI 1.40 to 1.94)). Associations were similar in emergencies; resuscitation (32.2% vs 12.3% (adjRR 2.40, 95% CI 2.30 to 2.50)), Apgar <7 (12.6% vs 2.8% (adjRR 3.87, 95% CI 3.56 to 4.20), and admission (31.6% vs 19.9% (adjRR 1.20, 95% CI 1.15 to 1.25). There was a weak association between general anesthesia in emergency cases and having ≥1 concern noted in developmental assessment at 2 years (21.0% vs 16.5% (adjRR 1.08, 95% CI 1.01 to 1.16)). Conclusions: General anesthesia for cesarean section, irrespective of urgency, is associated with neonatal resuscitation, low Apgar, and neonatal unit admission. Associations were strongest in non-urgent cases and at term. Further evaluation of long-term outcomes is warranted.

• Item Type: Articles
• Additional Information: The study was supported by the Obstetric Anaesthetists Association, Scottish Society of Anaesthetists and Chief Scientist’s Office (RK) and the Bristol NIHR Biomedical Research Centre (DAL & SMN). DAL works in an MRC Unit that is supported by the University of Bristol and Medical Research Council (MC_UU_00011/6) and she is a NIHR Senior Investigator (NF-0616-10102).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Kearns, Dr Rachel and Nelson, Professor Scott and Gromski, Dr Piotr and Shaw, Dr Martin and Iliodromiti, Dr Stamatina and Pell, Professor Jill
• Authors: Kearns, R. J., Shaw, M., Gromski, P. S., Iliodromiti, S., Pell, J. P., Lawlor, D. A., and Nelson, S. M.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Mental Health and Wellbeing; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Regional Anesthesia and Pain Medicine
• Publisher: BMJ Publishing Group
• ISSN: 1098-7339
• ISSN (Online): 1532-8651
• Published Online: 08 April 2021
• Copyright Holders: Copyright © 2021 American Society of Regional Anesthesia & Pain Medicine
• First Published: First published in Regional Anesthesia and Pain Medicine 46(6): 482-489
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher