Kearns, R. J. , Shaw, M., Gromski, P. S., Iliodromiti, S., Lawlor, D. A. and Nelson, S. M. (2021) Association of epidural analgesia in women in labor with neonatal and childhood outcomes in a population cohort. JAMA Network Open, 4(10), e2131683. (doi: 10.1001/jamanetworkopen.2021.31683) (PMID:34709386) (PMCID:PMC8554639)
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Abstract
Importance: Although use of epidural analgesia during labor is safe, detailed information about its association with neonatal and child outcomes is limited. Objective: To investigate the association of labor epidural analgesia with neonatal outcomes and childhood development during the first 1000 days of life. Design, Setting, and Participants: This population-based cohort study used Scottish National Health Service hospital administrative data of all 435 281 singleton live births in Scotland between January 1, 2007, and December 31, 2016, with follow-up over the first 1000 days of life. All 435 281 mother-infant pairs delivering between 24 weeks 0 days and 43 weeks 6 days’ gestation who were in active labor with cephalic presentation and who delivered vaginally or via unplanned cesarean delivery were included. Stillbirths and infants with known congenital anomalies were excluded. Data were analyzed between August 1, 2020, and July 23, 2021. Exposures: Epidural analgesia in labor. Main Outcomes and Measures: Neonatal outcomes included resuscitation, Apgar score less than 7 at 5 minutes, and neonatal unit admission. Childhood development measures (gross and fine motor function, communication, and social functioning) were obtained from standardized national childhood surveillance assessments performed at 2 years. Results: This study included a total of 435 281 live births with cephalic presentation in labor (median gestational age at delivery, 40 weeks [IQR, 39-41 weeks]; 221 153 male infants [50.8%]), of which 94 323 (21.7%) had labor epidural. Epidural analgesia was associated with a reduction in spontaneous vaginal deliveries (confounder-adjusted [Cadj] relative risk [RR], 0.46; 95% CI, 0.42-0.50), an increased risk of neonatal resuscitation (Cadj RR, 1.07; 95% CI, 1.03-1.11), and an increased risk of neonatal unit admission (Cadj RR, 1.14; 95% CI, 1.11-1.17). With additional analysis for mediation by mode of delivery (CMadj), these associations were reversed (CMadj RR, 0.83; 95% CI, 0.79-0.86 for neonatal resuscitation and CMadj RR, 0.94; 95% CI, 0.91-0.97 for neonatal unit admission). Epidural analgesia was associated with a reduced risk of an Apgar score less than 7 at 5 minutes in both confounder and confounder/mediation analyses. Epidural analgesia was associated with a reduced risk of having developmental concern in any domain at 2 years in confounder and confounder/mediation analyses (CMadj RR, 0.96; 95% CI, 0.93-0.98), with specifically fewer concerns regarding communication (CMadj RR, 0.96; 95% CI, 0.93-0.99) and fine motor skills (CMadj RR, 0.89; 95% CI, 0.82-0.97). Conclusions and Relevance: The results of this cohort study suggest that labor epidural analgesia is not independently associated with adverse neonatal or childhood development outcomes. Associations with neonatal resuscitation and admission were likely mediated by mode of delivery.
| Item Type: | Articles |
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| Additional Information: | Funding/Support: This work was supported in part by the Obstetric Anaesthetists’ Association (Dr Kearns), the Scottish Society of Anaesthetists (Dr Kearns), a National Health Service Research Scotland Career Researcher Fellowship (Dr Kearns), grant MR/N015177/1 from the Medical Research Council Career Development Fellowship and RG2040 from the Wellbeing of Women (Dr Iliodromiti), The National Institute for Health Research Biomedical Centre at the University Hospitals Bristol National Health Service Foundation Trust and the University of Bristol (Dr Lawlor and Professor Nelson, respectively), grant 669545 from the European Research Council (Professor Lawlor), and grant NF-0616-10102 from the National Institute for Health Research Senior Investigator award (Professor Lawlor). Professor Lawlor reported working in a unit that receives support (grant no. MC_UU_00011/6) from the University of Bristol and the Medical Research Council. Dr Iliodromiti was supported by a fellowship from the Healthcare Improvement Studies Institute, University of Cambridge. |
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Gromski, Dr Piotr and Kearns, Dr Rachel and Nelson, Professor Scott and Shaw, Dr Martin and Iliodromiti, Dr Stamatina |
| Authors: | Kearns, R. J., Shaw, M., Gromski, P. S., Iliodromiti, S., Lawlor, D. A., and Nelson, S. M. |
| College/School: | College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing |
| Journal Name: | JAMA Network Open |
| Publisher: | American Medical Association |
| ISSN: | 2574-3805 |
| ISSN (Online): | 2574-3805 |
| Published Online: | 28 October 2021 |
| Copyright Holders: | Copyright © 2021 Kearns RJ et al. |
| First Published: | First published in JAMA Network Open 4(10):e2131683 |
| Publisher Policy: | Reproduced under a Creative Commons Licence |
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