Epidural analgesia in labor was not associated with adverse immediate or longer-term offspring outcome

 Is the use of epidural analgesia during labor associated with adverse neonatal and childhood outcomes?

Findings  In this population-based cohort study of 435 281 mother-offspring pairs, the use of epidural analgesia in labor was not associated with adverse neonatal outcomes after adjustment for confounders and mediation by mode of delivery. Epidural analgesia was, however, associated with a small reduction in some adverse developmental outcomes at 2 years.

Meaning  In this study, epidural analgesia in labor was not associated with adverse immediate or longer-term offspring outcomes.

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   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.