Hypothesis: To assess the association between maternal lumbar epidural analgesia (LEA) exposure and risk of autism spectrum disorders (ASDs) in offspring.
Methods:
Included singleton children born by vaginal delivery at 28 - 44 weeks gestation within Kaiser Permanente hospitals between 12/2008 - 12/2015
Diagnosis of ASD was based on presence of diagnosis codes which included autistic disorders, Asperger syndrome, or pervasive developmental disorder not otherwise specified
Primary data analyses used inverse probability of treatment weighting (IPTW) to balance all potential confounders between LEA and non-LEA use as well as standard covariate adjustment.
Results:
Of 147,895 patient meeting inclusion criteria, 109,719 had exposure to LEA within 48 hrs of labor
Patients who received LEA were more likely to be younger age, non-hispanic white, have lower parity, have a higher level of education, have higher income, and have a greater number of comorbidities
There was a significant increase in the adjusted HR for ASD associated with LEA exposure. Within the LEA group, there was a significant trend of ASD risk associated with increasing duration of LEA exposure after adjusting for covariates (HR for linear trend, 1.05 [95% CI, 1.01-1.09] per 4 hours). Factoring in maternal fever did not affect the HR estimate associated with LEA exposure.
Strengths:
Sample size
Diverse patient cohort
Factored in the time of LEA exposure
Weaknesses:
Retrospective
Limits on generalizability
Didn’t account for all relevant confounding variable
Questionable evidence for biological mechanism
Key Point: Maternal LEA may be associated with an increased ASD risk in children.