• Ming Ann Sim, Liang Shen, TiLian KahLKNational University Hospital, Department of Anesthesia, Singapore; National University of Singapore, Singapore., Ban Leong Sng, BroekmanBirit F PBFPOLVG and Amsterdam UMC, Department of Psychiatry, Vrije Universiteit, Amsterdam, the Netherlands; Amsterdam Public Health, Mental Health Programme, the Netherlands., Lourdes Mary Daniel, Choon Looi Bong, and GUSTO study group.
• National University Hospital, Department of Anesthesia, Singapore. Electronic address: ming_ann_sim@Nuhs.edu.sg.
• J Clin Anesth. 2023 Oct 1; 89: 111162111162.

Study ObjectiveStudies investigating associations between maternal epidural analgesia (MEA) and autism spectrum disorder (ASD) in the offspring are conflicting and lack prospective neurobehavioral follow-up assessments for autistic traits. We aim to prospectively investigate associations between MEA and autistic traits in the offspring.DesignProspective neurobehavioral observational cohort study.SettingSingaporean tertiary healthcare institutions.PatientsParticipants recruited were singleton non-IVF children, >36 weeks gestation, delivered via normal vaginal delivery by mothers >18 years of age, delivered in Singapore from June 2009-September 2010 and followed up over 7 years.InterventionsExposure to maternal epidural analgesia during delivery.MeasurementsThe primary outcome is an abnormal Social Responsiveness Scale (SRS) T score at 7 years (≥60 points). Secondary outcomes include the diagnosis of ASD and abnormal scores for autistic traits assessed via a neurobehavioral battery comprising: CBCL (child behavioural checklist), Q-CHAT (Quantitative Checklist for Autism in Toddlers), and Bayley-III. Multivariable analyses adjusting for maternal and offspring characteristics were performed.Main Results704 out of 769 mother-child dyads recruited fulfilled the criteria for analysis. 365/704 mothers received MEA. The incidence of an abnormal SRS score at 7 years in offspring exposed to MEA was 19.9%, and 26.1% in non-exposed offspring (p = 0.154). Multivariable analysis did not demonstrate a significant association between MEA and abnormal SRS scores at 7 years (O.R.0.726, 95% C·I. 0.394-1.34, p = 0.305). After adjustment for maternal and fetal demographics, exposure to MEA was not significantly associated with an abnormal screen in all other tests for autistic traits. The clinical incidence of ASD was 1.76% in children without exposure to MEA, and 2.32% in children with MEA exposure (p = 0.506).ConclusionsMEA is not significantly associated with the development of ASD and autistic traits in offspring, assessed over 7 years. Results should be taken into perspective given our wide confidence intervals and small cohort size.Copyright © 2023 Elsevier Inc. All rights reserved.

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