Association Between Epidurals and Autism

[GassYous]

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Just saw this on reddit:

Epidural Analgesia During Labor and Risk of Autism Spectrum Disorders in Offspring

This cohort study assesses the association between maternal exposure to labor epidural analgesia and risk of autism spectrum disorders in offspring

jamanetwork.com

"This study suggests that exposure to epidural analgesia for vaginal delivery may be associated with increased risk of autism in children; further research is warranted to confirm the study findings and understand the potential mechanisms."

wtf?

 

[Justice4all]

Just saw this on reddit:

Epidural Analgesia During Labor and Risk of Autism Spectrum Disorders in Offspring

This cohort study assesses the association between maternal exposure to labor epidural analgesia and risk of autism spectrum disorders in offspring

jamanetwork.com

"This study suggests that exposure to epidural analgesia for vaginal delivery may be associated with increased risk of autism in children; further research is warranted to confirm the study findings and understand the potential mechanisms."

wtf?

SMH .Can’t believe an anesthesiology department is involved in this publication.

 

[coffeebythelake]

Quwstion: are pregnant women who choose epidural different than those who don't? Are there clinical situations where pregnant women are strongly advised from a medical perspective to get an epidural? There are your co-founders right there. Do obstetricians treat the delivery differently with epiduralized patients? Took me 1 minute to tear down their paper.

 

[sevoflurane]

Dumb

 

[dabears505]

I dont see how its not out of the realm of possibility. We do eras protocols with lifo infusions where people with giant incisions require minimal narcotic. Clearly they have an effect on the brain and body. Obviously the blood absorbancy of local anesthetic from the epidural space is very low, and maternal transfer is very low. However, in a developing brain, even a small amount of local may cause changes or have effects.

Also, does the use of epidurals allow the ob doctors to blast pitching at rates much higher than people can tolerate without epidurals? Could that also be a factor?

 

[IlDestriero]

Just saw this on reddit:

Epidural Analgesia During Labor and Risk of Autism Spectrum Disorders in Offspring

This cohort study assesses the association between maternal exposure to labor epidural analgesia and risk of autism spectrum disorders in offspring

jamanetwork.com

"This study suggests that exposure to epidural analgesia for vaginal delivery may be associated with increased risk of autism in children; further research is warranted to confirm the study findings and understand the potential mechanisms."

wtf?

Extraordinary claims require extraordinary evidence.

 

[coffeebythelake]

I want to see what the evidence is on the 1. Duration of epidural and total dose of local anwsthetjc administered, 2. If such association also seen with spinal anesthesia. 3. Does choice of local anesthetic matter?? One that has less placental transfer and accumulation would intuitively have less effect.. Seems it they are claiming local anesthesia causes such fetal effects, then they actually need evidence not an association

 

[Consigliere]

Fine. Let the same people who follow Jenny Mc Carthy's vaccine advice refuse epidurals and save future anesthesiologists the aggravation.

 

[MirrorTodd]

How many of those kids were vaccinated? 😉

 

[Consigliere]

Watch for the "have you or a loved one developed autism and had an epidural involved in your delivery? If so call 1-800-SCUMBAGS....." commercials.

 

[Propofool123]

M0r0nic. Doubt this will steer most women away from getting an epidural but will require me to 1) spend more time answering dumb questions about epidurals and autism and 2) will have to wait to do epidurals on women who are almost completely dilated and in unbearable pain because they thought they could do it “natural.”

 

[dhb]

I have made widely known on L&D that all my epidurals between 0:00 and 7:30 result in 100% autism in the child.

 

[deleted682700]

Retrospective study of little value except causing one more question before the epidural. One in 4 pregnant women are meth positive in Central Valley, California. No way or how she will deliver without a working epidural. Corelation with autism does not mean causation

 

[GaseousClay]

Weak data and weak study (retrospective) coming out of Kaiser Permanante Anesthesia folks. No purpose to this study except to cause hysteria and waste funding to try and substantiate this nonsense.

 

[kidthor]

It seems like a decently designed retrospective study. Nothing we do is benign and this correlation seems not un-plausible. I'm skeptical of the outcome but would like to see some specific breakdowns of their study rather than gut reaction opposition.

But again, I find the correlation suspect.

 

[GaseousClay]

Labor epidurals do not cause autism; safe for mothers and infants, say anesthesiology, obstetrics, and pediatric medical societies

The Society for Obstetric Anesthesia and Perinatology (SOAP), American Society of Anesthesiologists (ASA), Society for Pediatric Anesthesia (SPA), American College of Obstetricians and Gynecologists (ACOG) and Society for Maternal-Fetal Medicine (SMFM) aim to clearly reassure pregnant women that...

www.asahq.org

damage control starting

 

[deleted682700]

Kaiser permanente has a great reputation among lay people and is a wall street darling that has succeeded in lowering health care costs. However in this study, what happens To autism rate, if the epidural is not given? It will lead to less perineal relaxation and more instruments delivery and more csect rate leading to a Higher incidence and severity of autism because the baby brain is then subjected to general anesthesia For instrument delivery. We all know the advantage of regional vs general anesthesia in Ob population.
The midwives will be very happy withthese kinds of studies and the Obgyn will have to rescue more and take on more liability.

 

[coffeebythelake]

Kaiser permanente has a great reputation among lay people and is a wall street darling that has succeeded in lowering health care costs. However in this study, what happens To autism rate, if the epidural is not given? It will lead to less perineal relaxation and more instruments delivery and more csect rate leading to a Higher incidence and severity of autism because the baby brain is then subjected to general anesthesia For instrument delivery. We all know the advantage of regional vs general anesthesia in Ob population.
The midwives will be very happy withthese kinds of studies and the Obgyn will have to rescue more and take on more liability.

Exactly. The assumption is the patient population that choose epidural vs no epidural is the same. That is clearly not true.

 

[anonperson]

Just saw this on reddit:

Epidural Analgesia During Labor and Risk of Autism Spectrum Disorders in Offspring

This cohort study assesses the association between maternal exposure to labor epidural analgesia and risk of autism spectrum disorders in offspring

jamanetwork.com

"This study suggests that exposure to epidural analgesia for vaginal delivery may be associated with increased risk of autism in children; further research is warranted to confirm the study findings and understand the potential mechanisms."

wtf?

I didn't see them account for paternal age which is a large risk factor.

Advancing Paternal Age and Autism

Context Maternal and paternal ages are associated with neurodevelopmental disorders.Objective To examine the relationship between advancing paternal age at birth of offspring and their risk of autism spectrum disorder (ASD).Design Historical population-based cohort study.Setting ...

jamanetwork.com

Published by JAMA 14 years ago.

Plus they didn't account for illicit substance use. Meth use is exploding and is implicated in increased autism risk. Plenty of these Kaiser locations have patients rolling in with meth use (Baldwin Park for example).

I'm not saying there couldn't be an association but if you miss big variables, garbage in ==>garbage out.

 

[Urzuz]

Potential confounder: Kaiser doctors are salaried and are desperate to get less calls to L&D.

 

[CodeBlu]

I have made widely known on L&D that all my epidurals between 0:00 and 7:30 result in 100% autism in the child.

But, these epidurals make the most $$$... and that's the only reason to do this job right?

/sarcasm

 

[HalO'Thane]

I may have missed this but did they mention the average labor time for the non epidural group? From what I read it was the patients with prolonged labor (> 8 hours) in the epidural group that had the highest rates of autism. Did the non epidural patients have super quick labor times (hence not receiving an epidural) and if so was that a confounding variable?

 

[Aether2000]

It seems pregnancy itself is strongly associated with autism. It is clear that since 100% of autistic kids had a mother that was pregnant, that the only way to avoid autism is to avoid pregnancy. By the time they ask for the epidural, it is too late.

 

[D P356]

I have made widely known on L&D that all my epidurals between 0:00 and 7:30 result in 100% autism in the child.

You have won this thread.

When listing authors...
Et al = Andrew Wakefield?

 

[deleted875186]

Quite frankly, I’m amazed this got published in JAMA. But there it is, you can get a statistician to crunch some numbers and publish anything.

I think there should be some requirement to have a truely logical reason to do a study like this, otherwise the results can only be misconstrued by the public:

 

[TheLoneWolf]

From JAMA pediatrics

Epidural Labor Analgesia and Offspring Risk of Autism Spectrum Disorders

This population-based cohort study examines the association between epidural labor analgesia and offspring risk of autism spectrum disorder, adjusting for a large set of potential confounders, in the Canadian province of Manitoba.

jamanetwork.com

Original Investigation

April 19, 2021

Association of Epidural Labor Analgesia With Offspring Risk of Autism Spectrum Disorders

Elizabeth Wall-Wieler, PhD1,2; Brian T. Bateman, MD, MSc3; Ana Hanlon-Dearman, MD4; et alLeslie L. Roos, PhD1,2; Alexander J. Butwick, MBBS, MS5

Author Affiliations

JAMA Pediatr. Published online April 19, 2021. doi:10.1001/jamapediatrics.2021.0376

Key Points

Question Is epidural labor analgesia (ELA) associated with increased offspring risk of autism spectrum disorder (ASD)?

Findings In this cohort study of 123 175 offspring born in Manitoba, Canada, from 2005 to 2016, after accounting for maternal sociodemographic, preexisting, pregnancy-related, and birth-specific factors, no association was found between ELA exposure and offspring risk of ASD.

Meaning Results of this study suggest that ELA is not associated with an increased risk of ASD in offspring.

Abstract

Importance Epidural labor analgesia (ELA) has been associated with an increased offspring risk of autism spectrum disorder (ASD). Whether this finding may be explained by residual confounding remains unclear.

Objective To assess the association between ELA and offspring risk of ASD.

Design, Setting, and Participants Longitudinal cohort study of vaginal deliveries of singleton live infants born from 2005 to 2016 from a population-based data set linking information from health care databases in Manitoba, Canada; offspring were followed from birth until 2019 or censored by death or emigration. Data were analyzed from October 19, 2020, to January 22, 2021.

Exposures Epidural labor analgesia.

Main Outcomes and Measures At least 1 inpatient or outpatient diagnosis of ASD in offspring aged at least 18 months. For the full population and a sibling cohort, inverse probability of treatment-weighted Cox proportional hazards regression analyses were used to control for potential confounders.

Results

Of the 123 175 offspring included in this study (62 647 boys [50.9%]; mean [SD] age of mothers, 28.2 [5.8] years), 47 011 (38.2%) were exposed to ELA; 2.1% (985 of 47 011) of exposed vs 1.7% (1272 of 76 164) of unexposed offspring were diagnosed with ASD in the follow-up period (hazard ratio

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, 1.25; 95% CI, 1.15-1.36). After adjusting for maternal sociodemographic, prepregnancy, pregnancy, and perinatal covariates, ELA was not associated with an offspring risk of ASD (inverse probability of treatment–weighted HR, 1.08; 95% CI, 0.97-1.20). In the within-siblings design adjusting for baseline covariates, ELA was not associated with ASD (inverse probability of treatment–weighted HR, 0.97; 95% CI, 0.78-1.22). Results from sensitivity analyses restricted to women without missing data who delivered at or after 37 weeks of gestation, firstborn infants only, and offspring with ASD classified with at least 2 diagnostic codes were consistent with findings from the main analyses.

Conclusions and Relevance

In a Canadian population-based birth cohort study, no association between ELA exposure and an increased offspring risk of ASD was found.

 

[YadaYadaNext]

I’m far from an autism expert. Would be interested to see if the rate of autism is similar in other developed countries with a strong healthcare system and equal rate of epidural use for labor and delivery.

 

[caligas]

I am so past caring what nonsense people think is caused by epidurals.

 

[nimbus]

Again association is meaningless. An association could just as easily mean “autistic babies cause more painful labor increasing the incidence of epidural labor analgesia.”

 

[dabears505]

I truly don't understand why people don't think it's a possibility and should be studied more instead of just brushed aside. Who knows what ill effects local anesthetics can do to a fetal brain.

 

[MirrorTodd]

I truly don't understand why people don't think it's a possibility and should be studied more instead of just brushed aside. Who knows what ill effects local anesthetics can do to a fetal brain.

You serious bro?

 

[Volatile]

Does this even matter? A significant % of my patients think they are at high risk of paralysis due to an epidural (before I talk to them) and they are begging for it. I wonder how many would be swayed by a mention of autism 🤔

 

[nimbus]

I truly don't understand why people don't think it's a possibility and should be studied more instead of just brushed aside. Who knows what ill effects local anesthetics can do to a fetal brain.

The effect is especially profound between midnight and 6am.

 

[deleted875186]

From JAMA pediatrics

Epidural Labor Analgesia and Offspring Risk of Autism Spectrum Disorders

This population-based cohort study examines the association between epidural labor analgesia and offspring risk of autism spectrum disorder, adjusting for a large set of potential confounders, in the Canadian province of Manitoba.

jamanetwork.com

Original Investigation

April 19, 2021

Association of Epidural Labor Analgesia With Offspring Risk of Autism Spectrum Disorders

Elizabeth Wall-Wieler, PhD1,2; Brian T. Bateman, MD, MSc3; Ana Hanlon-Dearman, MD4; et alLeslie L. Roos, PhD1,2; Alexander J. Butwick, MBBS, MS5

Author Affiliations

JAMA Pediatr. Published online April 19, 2021. doi:10.1001/jamapediatrics.2021.0376

Key Points

Question Is epidural labor analgesia (ELA) associated with increased offspring risk of autism spectrum disorder (ASD)?

Findings In this cohort study of 123 175 offspring born in Manitoba, Canada, from 2005 to 2016, after accounting for maternal sociodemographic, preexisting, pregnancy-related, and birth-specific factors, no association was found between ELA exposure and offspring risk of ASD.

Meaning Results of this study suggest that ELA is not associated with an increased risk of ASD in offspring.

Abstract

Importance Epidural labor analgesia (ELA) has been associated with an increased offspring risk of autism spectrum disorder (ASD). Whether this finding may be explained by residual confounding remains unclear.

Objective To assess the association between ELA and offspring risk of ASD.

Design, Setting, and Participants Longitudinal cohort study of vaginal deliveries of singleton live infants born from 2005 to 2016 from a population-based data set linking information from health care databases in Manitoba, Canada; offspring were followed from birth until 2019 or censored by death or emigration. Data were analyzed from October 19, 2020, to January 22, 2021.

Exposures Epidural labor analgesia.

Main Outcomes and Measures At least 1 inpatient or outpatient diagnosis of ASD in offspring aged at least 18 months. For the full population and a sibling cohort, inverse probability of treatment-weighted Cox proportional hazards regression analyses were used to control for potential confounders.

Results

Of the 123 175 offspring included in this study (62 647 boys [50.9%]; mean [SD] age of mothers, 28.2 [5.8] years), 47 011 (38.2%) were exposed to ELA; 2.1% (985 of 47 011) of exposed vs 1.7% (1272 of 76 164) of unexposed offspring were diagnosed with ASD in the follow-up period (hazard ratio

---

, 1.25; 95% CI, 1.15-1.36). After adjusting for maternal sociodemographic, prepregnancy, pregnancy, and perinatal covariates, ELA was not associated with an offspring risk of ASD (inverse probability of treatment–weighted HR, 1.08; 95% CI, 0.97-1.20). In the within-siblings design adjusting for baseline covariates, ELA was not associated with ASD (inverse probability of treatment–weighted HR, 0.97; 95% CI, 0.78-1.22). Results from sensitivity analyses restricted to women without missing data who delivered at or after 37 weeks of gestation, firstborn infants only, and offspring with ASD classified with at least 2 diagnostic codes were consistent with findings from the main analyses.

Conclusions and Relevance

In a Canadian population-based birth cohort study, no association between ELA exposure and an increased offspring risk of ASD was found.

Was waiting for someone to publish a follow up to the crappy Kaiser study. Hopefully this will be it and we don’t get a bunch more useless retrospective studies to show there’s no link with autism, it’s just an absolute waste of time and resources.

 

[drmwvr]

post hoc ergo propter hoc fallacies surrounding epidurals have been around since the late 20th century. the list just keeps getting longer and longer. could save a lot of time by just going with the standby 'anesthesia's fault'. Sad part is, physicians are fighting each other over this stuff...

 

[anbuitachi]

Just saw this on reddit:

Epidural Analgesia During Labor and Risk of Autism Spectrum Disorders in Offspring

This cohort study assesses the association between maternal exposure to labor epidural analgesia and risk of autism spectrum disorders in offspring

jamanetwork.com

"This study suggests that exposure to epidural analgesia for vaginal delivery may be associated with increased risk of autism in children; further research is warranted to confirm the study findings and understand the potential mechanisms."

wtf?

SMH .Can’t believe an anesthesiology department is involved in this publication.

because they want to land in JAMA, and not just anesthesiology. autism is always a hot topic for dumb reasons

they've probably already moved on to the next study. 'propofol may be associated with autism'

 

[nimbus]

because they want to land in JAMA, and not just anesthesiology. autism is always a hot topic for dumb reasons

they've probably already moved on to the next study. 'propofol may be associated with autism'

Braun should sue JAMA and the authors for harming their business. Heck we anesthesiologists should get together and file a class action.

 

[Twiggidy]

Everyone seems to forget that a labor epidural is NOT a requirement. l

 

[okayplayer]

Everyone seems to forget that a labor epidural is NOT a requirement. l

Especially between midnight and 0600.

 

[GassYous]

Everyone seems to forget that a labor epidural is NOT a requirement. l

I just like poking young ladies from behind

 

[Twiggidy]

I just like poking young ladies from behind

 

[deleted162650]

I just like poking young ladies from behind

Insert 3.5” joke here:

 

[Twiggidy]

Insert 3.5” joke here:

From the ground buddy lol

 

[deleted162650]

From the ground buddy lol

Didn’t realize you were a bilateral above the knee amputee. My apologies for being insensitive.

 

[Twiggidy]

Didn’t realize you were a bilateral above the knee amputee. My apologies for being insensitive.

Touché

 

[GassYous]

From the ground buddy lol

When prone

 

[Gern Blansten]

Epidurals placed between midnight and 6 AM have a higher rate of autism...
Am I doing this right?

 

[deleted162650]

Epidurals placed between midnight and 6 AM have a higher rate of autism...
Am I doing this right?

Exactly. It’s also been shown that MediCaid epidurals have a higher incidence than privately insured ones.

 

[nimbus]

Another one essentially refuting the earlier study.

Association of Labor Epidural Analgesia With Autism Spectrum Disorder in Children

This nationwide retrospective cohort study among children in Denmark assesses whether maternal exposure to epidural analgesia during labor is associated with incidence of autism spectrum disorder in offspring.

jamanetwork.com

 

[D P356]

Yeah, forget the 9 months of pregnancy and all that entails, or the cognitive development/nutrition/environment from birth to diagnosable age. It’s about that last 2-8 hours of pregnancy where a local anesthetic is infusing and is minimally absorbed.