Behavioural disorders after prenatal exposure to anaesthesia for maternal surgery

Br J Anaesth. 2024 May;132(5):899-910. doi: 10.1016/j.bja.2024.01.025. Epub 2024 Feb 29.


Background: The association between prenatal exposure to general anaesthesia for maternal surgery during pregnancy and subsequent risk of disruptive or internalising behavioural disorder diagnosis in the child has not been well-defined.

Methods: A nationwide sample of pregnant women linked to their liveborn infants was evaluated using the Medicaid Analytic eXtract (MAX, 1999-2013). Multivariate matching was used to match each child prenatally exposed to general anaesthesia owing to maternal appendectomy or cholecystectomy during pregnancy with five unexposed children. The primary outcome was diagnosis of a disruptive or internalising behavioural disorder in children. Secondary outcomes included diagnoses for a range of other neuropsychiatric disorders.

Results: We matched 34,271 prenatally exposed children with 171,355 unexposed children in the database. Prenatally exposed children were more likely than unexposed children to receive a diagnosis of a disruptive or internalising behavioural disorder (hazard ratio [HR], 1.31; 95% confidence interval [CI], 1.23-1.40). For secondary outcomes, increased hazards of disruptive (HR, 1.32; 95% CI, 1.24-1.41) and internalising (HR, 1.36; 95% CI, 1.20-1.53) behavioural disorders were identified, and also increased hazards of attention-deficit/hyperactivity disorder (HR, 1.32; 95% CI, 1.22-1.43), behavioural disorders (HR, 1.28; 95% CI, 1.14-1.42), developmental speech or language disorders (HR, 1.16; 95% CI, 1.05-1.28), and autism (HR, 1.31; 95% CI, 1.05-1.64).

Conclusions: Prenatal exposure to general anaesthesia is associated with a 31% increased risk for a subsequent diagnosis of a disruptive or internalising behavioural disorder in children. Caution is advised when making any clinical decisions regarding care of pregnant women, as avoidance of necessary surgery during pregnancy can have detrimental effects on mothers and their children.

Keywords: anaesthetic neurotoxicity; behavioural deficit; maternal surgery; neurodevelopment; paediatric anaesthesia; prenatal exposure.

MeSH terms

  • Anesthesia, General / adverse effects
  • Attention Deficit Disorder with Hyperactivity* / epidemiology
  • Attention Deficit Disorder with Hyperactivity* / etiology
  • Child
  • Female
  • Humans
  • Infant
  • Mothers
  • Pregnancy
  • Prenatal Exposure Delayed Effects* / epidemiology
  • Proportional Hazards Models